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.

World Forum, The Hague, Netherlands

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.

Utrecht, Netherlands

Finally, at the end of my stay I visited Madurodam – where you might just spot the giant ducks – even bigger than trees?!

Giant ducks at Madurodam, The Hague, Netherlands

Between the 6th and 8th July Professor Niro Siriwardena and Fiona Togher attended the 40th annual scientific meeting of the Society for Academic Primary care. Two posters were presented during the poster sessions entitled “Effectiveness of an educational intervention for general practice teams to deliver problem focused therapy for insomnia: pilot cluster randomised trial” and “Effect of a quality improvement programme on leadership, innovation and use of quality improvement methods in general practice”. Both of these posters described and explained the findings of streams of work that had been encompassed within the Resources for Effective Sleep Treatment (REST) project.

Additionally Professor Siriwardena also gave an oral presentation of a study led by Zowie Davy entitled “Quantitative versus Qualitative notions of validity: investigating the validity of PSYCHLOPS as a patient outcome measure in trials of insomnia and sleep problems”. This presentation was very well received by the audience and generated a lot of interesting questions around the topic of outcome measures and validity testing.

The conference programme consisted of several parallel sessions during which presenters talked about the findings of their recently carried out research (at the pre-publication stage) and delegates could select which subjects they would find most interesting and informative to their own future research. The parallel session streams to choose from included; Research Methods, Musculoskeletal, Cardiovascular disease and Diabetes among many others.

Attendance at the conference was thoroughly enjoyable and was also a good opportunity to inform colleagues from other institutions about the Primary Care research that is being undertaken within the University of Lincoln.

SHSC Research Newsletter Summer 2011 (final)

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