Author's response

Sally Hull

doi:10.3399/bjgp11X561357

It is reassuring to have evidence that readers of the BJGP assess the robustness of statements in the leader articles by reviewing the quoted papers. Improving precision of the evidence cited can only be for the good.

Treasure takes exception to the quality of evidence quoted in support of my comments about the effectiveness of the Quality and Outcomes Framework (QOF) in improving standards and contributing to a reduction in health inequalities.1 In particular to the three articles I quoted after the statement ‘research has illustrated that practices in deprived localities improved performance to the level of their peers in the least deprived areas over a period of only 3 years’.

The article quoted by Campbell and others2 describes the positive changes in quality of care associated with the introduction of the QOF in targeted conditions. In the discussion they quote ‘an unanticipated benefit of the scheme has been a reduction in sociodemographic inequalities in health care’ citing other work by the same group of researchers.3 I agree with Treasure that reference to this article would have provided a more direct link to the evidence on the timescale of improvement that he sought.

I make no excuses for quoting the editorial by Asworth4 as illustration of this point. The piece provides an excellent narrative summary of the QOF story, quoting the evidence again for ‘the convergence between achievement in prosperous and deprived communities’ and also discussing the improvements in performance for small practices.5

The final paper in question is an interesting attempt to link high cardiovascular QOF scores to improved cardiovascular disease (CVD) outcomes (admissions and mortality). The cross-sectional study shows a stronger association in more deprived areas suggesting that improving the quality of primary care through the QOF pay-for-performance scheme reduces the inequalities in CVD outcomes.6

There is now a large body of evidence supporting the view that QOF has both improved performance in the targeted clinical domains, and that performance in deprived localities has improved disproportionately. Both these factors will contribute to a reduction in health inequalities.

REFERENCES

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1. Hull S
(2010) Health inequalities affect the health of all. Br J Gen Pract 60(581):877–878.
OpenUrl FREE Full Text
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1. Campbell SM,
2. Reeves D,
3. Kontopantelis E,
4. et al.
(2009) Effects of pay for performance on the quality of primary care in England. N Engl J Med 361(4):368–378.
OpenUrl CrossRef PubMed
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1. Doran T,
2. Fullwood C,
3. Kontopantelin E,
4. Reeves D
(2008) Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework. Lancet 372(9640):728–736.
OpenUrl CrossRef PubMed
↵
1. Ashworth M,
2. Krodowicz M
(2010) Quality and outcomes framework: time to take stock. Br J Gen Pract 60(578):637–638.
OpenUrl FREE Full Text
↵
1. Doran T,
2. Campbell S,
3. Fullwood C,
4. et al.
(2010) Performance of small practices under the UK's Quality and Outcomes Framework. Br J Gen Pract 60(578):643–648.
OpenUrl
↵
1. Kiran T,
2. Hutchings A,
3. Dhalla IA,
4. et al.
(2010) The association between quality of primary care, deprivation and cardiovascular outcomes: a cross-sectional study using data from the UK Quality and Outcomes Framework. J Epidemiol Community Health 64(10):927–934.
OpenUrl Abstract/FREE Full Text