Quality and Outcomes Framework

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What did we do in this project?

The project combined quantitative analysis of routine data with in-depth interviews. Research began in January 2008 and was published in April 2011. The final report was published in April 2011: Impact of Quality and Outcomes Framework on health inequalities.

You can see the key findings from this report with Anna Dixon's audio-slideshow

Why are we interested in this piece of work?

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.

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.

Project team

This is a joint project with the London School of Hygiene and Tropical Medicine (LSHTM).

Project lead

  • Anna Dixon

Research team

  • Artak Khachatryan, The King's Fund
  • Andrew Wallace, LSHTM
  • Stephen Peckham, LSHTM

External advisers

  • Tim Doran, replaced by Stephen Campbell, National Primary Care Research & Development Centre, University of Manchester
  • Stephen Gillam,University of Cambridge


This research has been funded by the National Institute for Health Research Service and Delivery Organisation Programme (ref no: PHA 202).

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.