NHS England are currently conducting a review of the Quality and Outcomes Framework (QOF). One of the key areas for investigation is the potential impact of removing the incentives on the quality of care delivered in general practice. There is little evidence on the impact of removing financial incentives and the available evidence is inconclusive. There has been limited national monitoring of the consequences of the indicators that have been removed from the QOF in England in recent years.
This project aimed to analyse the effect of indicator removal in a large, nationally-representative cohort of patients whose care quality has been consistently recorded over time. The research provides intelligence on the likely patient impacts of changing existing incentives. This is key to understanding the risks of change, but also what the change in practice activity has been as a consequence of removing incentives.
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Since the establishment of PRUComm in 2011 our research has focused on examining how the changes to the English NHS and public health system have developed. We continue to examine the development of CCGs and the new commissioning structures. We have also been exploring the mechanisms by which commissioning is undertaken, such as contracting and the use of competition and cooperation within the new system.
While most media attention has focused on changes to the commissioning and delivery of healthcare, the shift of public health to local authorities was a major part of the reforms introduced in April 2013. We have examined the progress and developments in the public health system with a particular emphasis on how governance and organisational structures develop and whether being embedded within local councils changes the way that public health services are provided. We have also been focusing on primary and community health care with recent projects examining general practice – including methods of funding primary care; research on recruitment and retention; QOF, scaling up primary care and running and analysing two rounds of the GP WorkLife survey (eight and nine).
Our research on CCGs has most recently focused on primary care co-commissioning and new forms of contracting, such as outcomes-based and alliancing. Given the increasing policy emphasis on this area of healthcare we anticipate that we will be increasingly involved in further research on primary and community healthcare. All these topics will be explored in today’s seminar with presentations by researchers from PRUComm.
Programme and speakers biographies [pdf]>>
9.30 Registration and refreshments
10.00 – Welcome and introduction: Professor Stephen Peckham (Director PRUComm).
10.00 – 10.25 Jonathan Walden: (Commissioning Policy Lead): Policy update – Department of Health and Social Care priorities. Slides [pdf]>>
10.25– 11.00 Dr Lindsay Forbes: Incentivising GPs: Review of the Quality and Outcomes Framework in England. Slides [pdf]>>
11.00 – 11.20 Coffee
11.20 – 12.00 Dr Jon Gibson and Prof Kath Checkland: Satisfaction, sources of stress and intentions to quit amongst GPs in England: the results of the 9th GP Worklife survey
12.00 – 12.40 Dr Marie Sanderson: Examining the implementation of new models of contracting in the NHS: what are the lessons for the formation of Accountable Care Systems?
12.40 – 13.20 Lunch
13.20 – 14.00 Dr Valerie Moran: How are CCGs managing conflicts of interest when they commission primary care? Lessons for Accountable Care. Slides [pdf]>>
14.00 – 15.50 Panel Discussion – STPs, and ACS’s the re-emergence of planning?
15.50 – 16.00 Professor Stephen Peckham: Current PRUComm research programme
Posted in CCG, Commissioning, Competition & cooperation, Contracting, Deputy Director of PRUComm, Director of PRUComm, Public Health, Seminar, Stephen Peckham
Tagged alliance contracting, CCG, CCGs, co-commissioning, commissioning, Competition, Contracting, Cooperation, England, FYFV, GP, HSCA2012, new care model, new models of care, NHS, planning, policy, policy-making, primary care, PRUComm, Public Health, QOF, Quality, STP
This is our fifth annual review of research and provides a brief overview of our research activities. Following confirmation last year of our extension until the end of 2018 we have now agreed a programme of work with the Department. This sees a stronger shift towards exploring the impact of system changes on commissioning. The introduction of Sustainability and Transformation Plans and new metapractice organisations creates a rapidly shifting landscape for the commissioning and delivery of healthcare in England.
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Posted in Director of PRUComm, Publications, Stephen Peckham
Tagged alliance contracting, CCG, co-commissioning, commissioning, Competition, Contracting, Cooperation, NHS, primary care, Public Health, QOF, STP
The Quality and Outcomes Framework (QOF), an incentive scheme in general practice, was introduced across the UK in 2004 to link payment to delivery of primary medical care. Drivers for its introduction included the recognition that there were variations between general practices in the quality of care and the need to increase investment to improve morale and recruitment in primary care. QOF, in the early years, led to a reduction in inequalities in delivery of those aspects of care that it incentivised. Currently, there is little variation in QOF achievement between practices – most derive maximum, or near maximum income from it.
The QOF had other effects, encouraging nurse-led multidisciplinary management of chronic disease to deliver incentivised services, and better practice computerisation, so that delivery could be recorded. However, the extent to which high QOF achievement means a higher quality service in general practice is not clear. Quality in primary care is difficult to define, but it certainly encompasses more than is measured by QOF. It is now explicit NHS policy to improve other aspects of primary care – in particular, to deliver better integrated, holistic and patient-centred care and more effective primary prevention in primary care. Whether QOF can deliver these policies has been questioned, as have its role in reducing inequalities and its ability to deliver better population health.
NHS England commissioned the Centre for Health Services Studies at the University of Kent, on behalf of the Policy Research Unit in Commissioning and the Healthcare System (PRUComm), to review the evidence of effectiveness of QOF in the context of a changing policy landscape. We examined the most recent evidence that QOF influences behaviour in general practice and health outcomes, taking a broad view of primary care quality. We also considered the evidence that QOF helps sustain changes in primary care and effects of withdrawing QOF indicators using recent patterns of QOF achievement and the published literature.
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