Quality and Outcomes Framework

• The final report, and our summary, were published in April 2011. The key points are summarised on the findings tab.

Anna Dixon introduces the key findings from this paper

This project was funded by the National Institute for Health Research Service Delivery and Organisation programme (project number 08/1716/207)

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR SDO programme or the Department of Health.

More about this project 

• Historically, GPs’ status as independent contractors to the NHS has meant general practice has had less direct management and monitoring compared to other parts of the NHS. Consequently, there has been widespread variation in the quality of care provided by practices.
• A first step to defining fees and service quality came in the 1990 contract, which introduced payments for achieving certain targets and financial incentives to provide health promotion. These had a limited effect on GP income, but some impact on improving quality. The GMS contract of 2004 introduced a pay-for-performance element – the Quality and Outcomes Framework (QOF) – which rewards practices for the quality of clinical care and organisational management.
• The main objective of QOF was to drive up the quality of primary care. There has also been interest in whether QOF reduces the variations in the quality of care between GP practices. Early studies report conflicting findings as to the impact on equity.
• This project was a joint venture with the London School of Hygiene and Tropical Medicine and has been funded by the National Institute for Health Research Service and Delivery Organisation Programme (ref no: PHA 202).