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

Checkland, Kath MBBS BMedSci MRCGP MA(Econ) PhD
Harrison, Stephen PhD AcSS

Walport Clinical Lecturer in Primary Care
Professor of Social Policy
National Primary Care Research and Development Centre, University of Manchester, Manchester, UK

PEER REVIEW

Commissioned; not externally peer reviewed.

CONFLICTS OF INTEREST

None.

ADDRESS FOR CORRESPONDENCE

Dr Kath Checkland, Walport Clinical Lecturer in Primary Care, National Primary Care Research and Development Centre, 5th Floor, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. Tel: +44 (0)161 275 7650; email: [email protected]

Received 22 December 2009

Accepted 7 March 2010

Quality in Primary Care 18(2):p 139-146, 2010.

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.