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Original Papers

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

Mark Ashworth, Paul Seed, David Armstrong, Stevo Durbaba and Roger Jones
British Journal of General Practice 2007; 57 (539): 441-448.
Mark Ashworth
Department of General Practice & Primary Care, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London
Roles: Honorary Senior Lecturer
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Paul Seed
Department of General Practice & Primary Care, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London
Roles: Medical Statistician
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David Armstrong
Department of General Practice & Primary Care, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London
Roles: Professor of Medicine & Sociology
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Stevo Durbaba
Department of General Practice & Primary Care, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London
Roles: E-Resources Developer
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Roger Jones
Department of General Practice & Primary Care, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London
Roles: Professor of General Practice
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    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

Tables

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    Table 1

    Characteristics of general practices in lowest and highest deprivation quintiles, 2005–2006.

    Least deprived quintileMost deprived quintile
    Number of practices12282373
    Fte GPs46606342
    List size per fte GP20632284
    Single-handed practice13.4%35.1%
    Training practice38.2%19.1%
    • Fte = full-time equivalent.

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    Table 2

    Differences between least and most deprived quintiles in mean QOF scores: clinical and non-clinical domains, 2005–2006.

    QOF points (%)
    QOF domainLeast deprived quintileMost deprived quintileDifference between quintiles
    Total QOF score (maximum = 1050)1026.9 (97.8)996.5 (94.9)30.4 (2.9)
    Total disease domain (maximum = 550)541.1 (98.4)528.7 (96.1)12.4 (2.2)
    Organisation domain (maximum = 184)175.6 (95.5)168.7 (91.7)6.9 (3.8)
    Patient experience domain (maximum = 100)98.2 (98.2)95.2 (95.3)2.9 (2.9)
    Additional services domain (maximum = 36)35.6 (98.9)34.3 (95.4)1.3 (3.6)
    Access bonus (maximum = 50)49.5 (99.0)48.1 (96.2)1.4 (2.9)
    • QOF = Quality and Outcomes Framework.

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    Table 3

    Differences between least and most deprived quintiles: proportion of practices achieving 2005–2006 practice based QOF indicators.

    QOF indicatorLeast deprived quintile, %Most deprived quintile, %Difference, % (95% CI)
    Medicines 7: identify and follow up SMI patients who do not attend their injectable neuroleptic appointment78.558.020.5 (17.5 to 23.6)
    Information 7: surgery open ≥45 hours/week90.374.116.2 (13.8 to 18.6)
    Education 7: practice has conducted ≥12 significant event audits in last 3 years93.280.712.5 (10.3 to 14.6)
    Patient experience 4: practice has discussed patient survey with patient group or non-executive director of PCT; changes proposed and some evidence that changes enacted95.287.67.6 (5.8 to 9.4)
    Records 18: case notes have clinical summary in ≥80%80.673.17.6 (4.7 to 10.4)
    Records 15: case notes have clinical summary in ≥60%92.085.66.4 (4.3 to 8.5)
    Child health surveillance 1: practice offers child health surveillance checks98.092.05.9 (4.6 to 7.3)
    Education 8: practice nurses have personal learning plan96.190.25.9 (4.3 to 7.5)
    Education 2: practice has conducted ≥6 significant event audits in last 3 years97.491.95.5 (4.1 to 6.9)
    Education 3: all practice nurses have annual appraisal96.791.55.2 (3.7 to 6.7)
    Medicines 9: medication review in last 15 months for all patients on repeat medication95.490.45.1 (3.4 to 6.7)
    • PCT = primary care trust. QOF = Quality and Outcomes Framework. SMI = severe mental illness.

    • View popup
    Table 4

    Differences between least and most deprived quintiles: proportion of patients achieving 2005–2006 clinical QOF indicators.

    QOF indicatorLeast deprived quintile, %Most deprived quintile, %Difference, % (95% CI)
    Epilepsy 4: seizure free for ≥12 months77.365.112.2 (11.1 to 13.3)
    Mental health 5: on lithium and serum level in therapeutic range90.178.012.0 (10.3 to 13.8)
    Mental health 3: on lithium and serum level checked94.084.49.6 (7.9 to 11.2)
    Mental health 4: on lithium and creatinine level and thyroid function checked94.385.48.9 (7.3 to 10.5)
    CHD 2: % new angina diagnosis confirmed by exercise test92.785.27.5 (6.3 to 8.8)
    LVD 2: % left ventricular disease patients with diagnosis confirmed by ECHO test92.985.67.3 (5.7 to 8.9)
    COPD 2: % new cases with diagnosis confirmed by spirometry91.384.56.8 (5.6 to 8.0)
    COPD 6: FEV1.0 in all patients diagnosed with COPD86.780.76.0 (4.8 to 7.1)
    Stroke 2: % new cases referred for confirmation of diagnosis by CT/MRI scan88.482.55.9 (4.1 to 7.0)
    COPD 3: % all cases who have had spirometry testing92.286.65.6 (4.6 to 6.6)
    Cervical screening 1: % women aged 25–65 years who have had a smear in the last 5 years85.079.55.5 (4.5 to 7.3)
    • CHD = coronary heart disease. COPD = chronic obstructive pulmonary disease. CT/MRI = computerised axial/tomography/magnetic resonance imaging. ECHO = echocardiogram. FEV1 = forced expiratory volume in 1 second. LVD = left ventricular disease. QOF = Quality and Outcomes Framework.

    • View popup
    Table 5

    Differences between least and most deprived quintiles: performance of training and group practices, selected QOF indicators, 2005–2006.

    Difference between quintiles, %
    QOF indicatorAll practicesGroup practicesTraining practices
    Medicines 7: identify and follow up SMI patients who do not attend their injectable neuroleptic appointment20.516.811.9
    Information 7: surgery open ≥45 hours/week16.211.09.2
    Education 7: practice has conducted ≥12 significant event audits in last 3 years12.59.44.2
    Epilepsy 4: seizure free for ≥12 months12.211.510.2
    Mental health 5: on lithium and serum level in therapeutic range12.07.43.3
    • QOF = Quality and Outcomes Framework. SMI = severe mental illness.

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British Journal of General Practice: 57 (539)
British Journal of General Practice
Vol. 57, Issue 539
June 2007
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The relationship between social deprivation and the quality of primary care: a national survey using indicators from the UK Quality and Outcomes Framework
Mark Ashworth, Paul Seed, David Armstrong, Stevo Durbaba, Roger Jones
British Journal of General Practice 2007; 57 (539): 441-448.

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The relationship between social deprivation and the quality of primary care: a national survey using indicators from the UK Quality and Outcomes Framework
Mark Ashworth, Paul Seed, David Armstrong, Stevo Durbaba, Roger Jones
British Journal of General Practice 2007; 57 (539): 441-448.
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Keywords

  • primary care
  • quality indicators
  • social deprivation

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Print ISSN: 0960-1643
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