Quality and Outcomes Framework (QOF)

In June 2003 GPs voted in favour of a new contract- The New General Medical Services Contract.

A sizeable proportion of my pay now comes from part of the new contract called the quality and outcomes framework, known as QOF, and pronounced as quaff.

The QOF is designed to "reward good clinical practice". But ask many GPs and they'll tell you it is converting us to "tick-box medicine" practitioners.

Let me explain a bit more.

The QOF pays you points for doing certain things- for instance if you keep a list of patients with an underactive thyroid, you score 2 points. Do a blood test during the year in more than 90% of these people to check whether they are getting enough thyroxine and you score a further 6 points.

In the year 2004/05 the average full time GP was paid roughly £25 per point. In 2005/06 this went up to £40 per point. There were up to 1050 points available.

For a complete run down on what you could score points for look here.

There are points to be scored for checking smoking status. Have you found that suddenly your GP is very interested in whether you smoke or not? That's because there are a lot of points available for asking these questions of asthmatics, diabetics, and certain other patients. How does this improve patient care? It doesn't, but it's a box to tick.

The government thought we as GPs would only score 750 odd points in the first year, and only budgeted for this. However the majority of GPs scored more than 1000 points.

Were we praised for performing so well? Of course not. We have been portrayed by the government as money grabbing, and responsible for the NHS overspend.

So now the goalposts have changed for 2006/07. More targets, tougher targets, and now only 1000 points.