GPs playing it straight
August 2006Research from the National Primary Care Research and Development Centre (NPCRDC) on the first year of the new GP contract suggests that few GPs are ‘cooking the books’ to increase their income. The new contract committed an extra £1.8 billion funding over three years for a new pay-for-performance scheme.
The NPCRDC was central to the creation of the Quality and Outcomes Framework, the first of its kind in the world. It can increase GPs’ gross income by up to 25% to fund new practice staff and facilities, based on GPs’ performance against a number of indicators on how well they are treating patients.
Exception reporting
However, GPs can exclude patients from this measurement process if a patient has a terminal illness, refuses a treatment or can’t tolerate a drug – an option called exception reporting. It had been suspected that GPs could be excluding patients for whom they have simply missed targets to bump up their score and attract more funding, a practice known as ‘gaming’.Low rates
But the NPCRDC’s evidence, published in the prestigious New England Journal of Medicine, suggests low rates of exception reporting, and that large-scale ‘gaming’ has so far been rare. Dr Tim Doran and his team found exception-reporting rates averaged just 6%, and that practices in low-income areas were no more likely to exclude patients in this way than those with more affluent populations.Careful monitoring
A small minority of practices (1.1%) however excluded more than 15% of their patients, and the team has therefore recommended careful monitoring to prevent abuse of the system. Its implementation is being watched closely by many other countries, and if successful could revolutionise primary care across the world.The University of Manchester is not responsible for the content of external internet sites.
