Abstract
OBJECTIVE: to determine the characteristics of general practices which perform poorly in terms of Quality and Outcome (QOF) performance indicators in England's NHS.
METHOD: retrospective, four year longitudinal study, 2005 to 2008. Data were obtained from 8515 practices (99% of practices in England) in year 1, 8264 (98%) in year 2, 8192 (98%) in year 3 and 8256 (99%) in year 4.
OUTCOME MEASURES: QOF performance scores; social deprivation (IMD-2007) and ethnicity from the 2001 national census; general practice characteristics.
RESULTS: we identified a cohort of 212 (2.7%) practices which remained in the lowest decile for total QOF scores in the four years following the introduction of the QOF. A total of 705,386 patients were registered at these practices in year 4. These practices were more likely to be singlehanded (odds ratio [OR], 13.8), non-training practices (OR, 3.9) and located in deprived areas (OR, 2.6; most vs least deprived quintiles). General practitioners (GPs) in these practices were more often aged ≥ 65 years or more (OR, 7.3; mean GP age ≥ 65 years vs <45 years), male (OR 2.0), UK qualified (OR 2.0) with small list sizes (OR 3.2; list size <1000 vs 1500-2000 patients). We identified individual QOF indicators which were poorly achieved. The reported prevalence of most chronic diseases was lower in the poorly performing cohort.
CONCLUSIONS: a small minority of practices have remained poor performers in terms of measurable performance indicators over a four-year period. The strongest predictors of poor QOF performance were singlehanded and small practices, and practices staffed by elderly GPs.
Original language | English |
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Pages (from-to) | 21 - 27 |
Number of pages | 7 |
Journal | Journal of health services research & policy |
Volume | 16 |
Issue number | 1 |
DOIs | |
Publication status | Published - Jan 2011 |
Keywords
- Aged
- Clinical Competence
- England
- General Practice
- General Practitioners
- Humans
- Longitudinal Studies
- Male
- Outcome Assessment (Health Care)
- Quality Indicators, Health Care
- Retrospective Studies
- State Medicine