Performance-related pay for GP practices has failed to improve their prevention and health promotion work, according to research published today.

The King’s Fund considered the effect of the quality and outcomes framework on improving health in deprived areas, after it was introduced in April 2004.

It found that where GP practices were taking part in preventive activities these were usually introduced before the framework, and so were not a result of its pay incentives.

More than £6bn of QOF payments have been made to GPs over the past six years, however this sum covers all activity, not just public health work.

Researchers looked at routine data produced as part of the framework, and interviewed practice and primary care trust staff.

They found the framework had not “provided incentives to improve primary prevention and public health”.

The study suggested that, despite payments for practices to keep a register of patients with certain chronic conditions, “practices in deprived areas have not actively sought to identify new cases or reach out to patients”.

They also found that while many practices’ performance as measured by the framework had improved, this “may be the result of practices in deprived areas becoming more organised and better at meeting the requirements of the QOF rather than having significantly improved the health of their populations”.

The research, funded by the National Institute for Health Research Service Delivery and Organisation programme, recommended future QOF and GP contract changes should be more closely linked to improving prevention.

For example, this could be by “[rewarding] population outcomes such as reductions in rates of emergency admissions”. It also recommended incentives for meeting the needs of excluded people such as homeless or drug dependent patients.

Lead author and King’s Fund policy director Anna Dixon said: “A great deal of money has been invested in providing GPs with financial incentives through the QOF. It is disappointing we have not gained greater return on investment so far in terms of health improvement in deprived areas.”

QOF: Recommendations

  • More primary prevention incentives
  • Focus on self-care and self management
  • Separate funding for practices in deprived areas
  • Reward population outcomes e.g. reduced emergency admissions
  • Link pay to improvement rather than absolute threshold
  • Scrutinise where practices are exempting patients from reporting