Financial incentives for general practitioners have failed to improve health standards or reduce inequalities, according to new research published by The King's Fund.
The pay-for-performance scheme for GPs introduced in April 2004, known as the 'quality and outcomes framework' (QOF), didn't improve ill-health prevention or health promotion by GPs, the think tank said. Where local practices were undertaking preventive activities, they usually pre-dated the QOF and weren't a result of the incentives.
The research did find that QOF had helped to get GP practices to adopt improved approaches to secondary prevention, for example, identifying and detecting illness. But it didn't provide incentives to improve primary prevention and public health.
And while differences in performance on QOF between the least and most deprived practices have all but disappeared in recent years, this is likely to be because practices in deprived areas have become more organised and better at meeting the requirements of the QOF rather than having significantly improved the health of their populations.
Anna Dixon, director of policy at The King's Fund, said: "A great deal of money has been invested in providing GPs with financial incentives through the QOF. It is disappointing that we have not gained greater return on investment so far in terms of health improvement in deprived areas."
She added: "General practice has an important contribution to make to improve public health. The development of GP commissioning provides an opportunity to improve the current system of incentives to ensure practices take responsibility for population health not just for treatment of the patients in front of them."
http://www.publicservice.co.uk/news_story.asp?id=16133
http://www.kingsfund.org.uk/publications/impact_of_quality.html
PDF version A major study of GP prescribing has found that while the vast majority of prescriptions written by family doctors are appropriate and effectively monitored, around 1 in 20 contain an error.
Researchers looking at a sample of GP practices in England found that where there were errors, most were classed as mild or moderate, but around 1 in every 550 prescription items was judged to contain a serious error. The most common errors were missing information on dosage, prescribing an incorrect dosage, and failing to ensure that patients got necessary monitoring through blood tests.
The research, commissioned by the General Medical Council, is the largest-scale study of its kind. It provides an important insight into how errors in prescribing come about. Researchers say improvements can be made to reduce the error rate.
The research recommends a greater role for pharmacists in supporting GPs, better use of computer systems and extra emphasis on prescribing in GP training.
Commenting on the research, Professor Sir Peter Rubin, Chair of the General Medical Council, said:
‘GPs are typically very busy, so we have to ensure they can give prescribing the priority it needs. Using effective computer systems to ensure potential errors are flagged and patients are monitored correctly is a very important way to minimise errors. Doctors and patients could also benefit from greater involvement from pharmacists in supporting prescribing and monitoring. We will be leading discussions with relevant organisations, including the RCGP and the CQC, and the Chief Pharmacist in the Department of Health, to ensure that our findings are translated into actions that help protect patients.’
Professor Tony Avery of the University of Nottingham’s medical school, who led the research, said:
‘Few prescriptions were associated with significant risks to patients but it’s important that we do everything we can to avoid all errors. GPs must ensure they have ongoing training in prescribing, and practices should ensure they have safe and effective systems in place for repeat prescribing and monitoring. I’d also encourage doctors to share their experiences of prescribing issues both informally within their practices, and also formally where appropriate through local or national reporting systems. Prescribing is a skill, and it is one that all doctors should take time to develop and keep up-to-date.’
Notes to editors:
The study follows 2009 research commissioned by the GMC examining prescribing errors made by foundation doctors in hospitals, which has resulted in extra emphasis on prescribing in medical school curricula: http://www.gmc-uk.org/about/research/research_commissioned_4.asp
For further information please contact the Media Relations Office on 020 7189 5454, out of hours 020 7189 5444/ 07920 461497, email press@gmc-uk.org, website www.gmc-uk.org.
The General Medical Council registers and licenses doctors to practise medicine in the UK.
The law gives us four main functions:
- keeping up-to-date registers of qualified doctors
- fostering good medical practice
- promoting high standards of medical education and training
- dealing firmly and fairly with doctors whose fitness to practise is in doubt
Health Secretary Andrew Lansley today welcomed the agreement between the Government and British Medical Association (BMA) over changes to the GP contract for next year. The deal will mean that patients will get more choice over which GP treats their family and will improve the quality of care of patients.
Andrew Lansley said:
“This is a good deal for GPs, a good deal for patients and a good deal for the NHS. These are difficult economic times and there are many financial challenges facing the NHS so I welcome the BMA's commitment to delivering more and better care for patients whilst there is a continuing freeze in GP pay.
“Patients often tell me that they want more choice over which practice they can register with, so I am pleased that this deal allows three major pilots to be launched across England that will allow patients to register at practices away from where they live, such as near to where they work.
“This will allow us to test and evaluate the issues that the profession has expressed concerns about.
“The deal will also mean that patients may not be forced to change GP surgery if they move locally. This will save up to three million people who move locally every year the hassle of re-registering as they can remain with the practice of their choice.”
The key points in the financial agreement are:
Financial settlement
This settlement involves a pay freeze for GPs.
As last year, the Government will apply a small (0.5%) uplift to contract payments to contribute to the general increase in practice expenses and to provide for practice staff earning less than £21,000 to receive a pay rise of at least £250. The combination of a below-inflation uplift and new quality requirements for GP practices will deliver an estimated efficiency improvement of around 3.5 per cent.
Quality improvements
The agreement includes a number of improvements to the Quality and Outcomes Framework (QOF), including new measures to improve care for asthma patients, patients with peripheral arterial disease at risk of heart attacks, together with additional support and treatment to help smokers to quit.
Greater patient choice
Three areas will run the pilot from April 2012, which will see people having greater choice and flexibility about the GP practice that provides their personal care. It will mean patients are able to register close to work, close to a relative they care for or even close to a child’s school. The pilots will also test new arrangements to enable patients who are away from home to use a GP surgery as a non-registered patient.
Seventy-five per cent of patients who responded to a recent consultation on GP choice made it clear that they wanted greater ability to register with a practice of their choice.
The settlement provides the opportunity to fully test and evaluate the impact of increasing choice in pilot areas and will inform and strengthen proposals before wider implementation is considered.
End to patients being forced to de-register from their practice
The agreement today will also mean that people who move house just a few miles down the road will not be forced to move practice, which they would have had to do in the past. This will benefit up to three million or so people who move house each year within a short distance.
Better working between GPs and A&E departments
GP practices will work in groups to review the patterns of A&E attendances and find ways of improving the quality and accessibility of the care they provide so that patients avoid unnecessary A&E attendances.
The scheme focus in particular on quality of care for older patients with complex health needs at high risk of admission, children with minor illness or injury and patients who frequently re-attend A&E.
Membership of Clinical Commissioning Groups
The Department also welcomes that the BMA has agreed that, subject to the Health and Social Care Bill, it will be a contractual duty for GP practices to be members of a clinical commissioning group (CCG). This provides clarity to GP practices over their contractual responsibilities and is an important step forward in the process of NHS modernisation.
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