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dc.contributor.authorClose, Jen
dc.contributor.authorFosh, Ben
dc.contributor.authorWheat, Hen
dc.contributor.authorHorrell, Jen
dc.contributor.authorLee, Wen
dc.contributor.authorByng, Ren
dc.contributor.authorBainbridge, Men
dc.contributor.authorBlackwell, Ren
dc.contributor.authorWitts, Len
dc.contributor.authorHall, Len
dc.contributor.authorLloyd, Hen
dc.date.accessioned2019-07-26T10:45:44Z
dc.date.available2019-07-26T10:45:44Z
dc.date.issued2019-07-23en
dc.identifier.issn2044-6055en
dc.identifier.urihttp://hdl.handle.net/10026.1/14700
dc.description.abstract

<jats:sec><jats:title>Objectives</jats:title><jats:p>To evaluate a county-wide deincentivisation of the Quality and Outcomes Framework (QOF) payment scheme for UK General Practice (GP).</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>In 2014, National Health Service England signalled a move towards devolution of QOF to Clinical Commissioning Groups. Fifty-five GPs in Somerset established the Somerset Practice Quality Scheme (SPQS)—a deincentivisation of QOF—with the goal of redirecting resources towards Person Centred Coordinated Care (P3C), especially for those with long-term conditions (LTCs). We evaluated the impact on processes and outcomes of care from April 2016 to March 2017.</jats:p></jats:sec><jats:sec><jats:title>Participants and design</jats:title><jats:p>The evaluation used data from 55 SPQS practices and 17 regional control practices for three survey instruments. We collected patient experiences (‘P3C-EQ’; 2363 returns from patients with 1+LTC; 36% response rate), staff experiences (‘P3C-practitioner’; 127 professionals) and organisational data (‘P3C-OCT’; 36 of 55 practices at two time points, 65% response rate; 17 control practices). Hospital Episode Statistics emergency admission data were analysed for 2014–2017 for ambulatory-sensitive conditions across Somerset using interrupted time series.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Patient and practitioner experiences were similar in SPQS versus control practices. However, discretion from QOF incentives resulted in time savings in the majority of practices, and SPQS practice data showed a significant increase in P3C oriented organisational processes, with a moderate effect size (Wilcoxon signed rank test; p=0.01; r=0.42). Analysis of transformation plans and organisational data suggested stronger federation-level agreements and informal networks, increased multidisciplinary working, reallocation of resources for other healthcare professionals and changes to the structure and timings of GP appointments. No disbenefits were detected in admission data.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The SPQS scheme leveraged time savings and reduced administrative burden via discretionary removal of QOF incentives, enabling practices to engage actively in a number of schemes aimed at improving care for people with LTCs. We found no differences in the experiences of patients or healthcare professionals between SPQS and control practices.</jats:p></jats:sec>

en
dc.format.extente029721 - e029721en
dc.language.isoenen
dc.publisherBMJ Publishing Groupen
dc.titleLongitudinal evaluation of a countywide alternative to the Quality and Outcomes Framework in UK General Practice aimed at improving Person Centred Coordinated Careen
dc.typeJournal Article
plymouth.issue7en
plymouth.volume9en
plymouth.journalBMJ Openen
dc.identifier.doi10.1136/bmjopen-2019-029721en
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/00 Groups by role
plymouth.organisational-group/Plymouth/00 Groups by role/Academics
plymouth.organisational-group/Plymouth/Faculty of Health: Medicine, Dentistry and Human Sciences
plymouth.organisational-group/Plymouth/Faculty of Health: Medicine, Dentistry and Human Sciences/Peninsula Medical School
plymouth.organisational-group/Plymouth/Faculty of Health: Medicine, Dentistry and Human Sciences/School of Psychology
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy
plymouth.organisational-group/Plymouth/Research Groups
plymouth.organisational-group/Plymouth/Research Groups/Institute of Health and Community
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)/CCT&PS
dcterms.dateAccepted2019-05-30en
dc.rights.embargodate9999-12-31en
dc.identifier.eissn2044-6055en
dc.rights.embargoperiodNot knownen
rioxxterms.versionofrecord10.1136/bmjopen-2019-029721en
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2019-07-23en
rioxxterms.typeJournal Article/Reviewen


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