NHS (National Health Service) England are currently conducting a review of the Quality and Outcomes Framework (QOF). The QOF is a scheme running since 2004 which financially rewards general practices for providing good quality of care to patients in a range of clinical areas (e.g. managing diabetes). Since the introduction of the QOF, some clinical indicators have been removed. It is important to understand what happens to quality of care when general practices are not paid anymore for delivering these activities. This is not only relevant for NHS England but it is of global interest, since similar programmes exist elsewhere in the world.
We will use CPRD data to evaluate what happens when clinical indicators (for example, one indicator refers to blood pressure management for patients with Chronic Kidney Disease) were removed from the QOF, and what that means for patients. We are interested in how these changes will affect different population groups (e.g. by older people, people in more deprived areas).
The results from this work will shed light on the potential impacts these changes in the GP contract have on patients, and they will help us identify potential risks from the changing policy. This work is for NHS England, and our findings will aid their review of the QOF.
NHS England are currently conducting a review of the Quality and Outcomes Framework (QOF), a primary care financial incentivisation scheme that started in 2004. It is possible that some elements of the scheme may be removed and it is important to understand what happens to quality standards when such incentives are removed. One of the key areas for investigation is the potential impact of removing the incentives on the quality of care delivered in general practice. There is limited evidence on the effect of removing indicators from pay-for-performance schemes and what evidence is available is contradictory.
By applying interrupted time series analysis to CPRD data (2006-2020), we will determine the effect of the retirement of QOF indicators on quality of care. To add to the literature that predominantly focuses on practice-level data, we will conduct patient-level analysis to consider heterogeneous effects by considering specific subpopulations and identify the distributional consequences of removing incentives. This is key to understanding the potential risks associated with removing incentives. We are expecting the findings from this research to aid NHS England with the review and the wider effects of the review.
Health Outcomes: clinical indicator met or not met
Matt Sutton - Chief Investigator - University of Manchester
Anna Wilding - Corresponding Applicant - University of Manchester
Bruce Guthrie - Collaborator - University of Edinburgh
Darren Ashcroft - Collaborator - University of Manchester
Evangelos Kontopantelis - Collaborator - University of Manchester
Luke Munford - Collaborator - University of Manchester
Rachel Meacock - Collaborator - University of Manchester
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation