Reaching the parts that QOF cannot reach: An Early Evaluation of a General Practice Quality Improvement Initiative in the English NHS

Talk Code: 
Donna Bramwell
Author institutions: 
University of Manchester


The 2018 review of the Quality and Outcomes Framework (QOF) found that its narrow focus on recording of multiple single processes and outcomes may not promote delivery of holistic, patient-centred care, limiting the role of professional judgement. One of the subsequent reforms to the QOF was the introduction of incentives for quality improvement (QI) activities for particular patient groups – in 2019-20 people at end-of-life and people taking certain medications i.e., valproate, lithium and non-steroidal anti-inflammatory drugs. In this presentation we report on a study commissioned by NHS England to examine how the first two QI modules have been received by practice staff, their experiences in implementing them and the practical challenges they faced in doing so. This will inform further implementation of QI modules.


We conducted 25 semi-structured, telephone interviews with practice managers between July and November 2019.We asked questions exploring experiences and perceptions of implementation of the QI modules. Interviews were audio-recorded and transcribed. Data were analysed using the Framework Method.


Despite delays caused by late release of business rules and templates, practices were generally accepting of the principle of incentivising QI. Practices reported that the prescribing safety module was straightforward to implement being already experienced in this.  The end-of-life module was perceived as more challenging because of the lack of indicators of good quality care and the need to survey patients and carers at a sensitive time. Participants also indicated that collaborating with colleagues across their Primary Care Networks (PCNs) on the modules was working well, although anticipated that this could be challenging in the future.


This work will be of interest to all general practice staff engaged in QOF implementation and researchers examining quality improvement in primary care. This work is important because the findings are reported directly to NHS England to inform future policy developments.


Presenting author: Dr Donna Bramwell - Division of Population Health, Health Services Research and Primary Care,            

                                University of Manchester,, @DonnaBramwell



1. Professor Lindsay Forbes, Clinical Professor of Public Health - Centre for Health Services Studies, University of Kent,

2. Dr Sarah Hotham - Centre for Health Services Studies, University of Kent,, @DrSarahHotham