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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

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Abstract:

Background: In 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.

Aim: To investigate in detail the impact of the QOF on practice organisation and service delivery.

Methods: Two 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 conclusion: A number of significant changes to practice organisation and service delivery were observed, including: changes to practice organisational 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.

Keywords: BIOMEDICAL MODEL; GENERAL PRACTICE; ORGANISATION; PAY-FOR-PERFORMANCE; QUALITY AND OUTCOMES FRAMEWORK

Document Type: Research Article

Affiliations: 1: Walport Clinical Lecturer in Primary Care, National Primary Care Research and Development Centre, University of Manchester, Manchester, UK 2: Professor of Social Policy, National Primary Care Research and Development Centre, University of Manchester, Manchester, UK

Publication date: April 1, 2010

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