Helen Salisbury: Payment for performance in general practice

Has the Quality and Outcomes Framework (QOF)—which pays GPs for recording processes and achieving clinical outcomes—led to improvements in patient care? This is the question that Ho and colleagues have tried to answer in their latest synthesis of the evidence.1 The system was introduced in 2004 and initially provided as much as a quarter of general practice income. Over the past 21 years the care indicators that are rewarded have changed, some being withdrawn and new ones introduced. This has provided a rich set of data to help identify whether incentivising specific elements of care will make them more likely to happen—and whether that improvement lasts when you stop paying. The way we look after patients with long term …