Achievement of metabolic targets for diabetes by English primary care practices under a new system of incentives

Diabet Med. 2007 May;24(5):505-11. doi: 10.1111/j.1464-5491.2007.02090.x. Epub 2007 Mar 22.


Objective: To analyse achievement of metabolic targets by English general practices following the introduction of a new system of incentives.

Methods: Clinical data were abstracted from the records of 2099 patients at 26 general practices in South London. Cross-sectional data for 2005 were obtained for all general practices in England, including characteristics of registered populations, practice organizational characteristics and 'Quality and Outcomes Framework' (QOF) metabolic targets.

Results: Among 26 practices in South London, the median practice-specific proportion of patients achieving HbA(1c) < or = 7.4% each year increased: 2000, 22%; 2001, 32%; 2002, 37%; 2003, 38% and in 2005 from QOF, 57%. In 8484 general practices in England in 2005, the median proportion of diabetic patients with HbA(1c) < or = 7.4% was 59.0%; the highest and lowest centiles ranged from 27.7 to 89.8% among general practices, from 46.9 to 71.0% among 303 primary care trusts and from 49.9 to 67.1.% among 28 health authorities. Comparing the highest and lowest tertiles of deprivation, the per cent achieving HbA(1c) < or = 7.4% was 2.96% (95% confidence interval 2.23-3.69%) lower in the most deprived areas. In areas with the highest proportion of ethnic minorities, the per cent achieving HbA(1c) < or = 7.4% was 2.73% (1.85-3.61%) lower than where there were few ethnic minorities. Practices with the highest total QOF organization scores had more patients achieving the HbA(1c) target (difference 5.03%, 4.43-5.64%).

Conclusions: Intermediate outcomes are improving but deprived areas with less organized services achieve worse glycaemic control. Financial incentives may contribute to improved services and better clinical outcomes.

MeSH terms

  • Diabetes Mellitus / therapy*
  • Family Practice / standards*
  • Family Practice / statistics & numerical data
  • Humans
  • London
  • Multicenter Studies as Topic
  • Outcome Assessment, Health Care
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Primary Health Care / standards*
  • Quality Indicators, Health Care*
  • Quality of Health Care*