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

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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

Table 2

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

	QOF points (%)

QOF domain	Least deprived quintile	Most deprived quintile	Difference 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)

Table 3

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

QOF indicator	Least deprived quintile, %	Most deprived quintile, %	Difference, % (95% CI)
Medicines 7: identify and follow up SMI patients who do not attend their injectable neuroleptic appointment	78.5	58.0	20.5 (17.5 to 23.6)

Information 7: surgery open ≥45 hours/week	90.3	74.1	16.2 (13.8 to 18.6)

Education 7: practice has conducted ≥12 significant event audits in last 3 years	93.2	80.7	12.5 (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 enacted	95.2	87.6	7.6 (5.8 to 9.4)

Records 18: case notes have clinical summary in ≥80%	80.6	73.1	7.6 (4.7 to 10.4)

Records 15: case notes have clinical summary in ≥60%	92.0	85.6	6.4 (4.3 to 8.5)

Child health surveillance 1: practice offers child health surveillance checks	98.0	92.0	5.9 (4.6 to 7.3)

Education 8: practice nurses have personal learning plan	96.1	90.2	5.9 (4.3 to 7.5)

Education 2: practice has conducted ≥6 significant event audits in last 3 years	97.4	91.9	5.5 (4.1 to 6.9)

Education 3: all practice nurses have annual appraisal	96.7	91.5	5.2 (3.7 to 6.7)

Medicines 9: medication review in last 15 months for all patients on repeat medication	95.4	90.4	5.1 (3.4 to 6.7)

PCT = primary care trust. QOF = Quality and Outcomes Framework. SMI = severe mental illness.

Table 4

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

QOF indicator	Least deprived quintile, %	Most deprived quintile, %	Difference, % (95% CI)
Epilepsy 4: seizure free for ≥12 months	77.3	65.1	12.2 (11.1 to 13.3)

Mental health 5: on lithium and serum level in therapeutic range	90.1	78.0	12.0 (10.3 to 13.8)

Mental health 3: on lithium and serum level checked	94.0	84.4	9.6 (7.9 to 11.2)

Mental health 4: on lithium and creatinine level and thyroid function checked	94.3	85.4	8.9 (7.3 to 10.5)

CHD 2: % new angina diagnosis confirmed by exercise test	92.7	85.2	7.5 (6.3 to 8.8)

LVD 2: % left ventricular disease patients with diagnosis confirmed by ECHO test	92.9	85.6	7.3 (5.7 to 8.9)

COPD 2: % new cases with diagnosis confirmed by spirometry	91.3	84.5	6.8 (5.6 to 8.0)

COPD 6: FEV1.0 in all patients diagnosed with COPD	86.7	80.7	6.0 (4.8 to 7.1)

Stroke 2: % new cases referred for confirmation of diagnosis by CT/MRI scan	88.4	82.5	5.9 (4.1 to 7.0)

COPD 3: % all cases who have had spirometry testing	92.2	86.6	5.6 (4.6 to 6.6)

Cervical screening 1: % women aged 25–65 years who have had a smear in the last 5 years	85.0	79.5	5.5 (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.

Table 5

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

	Difference between quintiles, %

QOF indicator	All practices	Group practices	Training practices
Medicines 7: identify and follow up SMI patients who do not attend their injectable neuroleptic appointment	20.5	16.8	11.9

Information 7: surgery open ≥45 hours/week	16.2	11.0	9.2

Education 7: practice has conducted ≥12 significant event audits in last 3 years	12.5	9.4	4.2

Epilepsy 4: seizure free for ≥12 months	12.2	11.5	10.2

Mental health 5: on lithium and serum level in therapeutic range	12.0	7.4	3.3