The Quality and Outcomes Framework—where next?

Introduced in 2004, the UK Quality and Outcomes Framework (QOF) is the most comprehensive national primary care pay for performance scheme in the world.1 It includes financial incentives and information technology (computerised prompts and decision support) to achieve evidence based quality targets. The inducements are substantial, with a maximum of 1000 points available to practices, and an average payment per practice in 2011-12 of £130 (€150; $205) for each point achieved.2 Over half of these points are allocated to clinical indicators, which currently cover 22 chronic conditions, and the remainder to organisational indicators (box).

The QOF was designed to improve the management of chronic disease by rewarding practices for delivering interventions linked to improved health outcomes for heart disease, diabetes, and other major scourges. The money to implement the scheme was intended to raise pay for general practices. Subsequently, proposed changes have been agreed by the General Practitioners Committee of the British Medical Association and the Department of Health. Negotiations over revisions to the General Medical Services contract in England having stalled, the Department of Health recently announced that it intends to impose changes …