title: Workload and reward in the Quality and Outcomes Framework of the 2004 general practice contract.
abstract: BACKGROUND
  The Quality and Outcomes Framework (QOF) of the 2004 UK General Medical Services (GMS) contract links up to 20% of practice income to performance measured against 146 quality indicators.
  
  
  OBJECTIVE
  To examine the distribution of workload and payment in the clinical domains of the QOF, and to compare payment based on true prevalence to the implemented system applying an adjusted prevalence factor. We aimed also to assess the performance of the implemented payment system against its three stated objectives: to reduce variation in payment compared to a system based on true prevalence, to fairly link reward to workload, and finally, to help tackle health inequalities.
  
  
  METHODS
  Retrospective analysis of publicly available QOF data.
  
  
  METHODS
  Nine hundred and three GMS general practices in Scotland.
  
  
  METHODS
  Comparison of payment under the implemented Adjusted Disease Prevalence Factor, and under an alternative True Disease Prevalence Factor.
  
  
  RESULTS
  Variation in total clinical QOF payment per 1000 patients registered is significantly reduced compared to a payment system based on true prevalence. Payment is poorly related to workload in terms of the number of patients on the disease register, with up to 44 fold variation in payment per patient on the disease register for practices delivering the same quality of care. Practices serving deprived populations are systematically penalized under the implemented payment system, compared to one based on true prevalence.
  
  
  CONCLUSIONS
  The implemented adjustment for prevalence succeeds in its aim of reducing variation in practice income, but at the cost of making the relationship between workload and reward highly inequitable and perpetuating the inverse care law.
authors.affiliation: Tayside Centre for General Practice, University of Dundee. b.guthrie@chs.dundee.ac.uk
authors.forename: Bruce
authors.initials: B
authors.lastname: Guthrie
authors.forename: Gary
authors.initials: G
authors.lastname: McLean
authors.forename: Matt
authors.initials: M
authors.lastname: Sutton
mesh_terms: D005194:Family Practice / Q000191:economics* / Q000592:standards; D017048:Health Care Costs; D006801:Humans; D011787:Quality of Health Care / Q000191:economics* / Q000592:standards; D012189:Retrospective Studies; D012201:Reward; D012606:Scotland; D012959:Socioeconomic Factors; D016526:Workload / Q000191:economics*