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Multicenter Study
. 2010 Sep;60(578):e335-44.
doi: 10.3399/bjgp10X515340.

Performance of small general practices under the UK's Quality and Outcomes Framework

Tim Doran  1 , Stephen Campbell, Catherine Fullwood, Evangelos Kontopantelis, Martin Roland
Affiliations
Multicenter Study

Performance of small general practices under the UK's Quality and Outcomes Framework

Tim Doran et al. Br J Gen Pract. 2010 Sep.

Abstract

Background: Small general practices are often perceived to provide worse care than larger practices.

Aim: To describe the comparative performance of small practices on the UK's pay-for-performance scheme, the Quality and Outcomes Framework.

Design of study: Longitudinal analysis (2004-2005 to 2006-2007) of quality scores for 48 clinical activities.

Setting: Family practices in England (n = 7502).

Method: Comparison of performance of practices by list size, in terms of points scored in the pay-for-performance scheme, reported achievement rates, and population achievement rates (which allow for patients excluded from the scheme).

Results: In the first year of the pay-for-performance scheme, the smallest practices (those with fewer than 2000 patients) had the lowest median reported achievement rates, achieving the clinical targets for 83.8% of eligible patients. Performance generally improved for practices of all sizes over time, but the smallest practices improved at the fastest rate, and by year 3 had the highest median reported achievement rates (91.5%). This improvement was not achieved by additional exception reporting. There was more variation in performance among small practices than larger ones: practices with fewer than 3000 patients (20.1% of all practices in year 3), represented 46.7% of the highest-achieving 5% of practices and 45.1% of the lowest-achieving 5% of practices.

Conclusion: Small practices were represented among both the best and the worst practices in terms of achievement of clinical quality targets. The effect of the pay-for-performance scheme appears to have been to reduce variation in performance, and to reduce the difference between large and small practices.

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Figures

Figure 1
Figure 1
Distribution of practice scores for percentage of total QOF points scored by number of patients, year 1 (2004–2005) to year 3 (2006–2007).
Figure 2
Figure 2
Distribution of practice scores for overall reported achievement by number of patients, year 1 (2004–2005) to year 3 (2006–2007).
Figure 3
Figure 3
Distribution of practice scores for overall exception reporting by number of patients, year 2 (2005–2006) to year 3 (2006–2007).
Figure 4
Figure 4
Distribution of practice scores for population achievement by number of patients, year 2 (2005–2006) to year 3 (2006–2007).
See this image and copyright information in PMC

References

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    1. Department of Health. High quality care for all: NHS next stage review. London: Department of Health; 2008.
    1. Roland M. Linking physicians’ pay to the quality of care — a major experiment in the United Kingdom. N Engl J Med. 2004;351(14):1448–1454. - PubMed

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