Intended for healthcare professionals

Rapid response to:


Effect of the quality and outcomes framework on diabetes care in the United Kingdom: retrospective cohort study

BMJ 2009; 338 doi: (Published 27 May 2009) Cite this as: BMJ 2009;338:b1870

Rapid Response:


Calvert et al. demonstrate clearly how care of diabetes has improved
annually in general practice, and rightly question the influence of QOF as
'not straightforward'.

The knee-bend in all trends in 2005 is readily visible in Figure 2.
QOF actually appears to be associated with a relative flattening-off.
This could be a ceiling-effect, a 'good-enough' effect, or a quirk of
retrospective data -editting ?

It reminds me of the early 1990's when vaccination target incentives
were introduced. That same levelling-off just above threshold (90%) was
visible in trends. What struck me as particularly noteworthy was not only
the knee-jerk DoH claims for the effects of performance-management, but
also the strong evidence for GP precognition..

How come GPs knew to aim their efforts perfectly toward that 90%
level, even before they knew the QOF rules ??!

Is it further proof of the power of retrospective prayer ??


Effects of remote, retroactive intercessory prayer on outcomes in
patients with bloodstream infection: randomised controlled trial
BMJ Dec 2001; 323: 1450 - 1451; doi:10.1136/bmj.323.7327.1450

Competing interests:
None declared

Competing interests: No competing interests

29 October 2009
L Sam Lewis
Surgery, Newport, Pembrokeshire, SA42 0TJ