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1.  The relationship between social deprivation and the quality of primary care: a national survey using indicators from the UK Quality and Outcomes Framework 
The existence of health inequalities between least and most socially deprived areas is now well established.
To use Quality and Outcomes Framework (QOF) indicators to explore the characteristics of primary care in deprived communities.
Design of study
Two-year study.
Primary care in England.
QOF data were obtained for each practice in England in 2004–2005 and 2005–2006 and linked with census derived social deprivation data (Index of Multiple Deprivation scores 2004), national urbanicity scores and a database of practice characteristics. Data were available for 8480 practices in 2004–2005 and 8264 practices in 2005–2006. Comparisons were made between practices in the least and most deprived quintiles.
The difference in mean total QOF score between practices in least and most deprived quintiles was 64.5 points in 2004–2005 (mean score, all practices, 959.9) and 30.4 in 2005–2006 (mean, 1012.6). In 2005–2006, the QOF indicators displaying the largest differences between least and most deprived quintiles were: recall of patients not attending appointments for injectable neuroleptics (79 versus 58%, respectively), practices opening ≥45 hours/week (90 versus 74%), practices conducting ≥12 significant event audits in previous 3 years (93 versus 81 %), proportion of epileptics who were seizure free ≥12 months (77 versus 65%) and proportion of patients taking lithium with serum lithium within therapeutic range (90 versus 78%). Geographical differences were less in group and training practices.
Overall differences between primary care quality indicators in deprived and prosperous communities were small. However, shortfalls in specific indicators, both clinical and non-clinical, suggest that focused interventions could be applied to improve the quality of primary care in deprived areas.
PMCID: PMC2078188  PMID: 17550668
primary care; quality indicators; social deprivation
2.  The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004–5 
BMC Family Practice  2006;7:68.
The descriptive information now available for primary care in the UK is unique in international terms. Under the 'Quality and Outcomes Framework' (QOF), data for 147 performance indicators are available for each general practice. We aimed to determine the relationship between the quality of primary care, as judged by the total QOF score, social deprivation and practice characteristics.
We obtained QOF data for each practice in England and linked these with census derived data (deprivation indices and proportion of patients born in a developing country). Characteristics of practices were also obtained. QOF and census data were available for 8480 practices.
The median QOF score was 999.7 out of a possible maximum of 1050 points. Three characteristics were independently associated with higher QOF scores: training practices, group practices and practices in less socially deprived areas. In a regression model, these three factors explained 14.6% of the variation in QOF score. Higher list sizes per GP, turnover of registered patients, chronic disease prevalence, proportions of elderly patients or patients born in a developing country did not contribute to lower QOF scores in the final model.
Socially deprived areas experience a lower quality of primary care, as judged by QOF scores. Social deprivation itself is an independent predictor of lower quality. Training and group practices are independent predictors of higher quality but these types of practices are less well represented in socially deprived areas.
PMCID: PMC1647283  PMID: 17096861
3.  Partnership effects in general practice: identification of clustering using intra-class correlation coefficients. 
Although most United Kingdom general practitioners (GPs) work together in a shared professional arrangement termed 'partnership', little is known about the nature of such partnerships. We report the results of a survey of 61 general practice partners in 15 group practices and their attitudes to prescribing and managerial issues related to participation in a commissioning group. Intra-class correlation coefficients (ICCs) were used to explore how these individually held attitudes clustered within groups. The low ICCs found for attitudes relating to prescribing issues suggested that GPs acted individually in this respect, while, in contrast, responses to managerial questions clustered strongly in partnerships, implying that managerial attitudes were more likely to be shared within partnerships. The ICC statistic is a useful tool for exploring homogeneity and heterogeneity within general practice partnerships.
PMCID: PMC1314729  PMID: 14702906

Results 1-3 (3)