Skip to main content

Systematic review of the role of the Quality and Outcomes Framework in the care of long-term conditions

Forbes, Lindsay, Marchand, Catherine, Doran, Tim, Peckham, Stephen (2017) Systematic review of the role of the Quality and Outcomes Framework in the care of long-term conditions. British Journal of General Practice, 67 (664). e775-e784. ISSN 0960-1643. E-ISSN 1478-5242. (doi:10.3399/bjgp17X693077)

PDF - Publisher pdf

Creative Commons Licence
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Download (148kB) Preview
PDF - Author's Accepted Manuscript
Restricted to Repository staff only
Contact us about this Publication Download (444kB)
Official URL


Background Improving care for people with long-term conditions is central to NHS policy. It has been suggested that the Quality and Outcomes Framework (QOF), a pay-for-performance scheme in primary care that rewards practices for delivering effective interventions in the management of longterm conditions, does not encourage high quality care for this group of patients. Aim To examine the evidence that the QOF has improved quality of care of patients with long-term conditions. Design Systematic review Method We used electronic databases to search for peer-reviewed empirical quantitative research on the QOF published since the scheme’s introduction in 2004. We searched for studies examining the effect of QOF on a broad range of processes and outcomes of care, including coordination and integration of care, holistic and personalised care, self-care, patient experience, physiological and biochemical outcomes, health service utilisation, and mortality. We carried out a narrative synthesis because the studies were heterogeneous. Results The QOF was associated with a modest slowing of the increase in emergency admission rates, a modest slowing of the increase in consultation rates in severe mental illness, and modest improvements in certain aspects of the care of diabetes. The nature of the evidence means that we cannot be sure that any of these associations is causal. No clear effect on mortality has been demonstrated. We found no evidence to suggest that QOF influences, positively or negatively, integration or coordination of care, holistic or personalised care, self-care, or patients’ experience, quality of life or satisfaction. Conclusion The NHS should consider more broadly what constitutes high quality primary care for people with long-term conditions, and consider other ways of motivating primary care to deliver it.

Item Type: Article
DOI/Identification number: 10.3399/bjgp17X693077
Uncontrolled keywords: Primary Health Care, Quality of Health Care Reimbursement, Incentive
Subjects: H Social Sciences > H Social Sciences (General)
H Social Sciences > HM Sociology
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Paula Loader
Date Deposited: 26 May 2017 13:52 UTC
Last Modified: 29 May 2019 19:04 UTC
Resource URI: (The current URI for this page, for reference purposes)
Forbes, Lindsay:
Peckham, Stephen:
  • Depositors only (login required):


Downloads per month over past year