QOF and whistleblowers

doi:10.1136/bmj.b2263

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Jane Smith, deputy editor, BMJ

jsmith{at}bmj.com

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 …