Developing performance indicators for primary care: Walsall's experience

There has been increasing interest in the development of performance indicators in primary care, especially since the introduction of the Quality and Outcomes Framework (QOF). Public health and primary care trusts collect a range of data from routine or non-routine sources that may be useful for this purpose.

To assess whether performance against the QOF is a robust measure of practice performance when compared with health-inequality indicators and to contribute to the development of a tool to monitor and improve primary care services.

A retrospective cross-sectional study.

Sixty-three GP practices contracted with Walsall Teaching Primary Care Trust.

Correlation analysis and scatter plots were used to identify possible significant relationships between QOF scores and health-inequality data. The study also utilised confidence limit theory and control chart methodology as tools to identify possible performance outliers.

Little correlation was found between overall QOF score and deprivation score. Uptake of flu immunisation (r2=0.22) and cervical screening (r2=0.11) both showed a slight increase with increased QOF score. Benzodiazepine (r2=0.06) and antibiotic prescribing levels (r2=0.02) decreased slightly with increased QOF scores, although not significantly. An increase in practice-population deprivation score was correlated with a reduction in cervical screening uptake (r2=0.27) and an increase in benzodiazepine prescribing (r2=0.25). Statistically significant relationships were found between the patient: GP ratio and flu immunisation uptake (r2=0.1) and antibiotic prescribing (r2=0.1). The majority of GPs found it acceptable to use performance indicator data as part of their annual appraisal.

QOF and health-inequality data can be used together to measure practice performance and to develop tools to help identify areas for performance development and the sharing of best practice.