QOF Plus Year 1 - Imperial College London

List turnoverConsultation with practices has identified a concern that higher thresholds will bedisproportionately more difficult for high-turnover practices (e.g. those based in areas withsignificant migrant or student populations) to attain. In addition to an increased equilibriumworkload (the number of cases that must be processed simply to maintain current attainment),there may be specific issues around identifying and contacting members of such transientpopulations.While regression modelling of QOF 04/05 did not identify list turnover as a factor contributory tolower QOF attainment (Ashworth and Armstrong, 2006), the effect of raised thresholds has notbeen explored. Data around turnover and attainment will be collated during the first months ofQOF+ 08/09 with the aim of determining the scope of the issue and evaluating whether thisshould be taken into account in calculating remuneration. In the meantime, we would valuefeedback from practices about their practical experience of any issues relating to turnover andmeeting the revised thresholds.ReferencesAsthworth M, Armstrong D (2006) The relationship between general practice characteristics andquality of care: a national survey of quality indicators used in the UK quality and outcomesframework, 2004-5. BMC Family Practice 7:68Chaix-Couturier C, Durand-Zaleski I, Jolly D, Durieux P (2000) Effects of financial incentives on medicalpractice: results from a systematic review of the literature and methodological issues. InternationalJournal for Quality in Health Care 12:133-42Department of Health (2003) New GMS contract 2003: investing in general practice. NHSConfederation and the BMA. London.Doran T, Fullwood C, Gravelle H, Kontopantelis E, Hiroeh U, Roland M (2006) Pay-for-performanceprograms in family practices in the United Kingdom. New England Journal of Medicine 355:375-84Doran T, Fullwood C, Reeves D, Gravelle H, Roland M (2008) Exclusion of patients from pay-forperformancetargets by English physicians. New England Journal of Medicine 359:274-84Fleetcroft, R and Cookson, R (2006) Do the incentive payments in the new NHS contract for primarycare reflect likely population health gains? Journal of Health Care Research and Policy 11:27–31Fleetcroft R, Steel N, Cookson R, Howe A (2008) “Mind the gap!" Evaluation of the performance gapattributable to exception reporting and target thresholds in the new GMS contract: National databaseanalysis. BMC Health Services Research 8: 131Hillman AL, Ripley K, Goldfarb N, et al. (1998) Physician financial incentives and feedback: failure toincrease cancer screening in Medicaid managed care. American Journal of Public Health 88:1699-1701Primary Care Contracting (2008) What is the workload associated with 1 QOF point? [Online, AccessedSeptember 01 2008] Available at: http://www.pcc.nhs.uk/qanda.php?article_request=133Roland M (2004). Linking physician pay to quality of care—a major experiment in the United Kingdom.New England Journal of Medicine 351:1448-54Sigfrid LA, Turner C, Crook D, Ray S (2006) Using the UK primary care quality and outcomes frameworkto audit health care equity: preliminary data on diabetes management. Journal of Public Health28:221-25The Information Centre (2008) National quality and outcomes framework exception reportingstatistics for England 2007/8 bulletin. [Online, Accessed November 01 2008] Available at:http://www.ic.nhs.uk/cmsincludes/_process_document.asp?sPublicationID=1225147131677&sDocID=4317115