Performance of small general practices under the UK's Quality and Outcomes Framework

Area of Science:

• General Practice
• Healthcare Quality
• Health Services Research

Background:

• Small general practices are often perceived to offer lower quality care compared to larger practices.
• This perception warrants investigation into the performance of small practices within national quality frameworks.

Purpose of the Study:

• To evaluate the comparative performance of small general practices within the UK's Quality and Outcomes Framework (QOF).
• To analyze how practice size influences performance on a national pay-for-performance scheme.

Main Methods:

• Longitudinal analysis of quality scores for 48 clinical activities in 7502 English family practices (2004-2007).
• Comparison of practice performance by list size, examining points scored, reported achievement rates, and population achievement rates.

Main Results:

• Smallest practices (<2000 patients) initially had the lowest achievement rates (83.8%).
• All practices improved, but smallest practices showed the fastest improvement, reaching the highest median achievement rates (91.5%) by year 3.
• Small practices exhibited greater performance variation, comprising significant portions of both the highest and lowest achieving practices.

Conclusions:

• Small practices are represented at both extremes of performance in achieving clinical quality targets.
• The Quality and Outcomes Framework (QOF) appears to have reduced performance disparities between small and large general practices.
• The pay-for-performance scheme has narrowed the performance gap, challenging the notion that small practices inherently provide worse care.