Intended for healthcare professionals

Views & Reviews From the Frontline

Bad medicine: general practice

BMJ 2010; 341 doi: (Published 22 December 2010) Cite this as: BMJ 2010;341:c7336
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

In 2004 a 1000 point plan called the quality and outcomes framework (QOF) was introduced with a fanfare into general practice in England, Wales, and Scotland. This initiative was to replace perceived poor quality and poorly coordinated care with evidenced based medicine—taking research from theory into practice. It was expensive, at a cost of £1bn, but health improvement would be rapid and real and worth it. Has it worked?

We slap ourselves on the back because we have seen recorded reductions in glycated haemoglobin HbA1C, blood pressure, and cholesterol. But an experiment this large …

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