The ‘Quality and Outcomes Framework’: improving care, but are all patients benefiting?

摘要

The Quality and Outcomes Framework (QOF), introduced as part of the General Practitioner contract in 2004, has been described as the boldest shift towards pay for performance in any health care system.1 Around one quarter of general practice income is now derived through the achievement of quality targets in managing chronic diseases – such as diabetes and coronary heart disease – and risk factors – such as hypertension – through QOF. Early evidence suggests that this policy has resulted in a step-change in quality for some conditions such as asthma and diabetes but not for coronary heart disease.2