The perfect English patient

Introduction

A recent note examined the revised UK National Institute for Care and Health Excellence (NICE) guidelines for cardiovascular disease (CVD) (Ref 1). In that note, we briefly looked at the Quality and Outcomes Framework (QOF), which was introduced in April 2004. The QOF is the system used to ensure that General Practitioner (GP) surgeries (family doctors to US people) do what the governments of the UK want them to do. Points mean money for the practice, so surgeries do their best to deliver QOF targets. Points are earned for patient profiles and outcomes, so some patients are more valuable to surgeries than others.

Since 1999, health has been devolved to the four countries of the UK: England, Northern Ireland, Scotland and Wales. In health matters generally, over time, Northern Ireland, Scotland and Wales, have increasingly broken away from England and introduced their own health policies. This was most apparent during Covid, when houses on one side of a street in Wales had different restrictions to houses on the other side of a street in England (Ref 2).

The Quality and Outcomes Framework (QOF) was introduced as part of the general medical services contract to replace other fee arrangements for general practices that were in existence at the time. The original arrangements allowed practices to earn up to 1,050 QOF points across 146 different indicators. The general medical services contract was revised in April 2006 and the number of key clinical areas was increased. The total number of points available was reduced to 1,000 and 138 points were reassigned.