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Showing content from https://pubmed.ncbi.nlm.nih.gov/31337661/ below:

Longitudinal evaluation of a countywide alternative to the Quality and Outcomes Framework in UK General Practice aimed at improving Person Centred Coordinated Care

Multicenter Study

. 2019 Jul 23;9(7):e029721. doi: 10.1136/bmjopen-2019-029721. Longitudinal evaluation of a countywide alternative to the Quality and Outcomes Framework in UK General Practice aimed at improving Person Centred Coordinated Care

Affiliations

¹ Community and Primary Care Research Group, University of Plymouth, Plymouth, UK.
² Sociology, Philosophy and Anthropology Department, University of Exeter, Exeter, UK.
³ Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK.
⁴ NHS Somerset Clinical Commissioning Group, Yeovil, UK.
⁵ South West Academic Health Science Network, Exeter, UK.
⁶ Psychology, University of Plymouth, Plymouth, UK.

PMID: 31337661
PMCID: PMC6661675
DOI: 10.1136/bmjopen-2019-029721

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Multicenter Study

Longitudinal evaluation of a countywide alternative to the Quality and Outcomes Framework in UK General Practice aimed at improving Person Centred Coordinated Care

James Close et al. BMJ Open. 2019.

. 2019 Jul 23;9(7):e029721. doi: 10.1136/bmjopen-2019-029721. Authors James Close¹, Ben Fosh¹, Hannah Wheat², Jane Horrell¹, William Lee¹, Richard Byng³, Michael Bainbridge⁴, Richard Blackwell⁵, Louise Witts⁵, Louise Hall⁵, Helen Lloyd⁶ Affiliations

¹ Community and Primary Care Research Group, University of Plymouth, Plymouth, UK.
² Sociology, Philosophy and Anthropology Department, University of Exeter, Exeter, UK.
³ Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK.
⁴ NHS Somerset Clinical Commissioning Group, Yeovil, UK.
⁵ South West Academic Health Science Network, Exeter, UK.
⁶ Psychology, University of Plymouth, Plymouth, UK.

PMID: 31337661
PMCID: PMC6661675
DOI: 10.1136/bmjopen-2019-029721

Item in Clipboard

Abstract

Objectives: To evaluate a county-wide deincentivisation of the Quality and Outcomes Framework (QOF) payment scheme for UK General Practice (GP).

Setting: In 2014, National Health Service England signalled a move towards devolution of QOF to Clinical Commissioning Groups. Fifty-five GPs in Somerset established the Somerset Practice Quality Scheme (SPQS)-a deincentivisation of QOF-with the goal of redirecting resources towards Person Centred Coordinated Care (P3C), especially for those with long-term conditions (LTCs). We evaluated the impact on processes and outcomes of care from April 2016 to March 2017.

Participants and design: The evaluation used data from 55 SPQS practices and 17 regional control practices for three survey instruments. We collected patient experiences ('P3C-EQ'; 2363 returns from patients with 1+LTC; 36% response rate), staff experiences ('P3C-practitioner'; 127 professionals) and organisational data ('P3C-OCT'; 36 of 55 practices at two time points, 65% response rate; 17 control practices). Hospital Episode Statistics emergency admission data were analysed for 2014-2017 for ambulatory-sensitive conditions across Somerset using interrupted time series.

Results: Patient and practitioner experiences were similar in SPQS versus control practices. However, discretion from QOF incentives resulted in time savings in the majority of practices, and SPQS practice data showed a significant increase in P3C oriented organisational processes, with a moderate effect size (Wilcoxon signed rank test; p=0.01; r=0.42). Analysis of transformation plans and organisational data suggested stronger federation-level agreements and informal networks, increased multidisciplinary working, reallocation of resources for other healthcare professionals and changes to the structure and timings of GP appointments. No disbenefits were detected in admission data.

Conclusion: The SPQS scheme leveraged time savings and reduced administrative burden via discretionary removal of QOF incentives, enabling practices to engage actively in a number of schemes aimed at improving care for people with LTCs. We found no differences in the experiences of patients or healthcare professionals between SPQS and control practices.

Keywords: organisation of health services; organisational development; primary care; quality in health care.

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Conflict of interest statement

Competing interests: None declared.

Figures
Figure 1

Our P3C mixed methods evaluation…

Figure 1

Our P3C mixed methods evaluation framework for SPQS2. LTC, long-term condition; P3C, Person…

Figure 1

Our P3C mixed methods evaluation framework for SPQS2. LTC, long-term condition; P3C, Person Centred Coordinated Care; QOF, Quality and Outcomes Framework; SPQS, Somerset Practice Quality Scheme.

Figure 2

Consultation time savings (top left),…

Figure 2

Consultation time savings (top left), administrative GP time savings (top right) and non-GP…

Figure 2

Consultation time savings (top left), administrative GP time savings (top right) and non-GP administrative time savings (bottom left). Per cent responses for 51 practices enrolled in Somerset Practice Quality Scheme. GP, General Practice; QOF, Quality and Outcomes Framework.

Figure 3

Results of interrupted time-series analysis.…

Figure 3

Results of interrupted time-series analysis. The four graphs show the ITS for the…

Figure 3

Results of interrupted time-series analysis. The four graphs show the ITS for the four ACSCs (from left to right, top to bottom, the graphs are: Acute Myocardial Infarction (AMI), Chronic Obstructive Pulmonary Disease (COPD), Diabetes and Stroke). Data starts at April 2011 and ends at January 2017. The SPQS contract was live from June 2014 (ie, intervention start time, indicated by vertical dashed line). Y-axis gives the number of admissions, normalised as admissions per month per practice. Black circles indicate the average number of emergency admissions in each month for SPQS practices; white circles are average admissions for QOF Somerset practices. The regression lines preintervention and postintervention are shown unbroken (for SPQS) and dashed (for QOF Somerset practices). All changes between preintervention and postintervention between SPQS and QOF practices are non-significant (see online supplementary file 4). ACSCs, ambulatory care sensitive conditions; ITS, interrupted time-series analysis; QOF, Quality and Outcomes Framework; SPQS, Somerset Practice Quality Scheme.