The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004-5.
BACKGROUND
The descriptive information now available for primary care in the UK is unique in international terms. Under the 'Quality and Outcomes Framework' (QOF), data for 147 performance indicators are available for each general practice. We aimed to determine the relationship between the quality of primary care, as judged by the total QOF score, social deprivation and practice characteristics.


METHODS
We obtained QOF data for each practice in England and linked these with census derived data (deprivation indices and proportion of patients born in a developing country). Characteristics of practices were also obtained. QOF and census data were available for 8480 practices.


RESULTS
The median QOF score was 999.7 out of a possible maximum of 1050 points. Three characteristics were independently associated with higher QOF scores: training practices, group practices and practices in less socially deprived areas. In a regression model, these three factors explained 14.6% of the variation in QOF score. Higher list sizes per GP, turnover of registered patients, chronic disease prevalence, proportions of elderly patients or patients born in a developing country did not contribute to lower QOF scores in the final model.


CONCLUSIONS
Socially deprived areas experience a lower quality of primary care, as judged by QOF scores. Social deprivation itself is an independent predictor of lower quality. Training and group practices are independent predictors of higher quality but these types of practices are less well represented in socially deprived areas.
Ashworth
Mark
M
Department of General Practice & Primary Care, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London, UK. mark.ashworth@gp-G85053.nhs.uk
Armstrong
David
D
D000368:Aged; D019352:Censuses; D003906:Developing Countries; D004739:England; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D017063:Outcome Assessment, Health Care; D011204:Poverty Areas; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D012923:Social Class; D012959:Socioeconomic Factors; D035862:Vulnerable Populations / Q000208:ethnology / Q000706:statistics & numerical data*