The impact of the Quality and Outcomes Framework on practice organisation and service delivery: summary of evidence from two qualitative studies

Qual Prim Care. 2010;18(2):139-46.


Background: In 2003, the new General Medical Services Contract introduced a pay-for-performance programme know as the Quality and Outcomes Framework (QOF) into UK general practice, with payment for meeting a number of both clinical and organisational quality standards.

Aim: To investigate in detail the impact of the QOF on practice organisation and service delivery.

Methods: Two linked qualitative case studies in England and Scotland, using interviews and observation to investigate in depth the impact of the QOF in four general medical practices.

Results and conclusion: A number of significant changes to practice organisation and service delivery were observed, including: changes to practice organisational structures; an increased role for information technology; a move towards a more biomedical form of medical care; and changes to roles and relationships, including the introduction of internal peer-review and surveillance. In spite of this, the practices maintained a narrative of 'no change', arguing that they had 'fitted QOF in' to their routines with little trouble.

MeSH terms

  • England
  • Family Practice / economics
  • Family Practice / organization & administration*
  • Family Practice / standards*
  • Humans
  • Outcome Assessment, Health Care / methods
  • Outcome Assessment, Health Care / standards
  • Program Evaluation
  • Qualitative Research
  • Quality Assurance, Health Care / methods
  • Quality Assurance, Health Care / standards*
  • Quality Indicators, Health Care / standards
  • Reimbursement, Incentive / standards*
  • Scotland