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‘Significant’ drop in QOF payments predicted by study

23 January 2014

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Plans to raise the upper quality and outcomes framework (QOF) payment threshold will “substantially” reduce the number of points achieved per practice, researchers have found. 

A study published in the British Journal of General Practice (BJGP) found that if clinical performance remains static, the planned hikes could result in a loss of 47.68 QOF points per practice. 

For most practices, this would result in a loss of £279.60 per year. However, larger practices could lose relatively more. 

Recently, the Department of Health suggested increasing the upper payment threshold to the 75th percentile of the previous year’s national performance. 

However, the British Medical Association’s GP Committee has expressed concern that the new indicators could “skew workloads” towards patients with specified conditions, leading to more box ticking. 

In BJGP, the authors write: “Payment for performance in health care is increasingly used to drive up performance. Although there is evidence that payment incentives increase the clinical management and outcomes of patients, there is an increasing body of evidence that demonstrates the unintended consequences of this approach with the increases in the rate of exception reporting being the most widely reported.

“Further research is required to examine both the positive and negative effects of payment incentives for performance within health care, especially the unintended consequences on patient groups with conditions not included in pay for performance schemes. The implementation of these proposed changes to the QOF payment thresholds may provide one such opportunity.” 

Increasing the QOF upper payment threshold in general practices in England: impact of implementing government proposals is available to view on the BJGP website