PubMed · 15668672
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J Craig Busey. 2005. Reviewing your contract: a basic primer.. https://doi.org/10.1016/j.jada.2004.12.026
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BACKGROUND: The provision of coronary heart disease (CHD) health care has been shown to be inequitous, with those most in need having the least access to high-quality care. The new UK general practitioner (GP) Quality and Outcomes Framework (QOF) contract offers substantial financial rewards to general practices that combine maximal CHD case finding with high-quality CHD care. OBJECTIVE: To examine whether GP practice-level CHD prevalence and the measures of quality of care derived from the new QOF data are associated with area-level socioeconomic deprivation. METHODS: An ecological study of 38 GP practices contracting with Rotherham Primary Care Trust, United Kingdom, was carried out. We calculated Spearman rank correlation coefficients for practice-level age-sex-standardized QOF CHD prevalence against area deprivation score and for 11 QOF CHD indicator achievements against area deprivation score. RESULTS: Practice-level CHD prevalence showed a positive correlation with deprivation (r=0.64, p<0.001), as did one of the 11 quality-of-care indicators (recording of smoking status, r=0.34, p=0.04). The remaining 10 quality-of-care indicators showed no significant correlation with deprivation. CONCLUSION: Practice-level CHD prevalence is associated with deprivation, but we found no evidence of socioeconomic inequality in CHD care. This finding is in contrast to that from previous studies and the widely reported inverse care law.
Effective commissioning is a key aim of the forthcoming PCT reconfiguration. It is thought that many practices will initially opt out of commissioning. There are fears that the top-down NHS reorganisation will threaten effective commissioning.
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