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GP pay-for-performance incentive ‘morally wrong’ – Patients Association

The Quality and Outcomes Framework (QOF), introduced to incentivise GPs to improve performance, is ‘morally wrong’, the Patients Association has said.

A new study by researchers from the universities of Michigan, Manchester and York, published in the Lancet, shows that the QOF has failed to improve patient survival rates.

The QOF, introduced in 2004, is the world’s largest primary care pay-for-performance programme and offers GPs financial incentives for fulfilling over 100 quality of care indicators.

However, the research shows that between 1994 and 2010, there was no significant difference in survival rates from conditions such as cancer and heart disease between the UK and other countries with comparable health systems.

Tim Doran, professor of health policy at the University of York's department of health sciences, said: “Previous studies have shown that financial incentives paid to providers can lead to modest improvements in patient care, but the effects on patient outcomes have been variable, and in some cases care has suffered.

“These research results raise questions about the cost-effectiveness of pay-for-performance in healthcare, and about the best way to improve population health and life expectancy.”

Katherine Murphy, chief executive of the Patients Association, said: “GPs need to focus on all their patients and not just those patients where they can measure or record data and get paid for it.

“Giving doctors bribes to focus on specific conditions is morally wrong and ethically wrong. GPs must focus on patient care and outcomes - their priorities should not be compromised by financial incentives.”

The Royal College of GPs has previously called for QOF to be replaced with a new funding arrangement, calling it an ‘unnecessary burden’ on GPs.

A Department of Health spokesman stated that NHS England has agreed to undertake a review of QOF in the coming year, to “see how we can best manage the system for the future”.

NHS England recently published its General Practice Forward View strategy, promising funding and recruitment increases to help deal with the crisis facing GP care.

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