TY - JOUR T1 - Commentary: Unintended consequences: what of quality outside the QOF? JF - British Journal of General Practice JO - Br J Gen Pract SP - e173 LP - e174 DO - 10.3399/bjgp09X420644 VL - 59 IS - 562 AU - James D Gubb Y1 - 2009/05/01 UR - http://bjgp.org/content/59/562/e173.abstract N2 - For over a decade general practice has been subject to increasing levels of governance, guidelines, incentives, and targets — what one professor of primary care has referred to as the ‘industrialisation’ of family medicine.1 A key step-change in this came with the introduction of the new GMS contract and Quality and Outcomes Framework (QOF) in 2004. For the first time, a significant proportion (typically around 20%, but in some cases up to one-third) of general practice income was linked to performance — predominantly against biomedical indicators of quality of care, but also practice organisation, the provision of additional services and, to a lesser degree, attention to patient experience.Gillies et al's learning journey reveals an underlying disquiet with such trends; and with the QOF in particular.2 While recognising the framework's potential to improve individual and population health, the authors cite ‘growing anxieties that the focus on the QOF, driven by financial incentives, may lead to the loss of something important but hard to measure in general practice’. Their concerns are widespread and justified.3Looking purely at biomedical indicators of quality included in the QOF, … ER -