Quality and Outcomes Framework

The project combined quantitative analysis of routine data with in-depth interviews. Research began in January 2008 and was published in April 2011.

Quantitative analysis

First we looked at variations and changes in practice performance against those QOF indicators that evidence suggests contribute to health gain or improvements in public health.

Second, we explored the association between the socio-economic status of the practice population and its performance – controlling for practice characteristics known to affect performance, as well as other socio-economic characteristics. We were interested in whether practices serving low-income populations perform worse against this set of measures.

Third, we assessed changes in performance over time to establish whether practices serving more deprived populations are improving more quickly or more slowly than those serving less-deprived populations. Overall, we want to assess whether the gap is closing in performance between practices serving more deprived populations and those serving less deprived populations.

The final component of the quantitative analysis assessed whether there is any correlation between QOF achievement and other measures of practice performance.

Qualitative analysis

To get insights into the way QOF affects their commitment and activities to improve the health of local populations, we conducted in-depth interviews at 12 carefully selected general practice sites in socially deprived areas.

Practices were selected from spearhead and non-spearhead PCTs. We also looked at the variance of QOF scores based on clinical indicators to identify the lowest, middle and highest performing practices. 

Interviews explored how GPs view the impact of QOF on service provision, and how they viewed their role in reducing health inequalities through improving outreach and access to services, case management and health promotion services for low-income groups. We explored how the general practices that serve deprived communities have responded to the financial incentives provided by QOF.

The interviews were semi-structured, recorded and transcribed and coded using qualitative software (NVIVO).