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Pay-for-performance has reduced health inequalities

A report on the data from the first three years of the Quality and Outcomes Framework (QOF) shows that blood pressure recording increased from 82.3% of adults in 2005 to 88.3% in 2007. The gap between median blood pressure recording levels narrowed in the most deprived and least deprived areas.

The QOF was introduced in 2004 to improve standards of primary care by linking financial incentives to 135 performance indicators for all GPs in the UK.

The report published in the BMJ online also shows that the achievement of blood pressure targets for the five chronic diseases improved substantially, particularly in diabetics in the most deprived practices.

High blood pressure is the single most important risk factor for developing heart disease and adds significantly to the gap in life expectancy between deprived and affluent areas.

Professor Helen Lester from the National Primary Care Research and Development Centre says, "Perhaps the greatest contribution that the QOF has made to changing practice will therefore be the largely unintended consequence of generating more equitable healthcare."

The authors conclude that this study, and other evidence, suggests pay-for-performance schemes should be designed with health inequalities in mind.


Do you agree that the QOF has made a significant difference to primary care practice? Your comments: (terms and conditions apply)

"Not where I work. GPs expect community nurses to earn a siginificant portion of QOF points; yet in the case of BP "checks" action is rarely taken." - Jeanette Clark, West Midlands