Does QOF work?

There is quite a bit of publicity today for a paper in the BMJ asking whether hypertension targets have any effect on outcomes. Neither blood pressure or cardiovascular morbidity seem to have been affected.

It was with a sense of dread that found the paper. QOF has had more than its fair share of thinly disguised rants appearing as research. I was however very pleasantly surprised to find a well constructed piece of research with tightly defined methods and considerably clarity of thought. Maybe it takes researchers in the USA (Harvard to be exact) to look at these things objectively.

There is considerably debate about performance related pay and very variable evidence about how effective it is. There has been some research in the USA where schemes tend to make up a much smaller proportion of practice income than in the NHS.

It is of course disappointing although not particularly surprising to see a lack of observable effect. QOF is not, of course, a controlled intervention and it is possible to argue that we will never know what would have happened without it but this is pretty weak.

Now for the political bit. The cash for the QOF came, to a large extent, from a transfer from the old capitation payments. So the pay which previously went to practices and was used for treatment of hypertension was paid, in a different way, to practice for the same treatment of hypertension.

So little change but I am strangely cheerful that it has been demonstrated in such a high quality piece of research. More please.

No comments: