Analysis

Person centred coordinated care: where does the QOF point us?

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2540 (Published 11 June 2015) Cite this as: BMJ 2015;350:h2540
  1. Martin McShane, medical director, long term conditions1,
  2. Edward Mitchell, core trainee2
  1. 1NHS England, Medical Directorate, Leeds LS2 7UE, UK
  2. 2Oxford Health NHS Trust, Warneford Hospital, Oxford OX3 7JX, UK
  1. Correspondence to: M McShane m.mcshane{at}nhs.net
  • Accepted 25 March 2015

Martin McShane and Edward Mitchell question the validity of the Quality and Outcomes Framework and suggest how it should change in the future

The Quality and Outcomes Framework (QOF) is a pay for performance programme that was introduced in 2004 to improve care in general practice. It now constitutes roughly 13% of practice income—QOF payments in 2013-14 were £1057m (€1451m; $1613m) (fig).1 The arguments for and against the QOF (and pay for performance schemes in general) have been hotly debated over the past decade. Its seminal impact on UK general practice is undeniable, but its influence is such that it has affected our idea of what constitutes quality improvement. It has been suggested, for example, that we equate (or perhaps conflate) good care with the recording of disease specific biomedical or process markers.2

QOF payments per year. Source: Health and Social Care Information Centre

The QOF is facing change. The 2014-15 GP contract deal has seen a 30% reduction in QOF points.3 After eleven years, and billions of pounds in QOF payments, we take stock of the QOF and discuss three changes in the healthcare system that mean QOF must change.

Origins of the QOF

By the late 1990s, the increasing use of clinical audits and computerised records showed considerable variations in the management of chronic diseases. The government’s desire to increase healthcare funding (which as a proportion of gross domestic product lagged behind that of most other European countries) was complemented by a political drive for more systematic clinical governance.4

The origins of QOF lie in the 1997 Primary Care Clinical Evaluation Project, in which a group of GPs and colleagues in Kent designed indicators and standards in 13 clinical areas. By 2000 they had signed up 85% of local practices to participate in the scheme at …

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