Bruce Guthrie Professor of General Practice

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Presentation transcript:

Bruce Guthrie Professor of General Practice What’s happened to QOF Bruce Guthrie Professor of General Practice

What was the QOF bargain? Important driver was recruitment and retention crisis GPs get increased income/ better working lives Government gets better quality Pay for performance attractive to payers Quality and Outcomes Framework was huge Did either side get what they wanted?

GP income and working lives (England) GP personal income GP satisfaction with work http://www.sspc.ac.uk/media/media_486342_en.pdf Data from the Eighth National GP Survey http://research.bmh.manchester.ac.uk/healtheconomics/research/Reports/EighthNationalGPWorklifeSurveyreport/

What did QOF achieve? Some improvement in quality (complicated) Reductions in inequalities at practice level Evidence of change in organisation of care Nurse led chronic disease care Specialist (fragmented) model of care Implementation failures Payment formula wrong (capitation not great either) Later indicators less successful (eg depression) Ran out of indicators that were “QOFable”

What happens when QOF stops? Segmented regression analysis – all changes stat sig Can’t distinguish changed documentation vs practice Minchin M et al. New England Journal of Medicine 2018;379(10):948-57

What happens when QOF stops? Segmented regression analysis – all changes stat sig Can’t distinguish changed documentation vs practice Minchin M et al. New England Journal of Medicine 2018;379(10):948-57

What happens when QOF stops? Segmented regression analysis – all changes stat sig Can’t distinguish changed documentation vs practice Minchin M et al. New England Journal of Medicine 2018;379(10):948-57

What does it mean? QOF didn’t always measure what mattered Who cares about measuring cholesterol annually? Throwing the baby out with the bathwater? We do care about regular blood pressure measurement and control We do care about many diabetes processes and intermediate outcomes We do care about medication review Payers dilemma – how do you know it’s worked?

Summary P4P small effects on introduction Initial indicators aligned with internal motivation Some later indicators were not (and failed) Effects appear to be lost on withdrawal Need to examine actual treatment and care... … but it is worrying Embed in wider improvement programmes? May buy engagement -> use other methods to win hearts and minds, & facilitate organisational change? Could do with more RCTs or planned evaluation…