UK GP activity exceeds expectations
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7516.536 (Published 08 September 2005) Cite this as: BMJ 2005;331:536
Family doctors exceeded all expectations in achieving the quality outcomes laid down in their new contract but have created a financial headache for hard pressed primary care trusts in the process.
New health department figures show that almost all England's 8542 practices took part in the first year of the Quality and Outcomes Framework, a funding arrangement that rewards practices for providing quality care. On average they achieved 959 (91%) of the 1050 points offered for meeting a range of clinical and organisational standards.
Under the new incentive scheme practices are rewarded for every point they score. Points are awarded on the basis of evidence based clinical indicators, including treatments for heart disease and cancer; on organisational issues, such as patients' records; and on indicators of patients' experiences. The normal value of a point is £77.50 ($143; €114) a year, meaning the average practice earned an extra £74 299 from this year's exercise—about 20% of its total income. Next year, the value of each point will rise to £124.60.
A total of 59 practices scored the maximum 1050. The top primary care trust (PCT) was South East Oxfordshire, whose practices achieved, on average, 99% of the 1050 points possible, while the worst was North Bradford PCT, with an average of 64.1%.
But the higher than expected rewards have created problems. The department based its funding on the assumption that practices would average 750 points and therefore earn £430m in bonuses. In fact the bonuses are closer to £630m, meaning trusts have to find an extra £200m.
Ministers hailed the results as a resounding success. “This system gives the NHS for the first time ever world leading intelligence on chronic diseases, like diabetes and heart disease,” said health minister Lord Warner. It would also make it easier to tackle health inequalities.
The findings show that the most common chronic condition is hypertension (11.3%) followed by asthma (5.8%), coronary heart disease (3.6%), and diabetes (3.3%). There are big regional differences. The rate of coronary heart disease in the north east, for example, is more than double that in London.
The figures also show that GPs have made substantial progress in both access and outcome targets. Nearly all practices now offer patients a range of appointment times, and 94% are spending at least 10 minutes with each booked patient. Meanwhile 71% of patients with coronary heart disease who are “available and suitable for treatment” now have a cholesterol concentration below 5 mmol/l, and 90% are receiving aspirin or alternative anticoagulants.
The BMA said that the figures were proof that the investment in general practice was paying off.