09 September 2005
Academics have cast doubt on the Department of Health's claim that its £200m 'quality payments' to GPs are tied to real improvements in patient care.
Research by Richard Fleetcroft and Richard Cookson of the University of East Anglia found a 'real danger that the incentive payments may skew activity towards highly rewarded labour-intensive activities with relatively low benefits to population health'.
The academics tested the incentive payments available to GPs under the new Quality Outcomes Framework, which were announced last week, against an earlier, authoritative study that ranked cardiac treatments according to their likelihood to save lives.
The points awarded under the QOF are based on the likely workload of each specified treatment. However, Fleetcroft and Cookson found that 'workload does not appear to be well correlated with likely health gain'.
They warned: 'Activities that deliver greater health gains but receive less – or no – financial incentive may be downplayed: what is not incentivised may be marginalised.'
David Jenner, new contracts lead at the NHS Alliance, welcomed the research and said that, while the QOF represented an important step forward for improving care standards in the NHS, the framework had also been designed as a way to increase GP salaries.
He said: 'If you wanted to design a system with the sole purpose of improving quality in the NHS, you wouldn't have designed the QOF as it was. But we're talking politics and human resources as well as health economics. Health care policy is complex and often politically expedient.
'I'm under no illusion that there has been a deliberate policy to increase GPs' pay to make the job more attractive, to help address the recruitment and incentives problem.'
The QOF contracts were agreed as the DoH faced the need urgently to recruit more GPs. Aligning pay to quality was one way of avoiding public sector wage inflation in other areas, Jenner said.
He added that it would be useful if similar research were carried out on other NHS initiatives, such as NHS Direct and star rating bonuses.
Last year, the average profit share for a GP practice partner was more than £100,000, according to the Association of Independent Medical Accountants. Under the QOF, the average practice stands to gain extra sums of up to £74,299.
A DoH spokesman said: 'We do not accept these claims and stand by our position that the QOF provides practices with a real incentive to provide better quality care.'
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