Impact of Quality and Outcomes Framework on health inequalities: Summary of full report

When it came to power in 1997 the Labour government committed to reducing health inequalities, and made extra funding available to those primary care trusts (PCTs) in areas of the country with the worst health and deprivation indicators (Spearhead areas).

The General Medical Services contract introduced a pay-for-performance scheme known as the Quality and Outcomes Framework (QOF). Although QOF was not developed explicitly to address public health issues or reduce health inequalities, there has always been interest in whether it could contribute to improvement.

The National Institute for Health Research Service Delivery and Organisation programme commissioned The King's Fund, together with the London School of Hygiene & Tropical Medicine, to explore the impact of the QOF on public health and health inequalities. Our research aimed to examine whether the GMS contract and, in particular, the QOF was contributing to improvements in public health and reductions in health inequalities; the focus was on health inequalities as determined by income deprivation.

The researchers on the QOF used routine data to assess the extent to which QOF encouraged activities that contributed to improvements in the health of the population. They also conducted interviews with staff from PCTs and practices to understand how they had responded to QOF and what impact they felt it had had on their ability to improve health and reduce inequalities.

Impact of Quality and Outcomes Framework on Health Inequalities summarises the findings of that research, specifically on:

• incentives for prevention and public health activities
• differences in performance by deprivation
• impact on population health
• practice characteristics
• exception reporting (allowing certain patients to be excluded from the performance figures)
• case finding (actively seeking to identify new people at risk).

The paper draws out the implications of those findings for future development of QOF and other pay-for performance schemes and concludes that general practice should be supported in its responsibility for improving public health and reducing inequalities.

• The full report of this research is available on the SDO website
• Anna Dixon discusses the main findings of this report