The £1bn quality and outcomes framework has failed to halt the rise in hospital admissions of people with long term conditions and needs to be overhauled, a think tank has claimed.

The Policy Exchange report Incentivising Wellness says admissions for diabetes and serious complications have increased, despite 98.4 per cent of GP practices hitting diabetes QOF targets in 2008-09.

The report highlights the lack of financial rewards for actively reducing the number of hospital admissions for people with long term conditions, or for ensuring that people at risk do not go on to develop diabetes and its complications.

The report says QOF should be overhauled, with rewards offered for reducing hospital admissions and the prevention of the development, or deterioration, of disease and its complications.

It says the government should start by setting an initial milestone of cutting use of hospitals for care of long term conditions by 20 per cent over the next five years.

It adds: “Additional indicators for all long term conditions should be developed which concentrate on outcome measures.

“For example, in diabetes these would reward reduced numbers of people with diabetes suffering renal failure or being admitted to hospital with life threatening diabetic ketoacidosis.”

National clinical lead for quality and productivity Sir John Oldham, who is leading the long term conditions work stream at the Department of Health, said it was partly because of the framework that the UK was already among the best in the world for the management of long term conditions.

However, he said: “What is true is that the beneficial effects have plateaued.”

He agreed there was a case to be made for introducing an element into the framework for unscheduled admissions for ambulatory sensitive conditions - those where adequate care can safely be provided in primary care - but achievable across a GP consortium rather than individual practices.

British Medical Association GPs committee deputy chair Richard Vautrey emphasised the need for any additional quality and outcomes indicators to be measurable across a 12 month period, and that outcomes had to be under a practice’s control.

He said “It is important to incentivise the right processes. If you fail to do so, practices will see that the outcome is potentially unachievable and won’t even embark on the processes that will potentially help them to get to that potential outcome.”