May 2005
By Martin Marshall
The most significant quality improvement initiative currently taking place in the UK primary care sector takes the form of a new contract for British general practices.
The contract makes use of financial rewards linked to specific quality indicators and works in the following way;
A practice is awarded points for the level of achievement on each indicator and these points attract payments.
The number of points for each indicator is weighted to reflect the relative importance of that indicator and the amount of effort required to meet it. There are a total of 136 indicators and a maximum of 1050 points that could be gained by the practice. 76 of the indicators, representing 70 percent of the total points available, relate to clinical care for common chronic conditions such as diabetes, heart disease and asthma. 56 indicators, representing 18 percent of the total points relate to organisational issues such as infrastructure, staff management and professional development. 4 indicators relate to patient views of care, assessed using standardised patient experience surveys. The remainder of the points related to so called 'additional services' such as minor surgery, child health and maternity care.
The contract was implemented in April 2004, following a significant vote in favour in a ballot of GPs. The National Primary Care Research and Development Centre is currently evaluating its impact, looking not only at the performance of practices in the areas attracting incentives, but also more widely at non-incentivised medical conditions and at issues such as coordination and continuity which may be damaged by a technically focused improvement initiative.
Early results suggest that practices have done very well in achieving a high level of points and thereby increasing their practice income by about 20%, though we do not yet have any empirical evidence of the wider impact of such a heavily performance managed approach to quality improvement.
Future reports will keep you updated about the progress of this ambitious and controversial approach to quality improvement.
