title: Nurse staffing and quality of care in UK general practice: cross-sectional study using routinely collected data.
abstract: BACKGROUND
  In many UK general practices, nurses have been used to deliver results against the indicators of the Quality and Outcomes Framework (QOF), a 'pay for performance' scheme.
  
  
  OBJECTIVE
  To determine the association between the level of nurse staffing in general practice and the quality of clinical care as measured by the QOF.
  
  
  METHODS
  Cross-sectional analysis of routine data.
  
  
  METHODS
  English general practice in 2005/2006.
  
  
  METHODS
  QOF data from 7456 general practices were linked with a database of practice characteristics, nurse staffing data, and census-derived data on population characteristics and measures of population density. Multi-level modelling explored the relationship between QOF performance and the number of patients per full-time equivalent nurse. The outcome measures were achievement of quality of care for eight clinical domains as rated by the QOF, and reported achievement of 10 clinical outcome indicators derived from it.
  
  
  RESULTS
  A high level of nurse staffing (fewer patients per full-time equivalent practice-employed nurse) was significantly associated with better performance in 4/8 clinical domains of the QOF (chronic obstructive pulmonary disease, coronary heart disease, diabetes, and hypertension, P = 0.004 to P<0.001) and in 4/10 clinical outcome indicators (diabetes: glycosylated haemoglobin [HbA(1C)] < or =7.4%, HbA(1C) < or =10% and total cholesterol < or =193 mg/dl; and stroke: total cholesterol < or =5 mmol/L, P = 0.0057 to P<0.001).
  
  
  CONCLUSIONS
  Practices that employ more nurses perform better in a number of clinical domains measured by the QOF. This improved performance includes better intermediate clinical outcomes, suggesting real patient benefit may be associated with using nurses to deliver care to meet QOF targets.
authors.affiliation: National Nursing Research Unit, King's College, 57 Waterloo Road, London, UK. peter.griffiths@kcl.ac.uk
authors.forename: Peter
authors.initials: P
authors.lastname: Griffiths
authors.forename: Trevor
authors.initials: T
authors.lastname: Murrells
authors.forename: Jill
authors.initials: J
authors.lastname: Maben
authors.forename: Simon
authors.initials: S
authors.lastname: Jones
authors.forename: Mark
authors.initials: M
authors.lastname: Ashworth
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004739:England; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009740:Nursing Staff / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive; D000078329:Workforce