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


OBJECTIVE
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.


CONCLUSIONS
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.
Walport Clinical Lecturer in Primary Care, National Primary Care Research and Development Centre, University of Manchester, Manchester, UK. Katherine.H.Checkland@manchester.ac.uk
Kath
K
Checkland
Stephen
S
Harrison
D004739:England; D005194:Family Practice / Q000191:economics / Q000458:organization & administration* / Q000592:standards*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards; D015397:Program Evaluation; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards; D012052:Reimbursement, Incentive / Q000592:standards*; D012606:Scotland