The relationship between social deprivation and the quality of primary care: a national survey using indicators from the UK Quality and Outcomes Framework

Abstract

Background: The existence of health inequalities between least and most socially deprived areas is now well established.

Aim: To use Quality and Outcomes Framework (QOF) indicators to explore the characteristics of primary care in deprived communities.

Design of study: Two-year study.

Setting: Primary care in England.

Method: QOF data were obtained for each practice in England in 2004-2005 and 2005-2006 and linked with census derived social deprivation data (Index of Multiple Deprivation scores 2004), national urbanicity scores and a database of practice characteristics. Data were available for 8480 practices in 2004-2005 and 8264 practices in 2005-2006. Comparisons were made between practices in the least and most deprived quintiles.

Results: The difference in mean total QOF score between practices in least and most deprived quintiles was 64.5 points in 2004-2005 (mean score, all practices, 959.9) and 30.4 in 2005-2006 (mean, 1012.6). In 2005-2006, the QOF indicators displaying the largest differences between least and most deprived quintiles were: recall of patients not attending appointments for injectable neuroleptics (79 versus 58%, respectively), practices opening > or =45 hours/week (90 versus 74%), practices conducting > or = 12 significant event audits in previous 3 years (93 versus 81%), proportion of epileptics who were seizure free > or = 12 months (77 versus 65%) and proportion of patients taking lithium with serum lithium within therapeutic range (90 versus 78%). Geographical differences were less in group and training practices.

Conclusions: Overall differences between primary care quality indicators in deprived and prosperous communities were small. However, shortfalls in specific indicators, both clinical and non-clinical, suggest that focused interventions could be applied to improve the quality of primary care in deprived areas.

Figure 1

Relationship between total Quality and Outcomes Framework (QOF) 2005–2006 scores and Index of Multiple Deprivation (IMD-2004) scores. Note: vertical lines represent cut-off points for each quintile of deprivation