They should be simplified and based more on disease treatment and prevention and less on risk factor measurement, experts advise in this week's BMJ.
General practice in the United Kingdom has the largest healthcare pay for performance programme in the world – the quality and outcomes framework (QOF). Practices earn points for the services they provide and these points attract financial resources into the practice.
Professor Bruce Guthrie and colleagues discuss the effectiveness of the system in relation to the management of cardiovascular disease and show how practices can earn many points and extra payments without necessarily reducing its risk.
For example, a practice could receive nine points (each worth about £125) for generating a list of patients with high blood pressure. An extra 30 points would be earned if 90% or more of such patients have a record of risk factors (blood pressure and smoking history) in their notes, and 56 more points would be earned if 70% or more of such patients have a record of blood pressure lowered to below specific target values.
Overall, 15% of payments, worth an estimated £200m across the approximate 11,000 general practices in the UK, arise from measuring cardiovascular risk factors (such as blood pressure and cholesterol) and recording whether they are below specified values.
They reason that it's time to incorporate treatment information into quality indicators, since it is the treatment of risk factors that reduces risk, not their measurement.