Authors: Griffiths, Peter¹; Murrells, Trevor¹; Maben, Jill¹; Jones, Simon¹; Ashworth, Mark²

Source: British Journal of General Practice, Volume 60, Number 570, January 2010 , pp. e36-e48(13)

Publisher: Royal College of General Practitioners

Abstract:

Background

In many UK general practices, nurses have been used to deliver results against the indicators of the Quality and Outcomes Framework (QOF), a `pay for performance' scheme.

Aim

To determine the association between the level of nurse staffing in general practice and the quality of clinical care as measured by the QOF.

Design of the study

Cross-sectional analysis of routine data.

Setting

English general practice in 2005/2006.

Method

QOF data from 7456 general practices were linked with a database of practice characteristics, nurse staffing data, and census-derived data on population characteristics and measures of population density. Multi-level modelling explored the relationship between QOF performance and the number of patients per full-time equivalent nurse. The outcome measures were achievement of quality of care for eight clinical domains as rated by the QOF, and reported achievement of 10 clinical outcome indicators derived from it.

Results

A high level of nurse staffing (fewer patients per full-time equivalent practice-employed nurse) was significantly associated with better performance in 4/8 clinical domains of the QOF (chronic obstructive pulmonary disease, coronary heart disease, diabetes, and hypertension, P = 0.004 to P<0.001) and in 4/10 clinical outcome indicators (diabetes: glycosylated haemoglobin [HbA_1C] ≤7.4%, HbA_1C ≤10% and total cholesterol ≤193 mg/dl; and stroke: total cholesterol ≤5 mmol/L, P = 0.0057 to P<0.001).

Conclusion

Practices that employ more nurses perform better in a number of clinical domains measured by the QOF. This improved performance includes better intermediate clinical outcomes, suggesting real patient benefit may be associated with using nurses to deliver care to meet QOF targets.

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Keywords: cross-sectional studies; family practice; health care; incentive; nursing staff; personnel staffing and scheduling; physician incentive plans; quality indicators; quality of health care; reimbursement

Document Type: Research article

DOI: http://dx.doi.org/10.3399/bjgp10X482086

Affiliations: 1: National Nursing Research Unit, King's College, London 2: Department of General Practice and Primary Care, King's College, London

Publication date: 2010-01-01

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• The British Journal of General Practice is an international journal publishing articles of interest to family practitioners and primary care researchers worldwide. The journal's 2010 Impact Factor is 2.07, making it the world's second most highly cited journal of general practice and primary health care.

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