TY - JOUR T1 - Secrecy and coercion in the QOF: a scandal averted? JF - British Journal of General Practice JO - Br J Gen Pract SP - 250 LP - 251 DO - 10.3399/bjgp17X690977 VL - 67 IS - 659 AU - Charlotte Williamson Y1 - 2017/06/01 UR - http://bjgp.org/content/67/659/250.abstract N2 - The Quality and Outcomes Framework (QOF) has ended in Scotland and is viewed with disapproval by some GPs in the rest of the UK.1 This is a good time to look at how it works: does it conform to medical ethics and, in particular, does it ensure that patients’ autonomy will be respected, since that is a fundamental principle in medical ethics?2 We can answer this question by reading the reports of inquiries into two high-profile ‘hospital scandals’ published shortly before the QOF was introduced into general practice in 2004. Official public inquiries found that the Bristol Royal Infirmary had sought parents’ consent to cardiac surgery on their child, without telling them that their surgeons’ outcomes were worse than in other hospitals.3 Doctors had also not told parents that, if they consented to a postmortem, their child’s organs might be retained for research, teaching, or audit, rather than being replaced in the child’s body. Alder Hey Hospital in Liverpool had also kept this practice secret.4 The inquiries’ reports concluded that parents or patients must be given all the information they need to reach their decisions on consent. Put another way, consent obtained without offering all relevant information is consent obtained coercively, denying patients autonomy.5 Thus the ‘scandals’ showed what patients’ autonomy meant in practice and why secrecy was unethical. The parents’ distress, the public’s disquiet, and the doctors’ dismay and regret were so manifest that it seemed that such breaches of medical ethics could never occur again. Yet for the QOF, they have.The QOF is a managerial scheme, not a … ER -