title: Primary care in an era of hospital bed reduction: what can we infer from QOF and PBC?
abstract: CONCLUSIONS
  The Quality and Outcomes Framework (QOF) has been efficiently and effectively incorporated into practice routines. One possible negative effect of this has been a move towards a more biomedical form of practice.There has been patchy but real engagement with practice-based commissioning (PBC), with significant moves in some areas towards GPs acting collectively to improve services across the health economy, including engaging in performance management of each others' practice.Together, responses to QOF and PBC suggest that GPs may be willing and able to act both individually and collectively to try to mitigate the negative impacts of future spending reductions.
  General practice will be under a great deal of pressure in the next few years. Understanding the impact of past policy changes is essential if we are to ensure that the core values of general practice are maintained.
authors.affiliation: Practising GP and Clinical Senior Lecturer.
authors.forename: Kath
authors.initials: K
authors.lastname: Checkland
authors.affiliation: Professor of Social Policy and Associate Director National Primary Care Research and Development Centre, University of Manchester, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Harrison
keywords: QOF; biomedicalisation; engagement; practice-based commissioning