Intended for healthcare professionals


The future of the Quality and Outcomes Framework in England

BMJ 2017; 359 doi: (Published 17 October 2017) Cite this as: BMJ 2017;359:j4681
  1. Martin Marshall, professor of healthcare improvement1,
  2. Martin Roland, emeritus professor of health services research2
  1. 1University College London, UK
  2. 2University of Cambridge, UK
  1. martin.marshall{at}

It’s time to rethink one of the most ambitious experiments in general practice

To describe the Quality and Outcomes Framework (QOF)—one of the most ambitious pay-for-performance schemes introduced into any health system—as divisive would be an understatement. Launched in the UK in 2004 as a way of encouraging adherence to specified evidence based elements of general practice care, QOF has changed the nature of general practice in ways that have polarised those who work in the sector and external commentators.1

Advocates highlight how patient care, especially for those with long term conditions, is now more structured, more systematic, and more likely to be based on high quality research evidence. They point out the rapid progress with computerisation that followed the implementation of the initiative, how better data are being used in more effective ways, and how work has been distributed more efficiently between a larger and more diverse primary care workforce. And they celebrate the extent to which these improvements have taken place across nearly every practice in the country.

Others have …

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