An examination of changes introduced in the Quality and Outcomes Framework in 2006/07 and their effects on the delivery of primary care in Scotland

The Quality and Outcomes Framework (QOF) was introduced in 2004 across the UK National Health Service. It is an expensive and elaborate performance-related pay scheme for general practices. All participating practices report their achievements on almost 150 quality indicators to receive a performance-related bonus that could increase their income by up to 25%.

Most of the quality indicators are related to clinical diagnosis and treatment. Rewards increase linearly with the proportion of patients treated to provide an incentive to practices to treat more patients up to a maximum threshold. Changes in the reward structure were introduced in 2006/7, 2007/8 and 2009/10.

Using data from 1,000 practices in Scotland and 8,000 in England, we examined how general practices responded to these changes. We then modelled treatment rates in later years as functions of earlier years’ treatment rates and changes to the reward functions across the years. This will inform future adjustments to the QOF.

Outcome and Translation

This research indicated that practices are responsive to even small changes in financial rewards and suggests that even small changes to the design of pay-for-performance schemes can stimulate further improvements in quality.

HERU researchers involved in this research project: Diane Skåtun and Ada Ma

External collaborators: M Sutton (University of Manchester); B Guthrie (University of Dundee) and H Gravelle (University of York)


Ma, A., Skåtun, D., Sutton, M., Guthrie, B. and Gravelle, H. (2011) An examination of changes introduced in the quality and outcomes framework in 2006/07 and their effects of the delivery of primary care in Scotland. Chief Scientist Office Final Report, Edinburgh: Scottish Government Chief Scientist Office.