Going local: devolving national pay for performance programmes

Millett, Christopher; Majeed, Azeem; Huckvale, Christopher; Car, Josip

doi:10.1136/bmj.c7085

Cited by 17 publications

(12 citation statements)

References 9 publications

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“…As some studies have suggested that the differential effect of QOF by practices' with different baseline performance, particularly the worst performers improved at the fastest rate after QOF [14], [15]. For this analysis, we created 3 approximately equal-sized number of GP practices groups based on their baseline performance in year 2003 for each indicator.…”

Section: Methodsmentioning

confidence: 99%

The Effects of Pay for Performance on Disparities in Stroke, Hypertension, and Coronary Heart Disease Management: Interrupted Time Series Study

et al. 2011

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BackgroundThe Quality and Outcomes Framework (QOF), a major pay-for-performance programme, was introduced into United Kingdom primary care in April 2004. The impact of this programme on disparities in health care remains unclear. This study examines the following questions: has this pay for performance programme improved the quality of care for coronary heart disease, stroke and hypertension in white, black and south Asian patients? Has this programme reduced disparities in the quality of care between these ethnic groups? Did general practices with different baseline performance respond differently to this programme?Methodology/Principal FindingsRetrospective cohort study of patients registered with family practices in Wandsworth, London during 2007. Segmented regression analysis of interrupted time series was used to take into account the previous time trend. Primary outcome measures were mean systolic and diastolic blood pressure, and cholesterol levels. Our findings suggest that the implementation of QOF resulted in significant short term improvements in blood pressure control. The magnitude of benefit varied between ethnic groups with a statistically significant short term reduction in systolic BP in white and black but not in south Asian patients with hypertension. Disparities in risk factor control were attenuated only on few measures and largely remained intact at the end of the study period.Conclusions/SignificancePay for performance programmes such as the QOF in the UK should set challenging but achievable targets. Specific targets aimed at reducing ethnic disparities in health care may also be needed.

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Section: Methodsmentioning

confidence: 99%

The Effects of Pay for Performance on Disparities in Stroke, Hypertension, and Coronary Heart Disease Management: Interrupted Time Series Study

et al. 2011

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“…12 The QOF Plus Health Check differs from the national minimum Health Check by including patients with hypertension and CKD. In the first year of the programme, patients determined to have high CVD risk (greater than 20 percent risk using a designated risk score) from existing medical records were prioritized for screening.…”

Section: Methodsmentioning

confidence: 99%

Assessment of cardiovascular risk factors prior to NHS Health Checks in an urban setting: cross-sectional study

et al. 2012

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ObjectivesTo assess the completeness of cardiovascular disease (CVD) risk factor recording and levels of risk factors in patients eligible for the NHS Health Check.DesignCross-sectional study.SettingTwenty-eight general practices located in Hammersmith and Fulham, London, UK.Participants42,306 patients aged 40 to 74 years without existing cardiovascular disease or diabetes.Main Outcome MeasuresMeasurement and level of CVD risk factors: blood pressure, cholesterol, body mass index (BMI), blood glucose and smoking status.ResultsThere was a high recording of smoking status (86.1%) and blood pressure (82.5%); whilst BMI, cholesterol and glucose recording was lower. There was large variation in BMI, cholesterol, glucose recording between practices (29.7–91.5% for BMI). Women had significantly better risk factor recording than men (AOR = 1.70 [1.61–1.80] for blood pressure). All risk factors were better recorded in the least deprived patient group (AOR = 0.79 [0.73–0.85] for blood pressure) and patients with diagnosed hypertension (AOR = 7.24 [6.67–7.86] for cholesterol). Risk factor recording varied considerably between practices but was more strongly associated with patient than practice level characteristics. Age-adjusted levels of cholesterol and BMI were not significantly different between men and women. More men had raised blood glucose, blood pressure and BMI than women (29.7% [29.1–30.4] compared to 19.8% [19.3–20.3] for blood pressure).ConclusionsBefore the NHS Health Check, CVD risk factor recording varied considerably by practice and patient characteristics. We identified significant elevated levels of raised CVD risk factors in the population eligible for a Health Check, which will require considerable work to manage.

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“…NHS Health Check was implemented ahead of the national schedule, beginning in July 2008 and organized under a local incentive framework for general practice (QOF Plus) (Box 1). 10 The primary care trust provided guidance and training 15 on implementation of the NHS Health Check programme to 31 independent general practices in the area; the programme was then largely administered by nurses and health care assistants employed by the practices.…”

Section: Nhs Health Check In Hammersmith and Fulham Londonmentioning

confidence: 99%

“…A small number of areas include Health Checks within a local quality outcomes framework (QOF), a more complex pay-forperformance framework. 10 We aimed to assess the impact of a local financial incentive scheme on uptake and statin prescribing in the first 2 years of Health Checks. Given inequalities in CVD risk factors, including smoking and obesity, 11,12 and total CVD burden, 13 we also examined whether uptake and prescribing within the programme differed between socio-demographic groups.…”

Section: Introductionmentioning

confidence: 99%

Uptake of the NHS Health Check programme in an urban setting

et al. 2013

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Background. The NHS Health Check programme aims to improve prevention, early diagnosis and management of cardiovascular disease (CVD) in England. High and equitable uptake is essential for the programme to effectively reduce the CVD burden. Objectives. Assessing the impact of a local financial incentive scheme on uptake and statin prescribing in the first 2 years of the programme.Methods. Cross-sectional study using data from electronic medical records of general practices in Hammersmith and Fulham, London on all patients aged 40-74 years. We assessed uptake of complete Health Check, exclusion of patients from the programme (exception reporting) and statin prescriptions in patients confirmed with high CVD risk.Results. The Health Check uptake was 32.7% in Year 1 and 20.0% in Year 2. Older patients had higher uptake of Health Check than younger (65-to 74-year-old patients: Year 1 adjusted odds ratio (AOR) 2.05 (1.67-2.52) & Year 2 AOR 2.79 (2.49-3.12) compared with 40-to 54-year-old patients). The percentage of confirmed high risk patients prescribed a statin was 17.7% before and 52.9% after the programme. There was a marked variation in Health Check uptake, exception reporting and statin prescribing between practices.Conclusions. Uptake of the Health Check was low in the first year in patients with estimated high risk despite financial incentives to general practices; although this matched the national required rate in second year. Further evaluations for cost and clinical effectiveness of the programme are needed to clarify whether this spending is appropriate, and to assess the impact of financial incentives on programme performance.

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Going local: devolving national pay for performance programmes

Abstract: The recommendation that part of the Quality and Outcomes Framework be devolved to local areas has not been widely implemented. However, the experience of Christopher Millett and colleagues shows that it can help focus attention on local health needs

Cited by 17 publications

References 9 publications

The Effects of Pay for Performance on Disparities in Stroke, Hypertension, and Coronary Heart Disease Management: Interrupted Time Series Study

The Effects of Pay for Performance on Disparities in Stroke, Hypertension, and Coronary Heart Disease Management: Interrupted Time Series Study

Assessment of cardiovascular risk factors prior to NHS Health Checks in an urban setting: cross-sectional study

Uptake of the NHS Health Check programme in an urban setting

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