title: Identifying poorly performing general practices in England: a longitudinal study using data from the quality and outcomes framework.
abstract: OBJECTIVE
  to determine the characteristics of general practices which perform poorly in terms of Quality and Outcome (QOF) performance indicators in England's NHS.
  
  
  METHODS
  retrospective, four year longitudinal study, 2005 to 2008. Data were obtained from 8515 practices (99% of practices in England) in year 1, 8264 (98%) in year 2, 8192 (98%) in year 3 and 8256 (99%) in year 4.
  
  
  METHODS
  QOF performance scores; social deprivation (IMD-2007) and ethnicity from the 2001 national census; general practice characteristics.
  
  
  RESULTS
  we identified a cohort of 212 (2.7%) practices which remained in the lowest decile for total QOF scores in the four years following the introduction of the QOF. A total of 705,386 patients were registered at these practices in year 4. These practices were more likely to be singlehanded (odds ratio [OR], 13.8), non-training practices (OR, 3.9) and located in deprived areas (OR, 2.6; most vs least deprived quintiles). General practitioners (GPs) in these practices were more often aged ≥ 65 years or more (OR, 7.3; mean GP age ≥ 65 years vs <45 years), male (OR 2.0), UK qualified (OR 2.0) with small list sizes (OR 3.2; list size <1000 vs 1500-2000 patients). We identified individual QOF indicators which were poorly achieved. The reported prevalence of most chronic diseases was lower in the poorly performing cohort.
  
  
  CONCLUSIONS
  a small minority of practices have remained poor performers in terms of measurable performance indicators over a four-year period. The strongest predictors of poor QOF performance were singlehanded and small practices, and practices staffed by elderly GPs.
authors.affiliation: Department of Primary Care & Public Health Sciences, King's College London, London, UK. markashworth@nhs.net
authors.forename: Mark
authors.initials: M
authors.lastname: Ashworth
authors.forename: Peter
authors.initials: P
authors.lastname: Schofield
authors.forename: Paul
authors.initials: P
authors.lastname: Seed
authors.forename: Stevo
authors.initials: S
authors.lastname: Durbaba
authors.forename: Maria
authors.initials: M
authors.lastname: Kordowicz
authors.forename: Roger
authors.initials: R
authors.lastname: Jones
mesh_terms: D000368:Aged; D002983:Clinical Competence; D004739:England; D058006:General Practice / Q000458:organization & administration / Q000592:standards*; D058005:General Practitioners / Q000592:standards; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013222:State Medicine