The Future of the Quality and Outcomes Framework (QOF) in England’s NHS

The Quality and Outcomes Framework (QOF) was introduced in 2004 as part of a new NHS GP contract with the aim of financially rewarding general practices for delivering evidence-based standards of care. While initially unique internationally, the QOF in the UK is now facing uncertainty, with calls to cut it back or abolish it due to various challenges faced by the NHS. In an article published in the journal BJJP Open, Mariam Molokhia and I discuss the role of the QOF in England’s NHS and argue for its importance in improving health outcomes and addressing public health challenges.

The Importance of Comprehensive Health Services

Primary care plays a vital role in providing comprehensive health services, covering both acute and long-term conditions. Beyond immediate patient needs, the focus should be on prevention, early diagnosis, and management of chronic diseases that contribute significantly to ill health, reduced quality of life, and increased NHS workload. Amid the COVID-19 pandemic, urgent care rightfully took precedence, but it is now crucial to restore high-quality care for long-term conditions.

The Role of QOF in Addressing Public Health Challenges

Public health challenges have underscored the importance of the QOF, especially in areas focused on secondary prevention and long-term condition management. Meeting QOF targets for conditions like type 2 diabetes leads to lower mortality rates, reduced emergency hospital admissions, and improved health outcomes. By using the QOF effectively, the NHS can alleviate pressures on other healthcare sectors and improve patient well-being.

Data Measurement and Research 

The QOF also facilitates data collection and measurement of healthcare quality, essential for planning health services, addressing health inequalities, and ensuring efficient use of public investments. The structured data entry required for QOF enables its use for clinical research, as shown during the COVID-19 pandemic. Abolishing or significantly cutting back the QOF would have far-reaching negative consequences, undermining these benefits.

Supporting Primary Care Teams and Addressing Challenges

Rather than discarding the QOF, it is crucial to support primary care teams in delivering structured care while addressing urgent patient needs. Adequate funding, including a review of funding allocation mechanisms, is necessary. Additionally, workforce issues should be addressed, promoting staff retention and expanding recruitment into new primary care roles. Integration of pharmacy and general practice services can also enhance primary care capabilities. Leveraging information technology and the wider primary care team can enable the delivery of QOF elements at scale, streamlining care processes and improving the efficiency of QOF.

Retaining Essential Elements of QOF

While criticisms exist regarding the QOF’s reporting domains and its evaluation of important dimensions of care quality, it is essential to retain its best elements. This includes focusing on early detection and management of long-term conditions while improving support through information technology and the wider primary care team. Recent research from Scotland demonstrates that the elimination of financial incentives can lead to reductions in recorded quality of care, emphasizing the importance of maintaining an effective QOF program.


The Quality and Outcomes Framework (QOF) remains an integral part of England’s NHS. Despite challenges faced by the healthcare system, the QOF’s role in improving health outcomes, addressing public health challenges, and promoting comprehensive care cannot be overlooked. By adequately supporting primary care teams, addressing workforce issues, and using technology and the wider primary care team, the QOF can continue to play a crucial role in reducing health inequalities and improving health outcomes in England.