The role of the Quality and Outcomes Framework in the care of long-term conditions: a systematic review

Abstract

BackgroundImproving care for people with long-term conditions is central to NHS policy. It has been suggested that the Quality and Outcomes Framework (QOF), a primary care pay-for-performance scheme that rewards practices for delivering effective interventions in long-term conditions, does not encourage high-quality care for this group of patients.AimTo examine the evidence that the QOF has improved quality of care for patients with long-term conditions.Design and settingThis was a systematic review of research on the effectiveness of the QOF in the UK.MethodThe authors searched electronic databases for peer-reviewed empirical quantitative research studying the effect of the QOF on a broad range of processes and outcomes of care, including coordination and integration of care, holistic and personalised care, self-care, patient experience, physiological and biochemical outcomes, health service utilisation, and mortality. Because the studies were heterogeneous, a narrative synthesis was carried out.ResultsThe authors identified three systematic reviews and five primary research studies that met the inclusion criteria. The QOF was associated with a modest slowing of both the increase in emergency admissions and the increase in consultations in severe mental illness (SMI), and modest improvements in diabetes care. The nature of the evidence means that the authors cannot be sure that any of these associations is causal. No clear effect on mortality was found. The authors found no evidence that the QOF influences integration or coordination of care, holistic care, self-care, or patient experience.ConclusionThe NHS should consider more broadly what constitutes high-quality primary care for people with long-term conditions, and consider other ways of motivating primary care to deliver it.

The future of the Quality and Outcomes Framework in England

“…5 There is little empirical evidence that QOF has a negative impact on the coordination or integration of care, the provision of holistic care, or patient experience, but little sign of benefit either. 6 These findings are consistent with evidence from other parts of the world, that financial incentives are often less effective than those who bring them in expect. 7 QOF has become increasingly unpopular with GPs, partly because of the administrative demands of the scheme at a time of rising workload, and partly because of indicators introduced in the past few years that were poorly evidence based or seemed to tackle a managerial rather than a clinical agenda.…”

Effects of Monetary Incentives in Physician Groups: A Systematic Review of Reviews

“…The concept of P4P has recently attracted widespread interest. It was examined in ten reviews [22,23,25,32,33,35,[65][66][67][68], of which three were of high, six were of moderate, and one was of low quality.…”

Quality and Outcomes Framework at the fork in the road

“…It has substantially altered how care in general practice is organised and delivered but, longer term, strategies for high quality primary care will need to evolve beyond QOF 12. The challenge for decision makers now is how QOF can build on the achievements of general practice, the professional motivation and skills of its staff, and the potential to do more in collaboration with others, without jeopardising the fragile edifice.…”