Scores of GP practices in deprived areas are consistently failing to demonstrate clinical quality under a national incentive scheme, analysis by HSJ has found.

The NHS Information Centre last week published the results of the quality and outcomes framework for 2010-11. The framework, introduced in 2004, rewards GP practices demonstrating strong performance with extra income.

Overall performance improved, with 26 per cent of practices achieving the maximum amount of points compared with 23 per cent in 2009-10. However, a significant number of practices have performed consistently badly over the past five years.

HSJ used the QOF points available from the full range of clinical care indicators to rank GP practices’ performance since 2006-07. The clinical care part of the framework was worth £708m in total and covers areas including coronary heart disease, mental health and asthma.

Some 170 GP practices, covering a total population of more than 600,000, have been in the bottom 10 per cent of practices nationally for their performance against clinical indicators in each of the past five years.

Primary Care Trust Network director David Stout said poor performance against quality indicators should draw commissioners’ attention to that practice as it suggested patients were missing out on services. He said because QOF was not mandatory and only “an incentive system”, poor performance would “stimulate a discussion but not a punitive intervention” by PCTs.

Neil Churchill, chief executive of charity Asthma UK, said the figures “warrant further investigation”.

“Many of the QOF’s clinical indicators reflect relatively basic standards of care, so if practices are consistently under-delivering on them, they should be prepared to answer some serious questions,” he added.

The populations covered by consistently low performing practices have an average index of multiple deprivation score of 32.5, well above the national average of 24.

King’s Fund policy director Anna Dixon said research by the think tank this year found that some practices with very deprived patients “did not even try at QOF” but were still meeting patients’ needs.

British Medical Association GPs committee deputy chair Richard Vautrey warned practices should not be judged on QOF alone. “It is just one of a whole range of indicators about a practice’s performance,” he said.

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