Intended for healthcare professionals


Future proofing the Quality and Outcomes Framework

BMJ 2013; 346 doi: (Published 25 March 2013) Cite this as: BMJ 2013;346:f1942
  1. Veena S Raleigh, senior fellow1,
  2. Niek Klazinga, professor of social medicine2
  1. 1King’s Fund, London W1G 0AN, UK
  2. 2Academic Medical Centre, University of Amsterdam
  1. V.Raleigh{at}

Depends on making it fit for purpose in the era of multimorbidity and cost savings

As the Quality and Outcomes Framework (QOF) approaches its 10th birthday, radical changes in its content and construction see a parting of the ways between the countries within the United Kingdom. The National Institute for Health and Clinical Excellence and the Department of Health have proposed such changes as dropping the organisational domain; creating a public health domain; raising payment thresholds; introducing directed enhanced services for dementia case finding; ensuring access to online general practice services and telehealth; and case managing patients at risk of hospital admission.1

Concerns about these proposals mean they have not been universally accepted across the UK’s four countries,2 which has led to the first sizeable split since the framework’s inception in 2004.3 Scotland and Wales have departed from England by not introducing all proposed changes to indicators (including the directed enhanced services), allocation of points across domains, and payment thresholds. Practices in England face tougher achievement thresholds and risk losing a sizable proportion of QOF funding if they opt out of directed enhanced services.

In a linked Analysis article (doi:10.1136/bmj.f659), Gillam and Steel wonder about where we are going to next with QOF?4 Whether the framework has had a positive impact is unclear. It has modestly improved the quality of care for chronic …

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