QOF Plus Year 1 - Imperial College London

Minimum attainment thresholdsIt was initially proposed that there be a set of minimum attainment thresholds, applicable to allexisting QOF and QOF+ indicators, that a practice must reach in order to receive anyremuneration under the QOF+ scheme. Beyond concerns that incentive schemes per se mayencourage neglect of non-incentivised areas of care (Roland, 2004; Chaix-Couturier et al., 2000),it is recognised that there may be competing interests within such schemes that lead to someindicator areas being systematically under-prioritised. Evidence from a US cancer screeningprogramme suggests that competition between incentive areas can compromise theeffectiveness of each to cause change (Hillman et al., 1998). Fleetcroft and Cookson (2006) notethe important distinction between cost-effectiveness in terms of workload and cost-effectivenessin terms of health outcomes, arguing that the former is more likely to shape clinical practice.Minimum attainment thresholds aim to stimulate a systematic approach to patient care;discouraging practices from ‘cherry-picking’ indicators that might be easy for them to attain whilepotentially neglecting other areas of patient care (including those areas of QOF not covered bythe QOF+ scheme.) Despite this goal, it proved difficult to peg thresholds that were meaningful(i.e. their attainment would represent true clinical merit) but did not penalise (and deterparticipation by) poorly performing practices.Because of this, and because significant negative feedback was elicited when the issue waspresented to practices, it has been decided to defer the introduction of minimum attainmentthresholds in QOF+ 08/09. The QOF+ Development Group remains committed to ensuring thatthe introduction of QOF+ in Hammersmith and Fulham does not come at the cost of progressmade in other clinical areas. Monitoring over the first 12 months will facilitate discussion aboutwhether this policy requires review in QOF+ 09/10.109