Table 1.

Primary research studies examining the effect of QOF on patient management and outcomes

AuthorsYear of publicationGeographical area and period under studyMain outcomeKey results
Ryan A, et al 382016Populations of UK and 27 other high income countries,1994–2010.Mortality levels from chronic diseases targeted by QOF.Mortality fell in all countries over the period.
QOF not associated with any step change in mortality in the UK.
Difference between mortality/100 000 between UK observed and expected −3.7 (95% CI = −8.2 to 0.8).
Harrison MJ, et al 392014All English practices, 1998–2010.Rates of emergency admissions:

  • that can be prevented in the community, including those for

    • — conditions for which care incentivised in QOF

    • — conditions for which care not incentivised in QOF

  • that cannot be prevented in community care.

Emergency admission rates increased by 34%, but rate of increase lower for conditions for which care incentivised by QOF than other types of emergency admission.

  • In 2003, no difference in emergency admission rates between those for conditions for which care is incentivised by QOF and those for which care not incentivised by QOF.

  • By 2010, rates of emergency admissions for conditions for which care is incentivised by QOF 8% (95% CI = 6.9 to 9.1) lower than those for which care is not incentivised by QOF.

  • By 2010, rates of emergency admissions for conditions for which care is incentivised by QOF 11% (95% CI = 10.1 to 11.7) lower than those that cannot be prevented.


The lower increase in emergency admission rates among those for whom care incentivised by QOF was mainly driven by admissions for coronary heart disease.
Kontopantelis E, et al 402015A total of 627 practices in the CPRD across UK, 2000–2011.Primary care consultation rates in people with SMI and people without SMI.Mean consultation rates between 2000 and 2011:

  • in SMI — increased from 22 to 49 per year (92% increase);

  • people without SMI — increased from 10 to 19 per year (75% increase).


For both, trend of increasing rates before 2004. Significant step change increase in 2004 for both groups, much bigger step change for people with SMI. After this, rate of increase declined in both groups.
Face-to-face consultation rate:

  • in people with SMI, nine/patient/year 2000–2003, rising to 11/patient/year in 2011;.

  • in people without SMI, about five/patient/year over the whole period.

Gallagher N, et al 412015A total of 516 practices in the GPRD across UK, 1999–2008.The % of newly diagnosed patients with type 2 diabetes prescribed medication within 24 months after diagnosis.Pre-intervention 1999–2003: rate decreasing by 1.4% per year (95% CI = 0.8 to 2.1).
Post-intervention 2004–2008: rate increased by 1.6% per year (95% CI = 0.8 to 2.3).
Kontopantelis E, et al 422013A total of 148 practices in the GPRD across England, 2001–2006.Delivery of care of type 2 diabetes — composite of achievement of the 17 diabetes QOF indicators, including processes and outcomes.Pre-intervention 2001–2003: delivery of care improving.
Post-intervention 2004–2006: delivery of care improved over and above the previous trend. In the first year, 14% improvement in score over and above expected (95% CI = 13.7 to 14.6). By third year, 7% improvement in score over and above expected (95% CI = 6.7 to 8.0).

  • CI = confidence interval. CPRD = Clinical Practice Research Datalink. GPRD = General Practice Research Database. QOF = Quality and Outcomes Framework. SMI = severe mental illness.