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Expert review says changes should be made to the QOF

5 December 2007

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A new review of the Quality and Outcomes Framework (QOF) says several changes should be made the framework to improve patient care.

The review, from the National Primary Care Research and Development Centre (NPRDC), examines evidence on the impact that QOF has had, and makes recommendations for how QOF should develop in the future.

The review says that “QOF needs to be seen as part of a wider range of quality improvement initiatives, and not as the ʻbe all and end all’ of quality improvement.”

It argues that while financial incentives have stimulated quality improvement activity, this is “on the back of a series of changes in the preceding five years”, including electronic records, widespread introduction of audit into general practice, and the development of national guidelines.

The review also says that the introduction of QOF has led to an increase in practice administration and nursing staff.

The review says QOF “has succeeded in making quality improvement a core part of general practice” and should be  retained. However, it also suggests several amendments to the QOF, which include:

  • Removal of some indicators/conditions and adding “justifiable” new clinical areas, which should be piloted.
  • Exception reporting should be carefully monitored by PCTs.
  • Introduction of a single national patient questionnaire.

The review also suggests the possibility of lowering the proportion of practice income dependant on QOF, since “there is anecdotal evidence of a disproportionate effect of the QOF on professional behaviour … although it is too early to be sure, it may be that the proportion of overall practice income dependent on the QOF should reduce in future.”

The organisational aspect of the QOF was also challenged. The review states: “There is a widespread view that the organisational indicators in the QOF now won’t improve care further … a rethink is needed.”


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