Intended for healthcare professionals

Letters Care and quality indicators

QOF and public health priorities don’t improve care in ageing

BMJ 2008; 337 doi: (Published 27 August 2008) Cite this as: BMJ 2008;337:a1403
  1. David Oliver, senior lecturer, geriatric medicine1
  1. 1School of Health and Social Care, University of Reading, Reading RG6 1HY
  1. d.oliver{at}

    The influence of the quality and outcomes framework (QOF) in the general practitioners’ contract cannot be discounted.1 But not everything can appear in the QOF, and if it doesn’t it doesn’t tend to happen.

    Urinary incontinence affects 25% of women over 65; 50% of people over 80 fall at least once a year, and women have a 50% lifetime risk of osteoporotic fracture; over 1 million people in the UK currently have dementia—yet none of these appear. Clearly such prevalent and debilitating conditions are of major importance, but as they primarily affect older people they haven’t been at the forefront of thinking. They don’t lend themselves to simplistic “metrics” for measurement and so it is too difficult to show that they are being met. Prescription and rationalisation of medicines in older people is another QOF related issue.

    Firstly, although iatrogenic illness related to polypharmacy accounts for many admissions of older people to hospital, primary care prescribing in over 65s has increased by 50% over the past three years.

    Secondly, targets around treatment of, say, hypertension or heart failure don’t take into account the high prevalence of side effects in frail older people with complex needs.

    Thirdly, although there is ostensibly an annual medication review target in the QOF, it is doubtful that this really stimulates meaningful risk benefit analysis and rationalisation of medicines in older people with multiple diseases.

    An entrepreneurial model with a performance framework based on what is easily measurable and prioritising conditions affecting young and middle aged people does nothing to improve the care of old people—the principal users of the service.


    Cite this as: BMJ 2008;337:a1403


    • Competing interests: DO is the national secretary of the British Geriatrics Society.


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