TY - JOUR T1 - The Quality and Outcomes Framework: too early for a final verdict JF - British Journal of General Practice JO - Br J Gen Pract SP - 525 LP - 527 VL - 57 IS - 540 AU - Martin Roland Y1 - 2007/07/01 UR - http://bjgp.org/content/57/540/525.abstract N2 - An editorial in this Journal in 2002 suggested that the new GP contract could prove to be the requiem or renaissance for general practice.1 What has been learned 5 years on?One obvious impact of the Quality and Outcomes Framework (QOF) has been the high quality scores achieved in the first year and the widely-publicised financial rewards. In retrospect, it is easy to see how GPs were able to score so well. Care was already improving rapidly in the years leading up to the new contract. So, for heart disease, for example, the percentage of patients with controlled blood pressure rose from 47% to 72% between 1998 and 2003, and the percentage of patients with cholesterol within recommended levels increased from 18 to 61 % in the same period.2 The roots for these improvements go back a decade or more. Audit was introduced as a compulsory part of the 1990 GP contract and seemed to have a modest impact at the time.3,4 But what happened during that decade was that GPs gradually started using electronic records, they got used to comparing their care with others, and many GPs employed nurses to improve the care of chronic illness. So, when the QOF came along, much of the infrastructure for quality improvement was already in place, and GPs were able to respond rapidly to the new incentives.Since the QOF was introduced, quality of care shows further improvement. For asthma and diabetes, care is now improving more rapidly than before the contract. For coronary heart disease, where care was already showing major change, the improvement has continued at the same rate.5 Care in relation to these three diseases has undergone definite if modest improvements over and above what was already being achieved. These trends should have … ER -