GP incentive scheme did NOT save lives, says Manchester uni study

A £10billion pay-for-performance incentive scheme aimed at GPs has no impact on reducing premature death, according to the University of Manchester.

The Quality and Outcomes Framework (QOF), first introduced in 2004, judges up to 25% of a GP’s income on their performance in more than 100 quality indicators.

The majority of these indicators cover diseases such as diabetes, heart disease and cancer and ensure that patients receive preventative care; however, Dr Evans Kontopantelis says the scheme has ‘failed to reduce mortality rates’.

“While we accept that there may be longer term benefits of the scheme which we cannot yet measure it appears that the Quality and Outcomes Framework has failed to reduce mortality rates since 2007,” he said. 

“This suggests that it has fallen far short of previous estimates of success.

“By far the greatest influence on premature mortality is poverty followed by geographical location: mortality rates in urban areas are higher than mortality rates in rural ones.  

“Both of these factors are known to have an effect on health, but the scale of their impact on premature mortality over time, particularly in the case of deprivation was greater than expected.”

Figures show that higher mortality was related with urban location, greater area deprivation, and higher proportion of a non-white population.

According to results, there was no relationship between quality indicators included in Quality and Outcomes Framework and mortality rates in the practice locality.

A team of researchers have applied a data analysis method which was able to analyse the link between specific GP surgeries and the people they served between 2007 and 2012. 

The researchers joint the information from the Office of National Statistics and the Health and Social Care Information Centre and were able to cover 99% of patients registered with a GP in England.

Dr Kontopantelis added: “If this incentive scheme and others like it around the world are to continue, more attention needs to be paid to ensure that the performance indicators are more closely aligned to evidence for mortality reduction.”

Image courtesy of Carl Jones, with thanks.

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