ABSTRACT
Background:
Financial
incentives are being increasingly adopted to help improve
standards of care within
general practice. However their effects on
care quality are unclear. This study aimed to evaluate the impact of practices opting out of the Quality and Outcomes Framework (QOF), a financial
incentive scheme in UK
general practice. Study
design:
A retrospective before and after study of all practices in Tower Hamlets, east
London.
Methods:
Practices were given an option by local commissioners of opting out of QOF without a financial penalty and instead opting for a locally designed financial
incentive scheme that promoted more holistic care. We compared those practices which opted out of QOF to those which continued. We used national, publicly available QOF
achievement data from 2016/17 and 2017/18. We undertook a sub-
analysis of 16 QOF
indicators to better understand the impact of the intervention.
Results:
Of the 36 practices in Tower Hamlets, 7 decided to continue with QOF and 29 opted out. The intervention resulted in a small but statistically significant reduction in the total QOF
achievement scores of practices which opted out of QOF. The sub-
analysis of 16 QOF
indicators showed statistically significant reductions in most of
achievement scores net of exceptions for the practices that opted out. The differences in performance between the two cohorts of practices became smaller when exceptions were included.
Conclusions:
The removal of QOF financial
incentives can result in a reduction in
achievement of QOF-related
indicators but the size of the effect seems to depend on the QOF exception rates. An alternative
incentive scheme that promotes a more holistic approach to care seems to be welcomed by general practices.
