Document Detail


Practice size and quality attainment under the new GMS contract: a cross-sectional analysis.
MedLine Citation:
PMID:  17132349     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The Quality and Outcomes Framework (QOF) of the new General Medical Services contract, for the first time, incentivises certain areas of general practice workload over others. The ability of practices to deliver high quality care may be related to the size of the practice itself. AIM: To explore the relationship between practice size and points attained in the QOF. DESIGN OF STUDY: Cross-sectional analyses of routinely available data. SETTING: Urban general practice in mainland Scotland. METHOD: QOF points and disease prevalence were obtained for all urban general practices in Scotland (n = 638) and linked to data on the practice, GP and patient population. The relationship between QOF point attainment, disease prevalence and practice size was examined using univariate statistical analyses. RESULTS: Smaller practices were more likely to be located in areas of socioeconomic deprivation; had patients with poorer health; and were less likely to participate in voluntary practice-based quality schemes. Overall, smaller practices received fewer QOF points compared to larger practices (P = 0.003), due to lower point attainment in the organisational domain (P = 0.002). There were no differences across practice size in the other domains of the QOF, including clinical care. Smaller practices reported higher levels of chronic obstructive pulmonary disease (COPD) and mental health conditions and lower levels of asthma, epilepsy and hypothyroidism. There was no difference in the reported prevalence of hypertension or coronary heart disease (CHD) across practices, in contrast to CHD mortality for patients aged under 70 years, where the mortality rate was 40% greater for single-handed practices compared with large practices. CONCLUSIONS: Although smaller practices obtained fewer points than larger practices under the QOF, this was due to lower scores in the organisational domain of the contract rather than to lower scores for clinical care. Single-handed practices, in common with larger practices serving more deprived populations, reported lower than expected CHD prevalence in their practice populations. Our results suggest that smaller practices continue to provide clinical care of comparable quality to larger practices but that they may need increased resources or support, particularly in the organisational domain, to address unmet need or more demanding QOF criteria.
Authors:
Yingying Wang; Catherine A O'Donnell; Daniel F Mackay; Graham Cm Watt
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The British journal of general practice : the journal of the Royal College of General Practitioners     Volume:  56     ISSN:  0960-1643     ISO Abbreviation:  Br J Gen Pract     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-11-29     Completed Date:  2007-04-06     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9005323     Medline TA:  Br J Gen Pract     Country:  England    
Other Details:
Languages:  eng     Pagination:  830-5     Citation Subset:  IM    
Affiliation:
Division of Community Based Sciences, University of Glasgow.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cross-Sectional Studies
Family Practice / organization & administration,  standards*
Female
Health Facility Size
Humans
Male
Middle Aged
Practice Management, Medical / organization & administration,  standards*
Quality Indicators, Health Care*
Scotland
Socioeconomic Factors
Urban Health Services / organization & administration,  standards*
Comments/Corrections

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