Person centred coordinated care: where does the QOF point us?

Abstract

Mitchell question the validity of the Quality and Outcomes Framework and suggest how it should change in the future Martin McShane medical director, long term conditions 1 , Edward Mitchell core trainee 2 1 NHS England, Medical Directorate, Leeds LS2 7UE, UK; 2 Oxford Health NHS Trust, Warneford Hospital, Oxford OX3 7JX, UK The Quality and Outcomes Framework (QOF) is a pay for performance programme that was introduced in 2004 to improve care in general practice. It now constitutes roughly 13% of practice income-QOF payments in 2013-14 were £1057m (€1451m; $1613m) (fig⇓). 1 The arguments for and against the QOF (and pay for performance schemes in general) have been hotly debated over the past decade. Its seminal impact on UK general practice is undeniable, but its influence is such that it has affected our idea of what constitutes quality improvement. It has been suggested, for example, that we equate (or perhaps conflate) good care with the recording of disease specific biomedical or process markers. 2The QOF is facing change. The 2014-15 GP contract deal has seen a 30% reduction in QOF points. 3 After eleven years, and billions of pounds in QOF payments, we take stock of the QOF and discuss three changes in the healthcare system that mean QOF must change.

Measuring and improving the quality of mental health care: a global perspective

“…The program has now been indefinitely postponed in implementation in favor of smaller areas of work 70 . One of these areas is the abovementioned IAPT initiative, which embedded routine outcome measurementusing validated tools such as the PHQ-9 and the Clinical Outcomes in Routine Evaluation (CORE) -and could demonstrate good outcomes that have led to further funding into the initiative 71 . In Canada, there has been the adoption of mental health care quality measures in electronic medical records 67 .…”

Quality after the QOF? Before dismantling it, we need a redefined measure of ‘quality’

“…9,10 Conversely, although most important clinical quality markers have not suffered, QOF de-incentivisation has led to less consistent record keeping, 9,10 contradicting arguments that high-quality data will continue to be captured. 2 If that trend was confirmed, general practice would become more opaque and less accountable, with adverse implications for research and healthcare management. Removing basic assurances of quality of care delivery 6 could prove a dangerous experiment.…”

“…It reduced between-practice variation in care delivery while also improving disease registers, recording of clinical activities, and adoption of electronic medical record systems, leading to an explosion in general practice data and research. 1,2 Despite some successes, recent years have seen accelerated debate concerning the removal of QOF. One major criticism is that QOF does not incentivise person-centred care for people with complex conditions, 2,3 who require individualised support.…”

“…1,2 Despite some successes, recent years have seen accelerated debate concerning the removal of QOF. One major criticism is that QOF does not incentivise person-centred care for people with complex conditions, 2,3 who require individualised support. This is not captured in the vast majority of indicators, which are based on clinical guidelines.…”

How could the quality and outcomes framework (QOF) do more to tackle health inequalities?

“…The future of QOF is undeniably uncertain. Since its introduction, the number of clinical indicators has reduced significantly,[ 3 ] and across the UK there is steadily growing scrutiny over its role. As of April 2016, QOF is no longer used in Scotland.…”