Reading Mangin and Toop's1 editorial one would get the impression that the QOF only means doom and gloom. No positive effect is mentioned and the ‘unwanted influence of the state’ seems near. They suggest a professional education system with the aim to improve the quality of care.
This seems a very one-sided view. Is everything regarding QOF so bad? Reading June's BJGP provides a more balanced impression. At least two articles provide a positive effect of QOF: Steel et al,2 show the substantial quality improvement for incentivised conditions. Tahrani et al,3 saw significant improvement in diabetes quality indicators recording. Obviously these studies have their limitations, yet at the very least these effects should not go unmentioned.
However, Mangin and Toop1 do not seem to look at these studies. Nor do they offer suggestions about how QOF could be improved, for example by more input from the Royal College of General Practitioners' (RCGP) regarding the evidence base of the indicators and which conditions should be covered. Instead, Mangin and Toop advocate an alternative: a professional education system, which uses evidence and feedback, guidance, and options for GPs and patients to interpret themselves. This sounds like an appealing option yet what wil their system bring? Grol provides a good overview regarding which interventions lead to improved medical care.4 This research indicates that a focus on education alone is seldom effective and, as such, Mangin and Toop's suggestion may not deliver. Combined and multi-faceted interventions are recommended and a combination of QOF with an educational system would have more chance of success. For example, one could add a system like Quality Team Development which would help to grasp the intangible aspects of care.5
Abandoning QOF completely, however, and going back to just education systems does not seem the way forward.
- © British Journal of General Practice, 2007.