A new systematic review of the UK Quality and Outcomes Framework (QOF) is published in the Annals of Family Medicine today. The QOF, a controversial program of financial incentives and information technology to promote structured and team-based care, is the most comprehensive national primary care pay-for-performance (P4P) program in the world.
The authors, Steve Gillam (University of Cambridge), Niro Siriwardena (University of Lincoln) and Nick Steel (University of East Anglia) found, despite an annual investment of over a billion pounds per year in incentives, only modest improvements since the QOF was introduced in 2004. The systematic review follows on from a book, co-edited by Steve Gillam and Niro Siriwardena entitled ‘The QOF: transforming general practice’ published in 2010.
The QOF has also contributed to reduced continuity of care and may have detracted from patient-centred care. In view of the findings policy makers should be cautious about implementing similar P4P programs. Systems need to be developed which improve quality while minimizing costs and unintended consequences.
A new study has been published on organisational factors associated with practice success in the annual seasonal influenza vaccination programme in BMJ Open, the new open access journal from the BMJ.
The study entitled ‘Strategies to increase influenza vaccination rates: outcomes of a nationwide cross-sectional survey of UK general practice‘ was led by Dr Laura Dexter, virologist, while based in Sheffield University under Prof Robert Read with collaboration from Niro Siriwardena at the University of Lincoln.
The study was funded by the NIHR Policy Research Programme to determine how to improve flu vaccination rates in at-risk groups in the UK. Flu vaccine uptake is below the national and international target of 75% particularly in the under 65-year-old age group. This study used an online survey to GPs, nurses and practice managers to identify which strategies and procedures reported were associated with higher rates of flu vaccine uptake. The recommendations have been summarised in annual guidance in the seasonal flu plan (Annex B – GP practice checklist p11-12) from the UK Chief Medical Officer, Dame Professor Sally Davies.
The study builds on previous work led by Niro Siriwardena on methods to improve influenza and pneumococcal vaccination rates in primary care and in general practice in Lincolnshire which led to a definitive cluster randomised controlled study of an educational intervention for general practice. The Community and Health Research Group are also working on the role of influenza vaccination in preventing cardiovascular disease. After studies showing a reduction in risk of heart attack linked to influenza vaccination (published in the Canadian Medical Association Journal and Vaccine) the team are now working on a case-control study to investigate potential role for influenza and/or pneumococcal vaccination in prevention against stroke and transient ischaemic attack (IPVASTIA), funded by the NIHR Research for Patient Benefit programme.
The new study in BMJ Open has identified seven key strategies that were significantly associated with the success of practices’ seasonal flu vaccination campaigns which include leadership (a named responsible flu lead), ordering sufficient vaccines, up-to-date registers of patients at risk, starting the programme early, robust call and recall arrangements, offering appointments and opportunistically vaccination, and working with community midwives for vaccination in pregnancy. If widely implemented by general practices, these strategies could improve vaccination rates by 7% to 8%. The learning has been publicised in professional magazines and translated into an online learning module for GPs which is having impact on professional practice.
The Resources for Effective Sleep Treatment (REST) project, led by Prof Niro Siriwardena, was featured on “Tonight” the flagship ITV1 documentary programme, the highest rating current affairs series on UK television for the past decade. In the programme “Waking up to Insomnia” screened on 17 November at 7:30pm, Geraint Vincent revealed some results of the Great British Sleep Survey and found out from sufferers how it affected their lives. The programme discussed the problems of insomnia, why sleeping tablets were not a good solution and why Cognitive Behavioural Therapy for insomnia (CBTi) although effective is not widely available in the NHS. The REST project funded by the Health Foundation aimed to improve primary care for insomnia by developing primary care friendly sleep assessment and CBTi. A follow-on translational project, Improving Primary Care Resources for Effective Sleep Treatment (IPCREST) funded by East Midlands Health Innovation and Educational Cluster aims to spread the learning through seminars, workshops and an e-learning programme for healthcare practitioners. Further information is available on the University website and at the REST website. Niro is presenting on “How to provide better care for insomnia: Resources for effective sleep treatment in the general practice consultation” at the Sleep and Mental Health conference at the Royal Society of Medicine on 23 November 2011.
A book edited by Dr Stephen Gillam (University of Cambridge) and Prof Niroshan Siriwardena (University of Lincoln) and published by Radcliffe Publishing Ltd entitled “The Quality and Outcomes Framework: QOF – transforming general practice” was highly commended at the BMA Medical Book Awards 2011. Steve Gillam and Niro Siriwardena were present at the awards ceremony in BMA House in London.
Highly commended in this year's BMA Medical Book Awards 2011
Contributors to the book include the architects of the QOF, developers, researchers, practitioners and commentators. Work is currently proceeding on a systematic review of research into the QOF involving the Universities of Cambridge, Lincoln and East Anglia.
At a well-attended seminar on 30th March, academics from Universities of Ghent and Antwerp in Belgium presented at University of Lincoln.
Sibyl Anthierens (medical sociologist working at the University of Antwerp) presented on “Benzodiazepines: sleeping through the problem”. This included works on the perceptions of general practitioners, patients and nurses on initiating (or avoiding) benzodiazepines in primary care.
This was followed by Thoen Anke (general practitioner) speaking about e-learning, specifically an interactive e-module including several tools and interventions useful within a benzodiazepine-consultation to support GPs.
Prof Thierry Christiaens (general practitioner, clinical pharmacologist and professor of general practice) then described an experimental real-life training programme set up with a simulation patient to look at the effect of possible interventions/tools within a benzodiazepine consultation.
Finally, Hanne Creupelandt (clinical psychologist) spoke about interactive meetings taking place with GPs in local quality groups discussing the non- pharmacological approach of insomnia, anxiety, stress and benzodiazepine withdrawal.
Good working links have been formed with our European colleagues in Belgium particularly in the area of insomnia and benzodiazepines and we plan to build on this with future work.