Soft and hard end points matter

doi:10.1136/bmj.a2922

Published 10 December 2008, doi:10.1136/bmj.a2922
Cite this as: BMJ 2008;337:a2922

Letters

QOFing whine

Soft and hard end points matter

The first 150 words of the full text of this article appear below.

Spence calls for hard end points such as cardiovascular mortalityfor the quality and outcomes framework (QOF).¹ Other correspondentssuggest that important but less measurable aspects of care havedeclined since the new general practice contract.

Soft end points are important, but so are hard ones. In recentyears UK life expectancy has steadily increased by around oneyear every five years,² cardiovascular mortality in men under75 fell by 38% between 1998 and 2006,³ and cancer survival hasincreased.⁴ These changes are no doubt due to a combinationof societal factors and improvements in both primary and secondarycare. In general practice some aspects of clinical care havedramatically improved since 1998.⁵

Let us by all means debate the cause of the improvements andthe unintended consequences of new initiatives. But let us notconduct the debate as if these major improvements in healthwere not real. They are . . . [Full text of this article]

Martin Roland, director¹

¹ National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL

m.roland@manchester.ac.uk