Published 4 June 2009, doi:10.1136/bmj.b2263
Cite this as: BMJ 2009;338:b2263

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QOF and whistleblowers

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

This week Chris Ham (doi:10.1136/bmj.b2198) contrasts the UK Conservative party’s reliance on markets to improve performance with the "targets and terror" approach that has driven many of the recent improvements in the NHS. Many readers will like that description—though you probably also share Ham’s (familiar) concerns about the effectiveness of markets for health care.

Yet not all targets have been accompanied by terror: some have hefty incentives. None more so than the Quality and Outcomes Framework (QOF) in general practice, one of the most ambitious "pay for performance" systems in the world (BMJ 2003;326:457, doi:10.1136/bmj.326.7387.457). So far the verdict has been generally favourable—improved outcomes and little evidence of gaming. But one or two BMJ articles have begun to question the ability of a target setting payment system to be responsive enough to changing evidence and the subtleties of medical practice. For example, Lehman and Krumholz . . . [Full text of this article]

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