Performance related pay schemes, such as QOF, are not suitable for professionals.

Management courses have taught for a long time now that Performance Related Pay (PRP) has a short half life. The box ticking production line style of management is not for professionals. The QOF (Quality Outcomes Framework) is another form of PRP and has been in existence for far too long. Elderly multi-pathology and terminal care patients are the future of primary care, and their care will mostly have to be at home. Hospital at home projects are the future, and they will need staffing…… Lets hope we can train them up from our own population, because we have alienated the immigrant labour force. NHSreality agrees that there may be a sudden surge in deaths from epidemics such as flu, and most of these will have to be at home. Commissioning groups need to abolish QOF, remove the perverse incentive to ration those services that pay less, and trust the overstretched GPs to ration their care appropriately.

Kat Lay reports 10th October in The Times: Cash incentives for GPs do not make care better

A financial incentive programme for GPs may not improve the quality of care, according to researchers.
The quality and outcomes framework, introduced as part of the 2004 GP contract, means that up to a quarter of a surgery’s income is linked to targets on areas such as heart disease, diabetes and smoking.
Researchers from University College London and Imperial College London reviewed a series of studies evaluating the worth of such financial incentives.
They found that although a number reported initial improvements in the treatment of a range of chronic diseases such as hypertension, diabetes and asthma, these were often not sustained. Any positive effects were not consistent across ethnic, gender and age groups.
There was also a suggestion that patients whose conditions were outside the framework “experienced higher mortality and poorer quality of care”.

The study, published in the British Journal of General Practice (BJGP) will add weight to calls to scrap the scheme. NHS England has said it supports such a move in principle but failed to make any changes in the latest round of GP contract negotiations. A year ago, Simon Stevens, the chief executive of NHS England, said: “For the most part it has descended into too much of a box-ticking exercise.”

Last month a review commissioned by NHS England concluded that the framework did not improve care and should be replaced, but cautioned that removing it could have a severe impact on GP practice incomes and patient care. The study’s authors warned that any new incentives should be looked at carefully. “Despite uncertainly about their effectiveness, financial incentives receive widespread political attention and are increasingly being implemented,” they said.

A spokesman for the British Medical Association said that the framework had “helped deliver substantial improvements to patients across the UK” and had raised detection rates.

•A survey in the BJGP found GPs were concerned about the introduction to the NHS of physician associates, graduates without traditional medical training. Patients, however, had fewer fears.


Tears, tantrums and no pay – my life on a zero-hours contract in the NHS

You get what you pay for — which, for most NHS users, is nothing

NHSreality response to the RCGP Questionnaire into the future of Welsh health and social care

A fearful anonymous consultant tells it as it is… “the NHS is in crisis”.

Fighting for the NHS’s moral life: There are 4 Chernobyl’s waiting for meltdown..

Getting to see a Health Service physio – like getting to see a health service dentist


This entry was posted in A Personal View, Commissioning, General Practitioners, Perverse Incentives, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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