title: The Quality and Outcomes Framework: Body commodification in UK general practice.
abstract: The UK's Quality and Outcomes Framework (QOF) is the largest pay-for-performance scheme in the world. This ethnographic study explored how QOF's monetary logic influences the approach to healthcare in UK general practice. From August 2013 to April 2014, we researched two UK general practice surgeries and one general practice training programme. These environments provided the opportunity for studying various spaces such as QOF meetings, consultation rooms, QOF recoding sessions, and the collection of computer-screen images depicting how patients' biomarkers are evaluated and costed through software systems. QOF as a biomedical technology has led to the commodification of patients and their bodies. This complex phenomenon breaks down into three main themes: commodification of patients, QOF as currency, and valuing commodities. Despite the ostensible aim of QOF being to improve healthcare in general practice, it is accompanied by a body commodification process. The interface between patients and care providers has been commodified, with QOF's pricing mechanism and fragmentation of care provision performing an important role in animating the UK economy.
authors.affiliation: Health Secretariat of Rio de Janeiro Municipality, Family and Community Medicine Specialty Training Programme, 16, Evaristo da Veiga Street, Cinelandia, 20031-040 Rio de Janeiro, RJ, Brazil. Electronic address: a.h.norman@dunelm.org.uk.
authors.forename: Armando H
authors.initials: AH
authors.lastname: Norman
authors.affiliation: Durham University, Anthropology Department, Dawson Building, South Road, DH1 3LE Durham, County Durham, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Russell
authors.affiliation: Durham University, Anthropology Department, Dawson Building, South Road, DH1 3LE Durham, County Durham, United Kingdom.
authors.forename: Claudia
authors.initials: C
authors.lastname: Merli
mesh_terms: D032821:Commodification; D058006:General Practice / Q000191:economics / Q000592:standards*; D006801:Humans; D011320:Primary Health Care / Q000191:economics / Q000379:methods; D058996:Quality Improvement / Q000191:economics*; D012052:Reimbursement, Incentive; D006113:United Kingdom
keywords: Audit culture; Clinical governance; Commodification; General practice; Health policy; Health technology; Pay-for-Performance; United Kingdom