Article Text

Download PDFPDF

Longitudinal evaluation of a countywide alternative to the Quality and Outcomes Framework in UK General Practice aimed at improving Person Centred Coordinated Care
  1. James Close1,
  2. Ben Fosh1,
  3. Hannah Wheat2,
  4. Jane Horrell1,
  5. William Lee1,
  6. Richard Byng3,
  7. Michael Bainbridge4,
  8. Richard Blackwell5,
  9. Louise Witts5,
  10. Louise Hall5,
  11. Helen Lloyd6
  1. 1Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
  2. 2Sociology, Philosophy and Anthropology Department, University of Exeter, Exeter, UK
  3. 3Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
  4. 4NHS Somerset Clinical Commissioning Group, Yeovil, UK
  5. 5South West Academic Health Science Network, Exeter, UK
  6. 6Psychology, University of Plymouth, Plymouth, UK
  1. Correspondence to Dr James Close; james.close{at}


Objectives To evaluate a county-wide deincentivisation of the Quality and Outcomes Framework (QOF) payment scheme for UK General Practice (GP).

Setting In 2014, National Health Service England signalled a move towards devolution of QOF to Clinical Commissioning Groups. Fifty-five GPs in Somerset established the Somerset Practice Quality Scheme (SPQS)—a deincentivisation of QOF—with the goal of redirecting resources towards Person Centred Coordinated Care (P3C), especially for those with long-term conditions (LTCs). We evaluated the impact on processes and outcomes of care from April 2016 to March 2017.

Participants and design The evaluation used data from 55 SPQS practices and 17 regional control practices for three survey instruments. We collected patient experiences (‘P3C-EQ’; 2363 returns from patients with 1+LTC; 36% response rate), staff experiences (‘P3C-practitioner’; 127 professionals) and organisational data (‘P3C-OCT’; 36 of 55 practices at two time points, 65% response rate; 17 control practices). Hospital Episode Statistics emergency admission data were analysed for 2014–2017 for ambulatory-sensitive conditions across Somerset using interrupted time series.

Results Patient and practitioner experiences were similar in SPQS versus control practices. However, discretion from QOF incentives resulted in time savings in the majority of practices, and SPQS practice data showed a significant increase in P3C oriented organisational processes, with a moderate effect size (Wilcoxon signed rank test; p=0.01; r=0.42). Analysis of transformation plans and organisational data suggested stronger federation-level agreements and informal networks, increased multidisciplinary working, reallocation of resources for other healthcare professionals and changes to the structure and timings of GP appointments. No disbenefits were detected in admission data.

Conclusion The SPQS scheme leveraged time savings and reduced administrative burden via discretionary removal of QOF incentives, enabling practices to engage actively in a number of schemes aimed at improving care for people with LTCs. We found no differences in the experiences of patients or healthcare professionals between SPQS and control practices.

  • organisational development
  • organisation of health services
  • quality in health care
  • primary care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors JC corresponded with partaking practices, collected data, analysed data and compiled manuscript. BF input, validated and analysed data. HW corresponded with partaking practices and collected data. JH corresponded with partaking practices and collected data. WL supported the Interrupted Time Series analysis. RBy aided study design and conception. MB corresponded with partaking practices and data collection. LW helped with study design, data collection and corresponded with partaking practices. RBl collected and analysed data for Hospital Episode Statistics. LH corresponded with partaking practices and collected data. HL designed and oversaw the study from inception to completion. All authors read, contributed to and approved the manuscript.

  • Funding This research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula. Funding for this evaluation was provided by South West Academic Health Sciences Network (SWAHSN). BF was supported by additional funding from the University of Gothenburg Centre for Person-centred Care (GPCC)

  • Competing interests None declared.

  • Ethics approval Ethical clearance was obtained from the Plymouth University Ethics Committees (FREC). All participants were given an information pack about the study and gave informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Patient consent for publication Not required.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.