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The future of the quality and outcomes framework

BMJ 2008; 337 doi: (Published 19 December 2008) Cite this as: BMJ 2008;337:a3017
  1. Helen Lester, professor of primary care1,
  2. Azeem Majeed, professor of primary care2
  1. 1National Primary Care Research and Development Centre, Manchester M13 9PL
  2. 2Department of Primary Care and Social Medicine, Imperial College, London W6 8RP
  1. a.majeed{at}

    NICE involvement means the framework will remain part of the fabric of primary care

    The quality and outcomes framework was introduced into primary care in the United Kingdom in April 2004. The original aims of the framework were to improve the quality of care delivered in general practice, to help recruitment and retention, and to reward practices for the delivery of existing high quality care. Although the scheme is voluntary, 99.8% of practices in the UK participate. The framework currently includes 1000 points in four domains: clinical care (650 points), organisation (167.5), patient experience (146.5), and additional services (36). Average achievement has consistently been over 90%, with a mean score of 96.8% in 2007-8.1 Framework payments can make up to a third of a practice’s income, and the UK government currently spends about £1bn (€1.1bn; $1.5bn) each year (15% of primary medical care costs) on the framework.

    Since 2005, academic stewardship of the framework has been provided by a collaboration of more than 40 senior primary care academics, supported by a small working group. It is overseen by a steering committee with representatives from the Royal College of General Practice and lay representatives from the four countries of the UK. The evidence base for …

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