After 12 years, where next for QOF?

The recent EU referendum result reminds us that behaviour is not simply determined by economic self interest, yet the notion of paying physicians to perform remains remarkably popular. Medicare payments in the US are increasingly linked to the quality of services, and pay for the 32 000 UK general medical practitioners working for the National Health Service has been linked to quality of care through the Quality and Outcomes Framework (QOF) since 2004.1 2

Back then, quality indicators for general practice were new, and electronic medical records had become widespread in British general practice.3 The UK Department of Health wanted to improve population coverage of healthcare processes that had evidence of improved health outcomes and invested £8bn (€9.5bn; $10.5bn) over the first three years of QOF to reward performance in four areas: clinical, organisational, patient experience, and additional services. There were 80 clinical indicators in 2004 and 77 in 2016, covering cardiovascular disease, diabetes, …