Mitchell question the validity of the Quality and Outcomes Framework and suggest how it should change in the future Martin McShane medical director, long term conditions 1 , Edward Mitchell core trainee 2 1 NHS England, Medical Directorate, Leeds LS2 7UE, UK; 2 Oxford Health NHS Trust, Warneford Hospital, Oxford OX3 7JX, UK The Quality and Outcomes Framework (QOF) is a pay for performance programme that was introduced in 2004 to improve care in general practice. It now constitutes roughly 13% of practice income-QOF payments in 2013-14 were £1057m (€1451m; $1613m) (fig⇓). 1 The arguments for and against the QOF (and pay for performance schemes in general) have been hotly debated over the past decade. Its seminal impact on UK general practice is undeniable, but its influence is such that it has affected our idea of what constitutes quality improvement. It has been suggested, for example, that we equate (or perhaps conflate) good care with the recording of disease specific biomedical or process markers. 2The QOF is facing change. The 2014-15 GP contract deal has seen a 30% reduction in QOF points. 3 After eleven years, and billions of pounds in QOF payments, we take stock of the QOF and discuss three changes in the healthcare system that mean QOF must change.
PurposeChanges in demographics and disease patterns are challenging health and care systems across the world. In England, national policies have reset the direction of travel for the NHS. Collaboration, integration and personalisation are intended to become prime principles and drivers for new models of care. Central to this is the concept of population health management. This has emerged, internationally, as a method to improve population health. Fundamental for population health management to succeed is the use of integrated data, analytics combined with professional insight and the adoption of a learning health system culture. This agenda reaches beyond the NHS in England and the public health profession to embrace a broad range of stakeholders. By drawing on international experience and early experience of implementation in the United Kingdom, the potential for health and care systems in England to become world leading in population health management is explored.Design/methodology/approachA viewpoint paper.FindingsPopulation health management is a major change in the way health and care systems look at the challenges they are facing. It makes what is happening to individuals, across the continuum of care, the essence for insight and action. The NHS has the components for success and the potential to become world leading in delivery of population health management as part of its integrated care agenda.Originality/valueThis is the first viewpoint paper to set out how population health management contributes to the integrated care agenda in the NHS.
NHS funding is set to fall in real terms but it is unclear how the system will cope. Martin McShane and Richard Smith describe their experience of a simulation exercise designed to find out
Commissioning organisations in England face losing a quarter of the “quality premium” if they do not keep down their emergency admissions for specific conditions. Martin McShane supports the plan, but Chaand Nagpaul (doi:) worries about possible unintended consequences
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