Do quality improvements in primary care reduce secondary care costs?
Primary research into the impact of the Quality and Outcomes Framework on hospital costs and mortality, carried out by Professor Peter C. Smith, Imperial College London and a team from University of York.
As the NHS faces up to the economic crisis, it is important to understand how the service is currently using resources and where costs can be reduced by doing things differently.
The Health Foundation is therefore funding a programme of research into value for money in the NHS, including analysis of a newly available large data set for hospital care in England and the ability to link this to patient level data by GP practice.
This report
This report considers the Quality and Outcomes Framework (QOF) from the perspective of attempting to answer two crucial questions:
- Does improved performance in the clinical domain of the QOF lead to reduced hospital costs?
- Does improved performance in the clinical domain of the QOF lead to a reduction in mortality?
The research makes an important contribution to a number of topical policy initiatives, including the merits of prevention and early intervention and shifting care from secondary settings to primary care.
As we introduce new models of commissioning, such new evidence can help to guide more effective commissioning processes.
Key findings
Our research:
- shows an association between GPs achieving the QOF indicators and a reduction in hospital costs and lives saved, particularly for stroke care
- finds that a single point increase in the QOF stroke score, across England, could lead to 2,385 fewer deaths in a year
- estimates that improvements in primary care for stroke may have reduced secondary costs by £165 million over a four-year period from 2004 to 2008, measured by a 10 per cent increase in the mean practice QOF stroke score
- finds that attainment of higher QOF scores in one clinical area could reduce hospital costs in other clinical areas.
Who should read this report?
This report provides a useful analysis for policy-makers, commissioners and health economists of the association between achievement of QOF indicators and some measurable reductions in costs for hospital care.
The association of QOF with material but limited gains needs to feed into new models for commissioning and consideration of revisions to QOF and the design of other incentive schemes to promote effective care.
