26.01.11
Target scheme for GPs costing almost £2bn had ‘no impact’
Doctors have said more time needs to be given to a target and incentive scheme for GPs to improve the care of patients with high blood pressure after a study said it has had ‘no impact’.
The £1.8bn Quality and Outcomes Framework (QOF) has been in place since 2004, but a study published on the website of the British Medical Journal said there is “little evidence” that it works.
But Dr Laurence Buckman, chairman of the BMA’s GPs Committee, said today: “The QOF is still relatively new. Other studies have shown that it has improved care and treatment for people with diabetes and reduced the number of heart attacks and deaths, particularly in deprived areas. We expect the true gains will be seen in the long term as more evidence becomes available.”
The researchers from the UK, USA and Canada studied a database of primary care records from 358 general practices. Between January 2000 and August 2007, there were 470,725 patients diagnosed with hypertension.
But they found that, allowing for long-term trends, there was no change in blood pressure monitoring, blood pressure control, or treatment intensity attributable to QOF targets.
Treatments changed, with more patients getting a combination of medications, but again the QOF targets were not associated with these changes.
The quality of care for hypertension, such as blood pressure monitoring and treatment intensification, was already improving before the QOF began, said the researchers.
They conclude: “The programme’s lack of effect may be explained in part by performance targets that were set too close to existing practice. To stimulate further improvement in hypertension care in the UK, it may be necessary to implement other evidence based interventions on a large scale.”
Buckman said: “There is a mistaken belief that the Quality and Outcomes Framework is simply an incentive scheme, but it’s much more than that. It was designed to fund work by GPs that previously wasn’t being funded, to ensure that patients received uniform high-quality care no matter where they lived in the country, and, by doing that, to improve public health over the long term and help reduce health inequalities.
“It is also thanks to the QOF that we now have a wealth of public health data, meaning we know more than ever before about the prevalence of disease in this country, and we have a method of delivering evidence-based care to improve it.”
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