I had the great privilege of being invited to the Hague to give a keynote at a national conference on transparency in primary care in my role as an executive board member for the European Forum for Primary Care.
The Netherlands has been fortunate to have one of the best primary care systems in the world. Over the past few years their system, which combines public and insurance based funding, has been reformed to introduce greater marketisation. More recently the organisation of primary care into care groups and the introduction of bundled payments has brought even greater measurement and transparency into the Dutch health system.
The conference was about transparency and how payments could be linked more closely to performance measures and indicators. I was invited to speak about the pay-for-performance system for general practice in the United Kingdom – the Quality and Outcomes Framework (QOF) – having recently edited a book on this subject with my colleague Steve Gillam. This was published in 2010 ‘The Quality and Outcomes Framework: QOF transforming general practice’ and we were fortunate to have so many distinguished and illustrious authors and researchers as contributors, among them sadly the late Barbara Starfield.
I spoke about the QOF, its effects on health processes and outcomes, equity, efficiency and patient experience (click here to see the presentation). In summary the system that has been developed has led to extraordinary advances in the organisation and transparency of primary care in the UK. However, this has been at huge cost (around £1 billion a year) and with relatively small improvements over and above what might have been expected given previous trends. Although the current system does provide the infrastructure for improvement, it is currently designed as a target rather than an improvement mechanism; and although I am not in favour of abolishing it I would advise against other countries adopting our system wholesale – instead they should look at what works in the QOF and try to improve on it.
I had an excellent host in Dr Marc Bruijnzeels, Director of the Jan van Es Instituut. The evening before the conference we travelled to Utrecht to meet with a group of experts, including academics, GPs and insurance organisation representatives, to discuss the same issues more informally over dinner.
Finally, at the end of my stay I visited Madurodam – where you might just spot the giant ducks – even bigger than trees?!