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.
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.