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Should the Quality and Outcomes Framework be abolished? No

BMJ 2010; 340 doi: (Published 07 June 2010) Cite this as: BMJ 2010;340:c2794
  1. A Niroshan Siriwardena, foundation professor in primary care
  1. 1Faculty of Health, Life and Social Sciences, University of Lincoln, Lincoln LN6 7TS
  1. nsiriwardena{at}

    Steve Gillam (doi:10.1136/bmj.c2710) argues that the general practice pay for performance scheme is not good value for money, but Niroshan Siriwardena believes it needs to be improved not removed

    Strong primary care is a cost effective solution to better population health and reducing inequalities.1 The Quality and Outcomes Framework (QOF), the most comprehensive national primary care pay for performance scheme in the world, was introduced in 2004 to encourage evidence based practice and reduce variations in care for chronic conditions.2 It is a complex intervention comprising several elements including financial incentives, support for structured and team based care, and the pursuit of evidence based care.

    There are early indications that the framework is associated with better recorded care, enhanced processes, improved intermediate outcomes,3 and reductions in inequalities4 and that it provides value for money in some but not all its clinical domains.5 It has helped consolidate evidence based methods for improving care by, among other things, increasing the use of computerisation, decision support, provider prompts, patient reminders (and recalls), skill mix, and teamwork.6 Many of these features were introduced before the framework but continue to be strengthened …

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