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Identifying poorly performing general practices in England: a longitudinal study using data from the quality and

Mark Ashworth¹, Peter Schofield, Paul Seed

¹Department of Primary Care & Public Health Sciences, King's College London, London, UK. markashworth@nhs.net

Journal of Health Services Research & Policy

|December 28, 2010

Summary

A small number of UK general practices consistently underperform on Quality and Outcome (QOF) indicators. Poor performance is linked to single-handed, small, and elderly GP staffing, particularly in deprived areas.

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Area of Science:

General Practice
Healthcare Quality
Health Services Research

Background:

The Quality and Outcome Framework (QOF) incentivizes high-quality care in England's NHS.
Understanding characteristics of consistently underperforming practices is crucial for targeted improvement.

Purpose of the Study:

To identify the characteristics of general practices with persistently poor Quality and Outcome (QOF) performance in England.
To analyze factors associated with sustained low performance over a four-year period.

Main Methods:

A retrospective, four-year longitudinal study (2005-2008) analyzed data from over 8000 general practices in England.
Data included QOF performance scores, social deprivation, ethnicity, and practice characteristics.

Main Results:

A cohort of 212 practices (2.7%) remained in the lowest decile of QOF scores for four years.
Poorly performing practices were more likely to be single-handed, non-training, located in deprived areas, and staffed by older, male GPs with small patient lists.
Lower reported prevalence of chronic diseases was noted in these practices.

Conclusions:

A small minority of general practices demonstrate persistent underperformance in QOF indicators.
Key predictors of sustained poor performance include single-handed or small practice size and older GP age.