Abstract
BackgroundImproving care for people with long-term conditions is central to NHS policy. It has been suggested that the Quality and Outcomes Framework (QOF), a primary care pay-for-performance scheme that rewards practices for delivering effective interventions in long-term conditions, does not encourage high-quality care for this group of patients.AimTo examine the evidence that the QOF has improved quality of care for patients with long-term conditions.Design and settingThis was a systematic review of research on the effectiveness of the QOF in the UK.MethodThe authors searched electronic databases for peer-reviewed empirical quantitative research studying the effect of the QOF on a broad range of processes and outcomes of care, including coordination and integration of care, holistic and personalised care, self-care, patient experience, physiological and biochemical outcomes, health service utilisation, and mortality. Because the studies were heterogeneous, a narrative synthesis was carried out.ResultsThe authors identified three systematic reviews and five primary research studies that met the inclusion criteria. The QOF was associated with a modest slowing of both the increase in emergency admissions and the increase in consultations in severe mental illness (SMI), and modest improvements in diabetes care. The nature of the evidence means that the authors cannot be sure that any of these associations is causal. No clear effect on mortality was found. The authors found no evidence that the QOF influences integration or coordination of care, holistic care, self-care, or patient experience.ConclusionThe NHS should consider more broadly what constitutes high-quality primary care for people with long-term conditions, and consider other ways of motivating primary care to deliver it.
Highlights
The UK’s Quality and Outcomes Framework (QOF) is the world’s largest pay-forperformance scheme in primary care
The QOF was associated with a modest slowing of both the increase in emergency admissions and the increase in consultations in severe mental illness (SMI), and modest improvements in diabetes care
The authors found no evidence that the QOF influences integration or coordination of care, holistic care, self-care, or patient experience
Summary
The UK’s Quality and Outcomes Framework (QOF) is the world’s largest pay-forperformance scheme in primary care. It rewards general practices financially for delivering interventions and achieving patient outcomes using evidence-based indicators developed by the National Institute for Health and Care Excellence (NICE).[1] the QOF is voluntary, nearly 99% of practices in England participate, on average deriving 10–15% of total practice income from the scheme.[2]. The introduction of the QOF in 2004 was a part of a new national contract for GPs, driven by the need to respond to years of underinvestment in general practice compared with other parts of the health service, low morale among GPs, and variations in the quality of primary medical care.[3,4] The QOF was intended to provide a mechanism to motivate GPs and to increase funding for their practices, and the vast majority of practices took up the opportunity for additional income. It has been suggested that the Quality and Outcomes Framework (QOF), a primary care pay-forperformance scheme that rewards practices for delivering effective interventions in long-term conditions, does not encourage high-quality care for this group of patients
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