GP incentive increases death risk for patients, study suggests

According to a Lancet study, the ‘pay for performance’ system in practice at some practices has worsened patient care and increased the death risks for some conditions.

The scheme was introduced in 2004 and saw average earnings for GPs rise by around 25 per cent to over £100,000 per year. The pay was linked to a number of targets ranging from taking a patient’s blood pressure to prescribing them statins.

The international study compared the UK with 26 other countries but found no statistically significant decline in mortality rates in conditions such as heart disease and diabetes, which the programme was initially predicted to produce. The study identified that the death rates among the group of patients with conditions which were not covered, such as pneumonia, osteoarthritis and hip fractures, actually increased when compared with underlying trends.

The study examined data over seven years and was conducted by the University of York, the University of Manchester and the University of Michigan. Commenting on the findings, a number of patients group have said the payments were ‘morally and ethically wrong’ and left many patients neglected.

Under the system around 25 per cent of a GP’s income is dictated by achievement of targets which are linked to common conditions such as hear disease, stroke, diabetes and hear failure. However, there are no bonuses linked to the prevention of other serious issues such as hip fractures and cancer.

The authors of the study concluded: “Our results show that introduction of the Qualities and Outcomes Framework (QOF) in the UK was not significantly associated with changes in population mortality for disease areas that were targeted by the programme. We recorded that the QOF was also not significantly associated with changes in mortality for disease areas that were not targeted by the programme.”

Katherine Murphy, chief executive of the Patients Association, said: “GPs need to focus on all their patients and not just those patients where they can measure or record data and get paid for it.

"Giving doctors bribes to focus on a specific condition is morally wrong and ethically wrong. GPs must focus on patient care and outcomes - their priorities should not be compromised by financial incentives.”

A Department of Health Spokesperson commented: "We recognise GPs are under a lot of pressure and have already revised the QOF to remove 10 minute minimum slots for booked appointments, as well as reducing unnecessary paperwork for GPs so that they can spend more time with patients.

"NHS England has agreed to undertake a review of QOF in the coming year, to see how we can best manage the system for the future."