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QOF review must avoid “postcode lottery in patient care”

31 October 2008

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The Quality and Outcomes Framework (QOF) must continue to be nationally focused to avoid a “postcode lottery” in patient care, the British Medical Association (BMA) has said in response to yesterday’s (30 October 2008) proposals that changes should be made to the way the QOF is reviewed.

The core government proposal is that the National Institute for Health and Clinical Excellence (NICE) should oversee assessment of the QOF’s clinical indicators. In response to this, thinktank Civitas suggested that “turning over responsibility for future QOFs to a quango concerned with crude economic calculations is unlikely to be the way forward”.

The BMA highlighted the achievements of the QOF. Dr Laurence Buckman (pictured), Chairman of the BMA’s GP Committee (GPC), called the QOF a “huge step forward in the government’s promise to address health inequalities across the UK,” saying: “It is doing exactly what it was supposed to do by ensuring that patients get consistent, evidence-based care wherever they live.”

However, responding to the proposal that a more flexible approach to review could mean local health bodies could select some indicators to reflect local needs, Dr Buckman said: “We would be concerned if this review undermined this vital national approach to quality standards.

“There is the possibility of a postcode lottery in patient care developing if primary care organisations can choose which bits of QOF they want to provide. Patients should expect the same high quality of care wherever they live in the UK.”

While Civitas welcomed a full assessment of the benefits of the QOF’s indicators, it said it was “wary” of turning over all responsibility to NICE, due to its focus on “purely clinical effectiveness”, which it said was “not a good remit for assessing primary care interventions, where ‘interpersonal’ effectiveness is equally important.”

James Gubb, Director of the Health Unit at Civitas, said: “There should be a full assessment of the net benefit of the framework as a whole. Mounting evidence suggests the QOF as it stands risks crowding out the patient-centred and holistic benefits of general practice.

“Turning over responsibility for future QOFs to a quango concerned with crude economic calculations is unlikely to be the way forward.”

The BMA will be responding formally to the Department of Health consultation.