Has pay for performance improved the management of diabetes in the United Kingdom?

Prim Care Diabetes. 2010 Jul;4(2):73-8. doi: 10.1016/j.pcd.2010.02.003. Epub 2010 Apr 2.


Over the past decade the UK government has introduced a number of major policy initiatives to improve the quality of health care. One such initiative was the introduction of the Quality and Outcomes Framework (QOF), a pay for performance scheme launched in April 2004, which aims to improve the primary care management of common chronic conditions including diabetes. Some evidence suggest that introduction of QOF has been associated with improvements in the quality indicators for diabetes care included in the framework. However, it is difficult to disentangle the impact of QOF from other quality initiatives as few studies adjusted for underlying trends in quality. There is some evidence that QOF may have reduced inequalities in diabetes care between affluent and deprived areas but women and individuals from ethnic minority groups appear to have benefited least from this initiative. Less is known about the impact of QOF on aspects of diabetes care not reflected in the framework, including self-management and continuity of care.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Diabetes Mellitus, Type 1 / economics
  • Diabetes Mellitus, Type 1 / therapy*
  • Diabetes Mellitus, Type 2 / economics
  • Diabetes Mellitus, Type 2 / therapy*
  • Humans
  • Primary Health Care / economics
  • Primary Health Care / standards*
  • Quality Assurance, Health Care / economics
  • Quality Assurance, Health Care / standards*
  • Reimbursement, Incentive / standards*
  • State Medicine / economics
  • State Medicine / standards
  • United Kingdom