Should the Quality and Outcomes Framework be abolished? Yes

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