A study was conducted on the impact of the new pay for performance scheme that was introduced as part of the new GP contract in 2004. GPs were awarded points for achieving targets aimed at improving care for patients across a range of diseases. A total of £1.8bn was available for GPs in England under the scheme, called the Quality and Outcomes Framework, and 20 per cent of that was awarded for achieving five targets related to blood pressure. The move was controversial as most GPs achieved near to maximum points, leading to critics saying the Labour government had negotiated a bad deal for the taxpayer. The research published in the British Medical Journal analysed the effect of the scheme on the care of patients with high blood pressure.
The team from Harvard University in Boston, America, and Nottingham Medical School in Britain found that there was no impact of the scheme, largely because doctors were already improving care and were acheiving the targets that had been set. Monitoring of blood pressure did not increase, prescribing of drugs for the condition did not change significantly and there was no change in the rates of strokes, heart attacks and other problems that are caused by high blood pressure, they found. Lead author Brian Serumaga, who works at both Nottingham University and Harvard in pharmaceutical policy research, wrote in the journal: "Our study has shown that explicit financial incentives did not improve the quality of care and clinical outcomes for patients with hypertension in primary care in the United Kingdom. "We found that the quality of care for hypertension was improving and already close to the threshold set for maximum payment in the pay for performance initiative. Some performance thresholds may have been set too low for the financial incentives to be effective. "It seems that doctors may be less responsive to performance based monetary incentives to improve the care of hypertension than most policy makers believe. "Furthermore, evidence from studies of educational interventions suggests that fewer, simpler messages are more likely to achieve behaviour change than more complex, diffuse messages. "Perhaps the resources devoted to pay for performance for hypertension would be better spent on implementing these interventions more widely."
Dr Laurence Buckman, Chairman of the British Medical Association's GPs Committee, said: "There is a mistaken belief that the Quality and Outcomes Framework is simply an incentive scheme, but it's much more than that. "It was designed to fund work by GPs that previously wasn't being funded, to ensure that patients received uniform high-quality care no matter where they lived in the country, and, by doing that, to improve public health over the long term and help reduce health inequalities. "The QOF is still relatively new. Other studies have shown that it has improved care and treatment for people with diabetes and reduced the number of heart attacks and deaths, particularly in deprived areas. We expect the true gains will be seen in the long term as more evidence becomes available."
A spokesman for the Department of Health said: "The Health Bill sets out the Government's vision for a patient-centred NHS that achieves health outcomes that are among the best in the world. "The Quality and Outcomes Framework and other incentives for GPs are insufficiently focused on outcomes, including patient experience. "We therefore intend to reform the current payment system so that GPs are rewarded appropriately for improving patient outcomes."
Source: Daily Telegraph
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