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

Kath Checkland, Stephen Harrison

BackgroundIn 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. AimTo investigate in detail the impact of the QOF on practice  organisation and service delivery.MethodsTwo 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. Results and conclusionA number of significant changes to practice organisation and service delivery were observed, including: changes to practice organizational 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.