My new editorial in the BMJ discusses the GP Quality and Outcomes Framework (QOF). My conclusion is that QOF in England requires selective reform rather than wholesale abolition. While QOF initially improved recorded quality of care through financial incentives, these gains are not always sustained long-term and may not reflect true clinical improvements.
Policymakers should be encouraged to retain the most effective elements — particularly those related to early detection and management of long-term conditions — while removing less useful or overly bureaucratic aspects. Going forward, QOF should be integrated into a broader strategy that supports sustainable quality improvement, continuity of care, and minimised administrative burden, using developments in information technology to support better outcomes and reduce health inequalities.
Majeed A, Molokhia M. Impact of pay for performance in primary care. BMJ 2025; 389 :r1171 doi:10.1136/bmj.r1171