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Experts warn QOF may not be best for patients

26 November 2007

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The practice earns points system reaps in financial resources but may not be giving patients what they need, experts warn in the British Medical Journal (BMJ).

The quality and outcomes framework (QOF) has been hailed as a successful system for providing quality care, but Dr Iona Heath and colleagues now warn that GP performance targets may be leading to lower levels of healthcare.

The team says that clinical care needs to be tailored to individual patients rather than using a “mechanistic approach”.

They say QOF diminishes the responsibility of doctors to think about their individual patients, and instead encourages them to concentrate on treatment processes.

It is argued that even the framework aiming to tackle health inequalities has the potential to work in the opposite direction.

Dr Heath and colleagues say socially disadvantaged people are more likely to be listed as exceptions from QOF payments, and then risk receiving proportionally less attention.

They add that evidence shows that payment for performance systems reward high achievers and penalise low achievers, exacerbating inequalities.

The researchers conclude that emphasis on processes brought about by the framework should not be allowed to distract from the fundamental aims of medical care.


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“A ‘spert’ is a drip under pressure, ‘Ex’ refers to someone who used to be. I wonder why experts were required to spot such an obvious conclusion” – Richard Ward, Devon