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Should the Quality and Outcomes Framework be abolished? Yes

BMJ 2010; 340 doi: (Published 07 June 2010) Cite this as: BMJ 2010;340:c2710
  1. Steve Gillam, general practitioner
  1. 1 Lea Vale Medical Group, Luton
  1. sjg67{at}

    Steve Gillam argues that the general practice pay for performance scheme is not good value for money, but Niroshan Siriwardena (doi:10.1136/bmj.c2794) believes it needs to be improved not removed

    The impact of the Quality and Outcomes Framework (QOF) on general practice has, arguably, exceeded that of any other policy development since the Family Doctors’ Charter of 1966. A sensible verdict needs to balance a nuanced assessment of health and other gains against its costs, many of which are hard to describe let alone quantify. But I believe that the evidence supports its abolition.

    The £1bn (€1.2bn; $1.4bn) a year that the scheme costs has yielded remarkably modest improvements in measured quality of care and only slight reductions in disparities between socioeconomic groups.1 2 In many cases, improvements in clinical indicators were in line with increases that might have been predicted on the basis of secular trends before the framework was introduced.

    To what extent these improvements are the vicarious result of better recording remains unclear. What is clear is that commercially constructed evidence is driving up prescription rates for antidepressants, statins, and other drugs with little evidence of improvement in proxy outcomes.3

    Distorted priorities

    Incentives were not aligned to tackle inequalities in …

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