Increasing the QOF upper payment threshold in general practices in England: impact of implementing government proposals

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Background: General practices in the UK receive incentive payments for managing patients with selected chronic conditions under the Quality and Outcomes Framework (QOF) scheme. Payments are made when a negotiated threshold percentage of patients receive the appropriate intervention.

Aim: From 2013–2014 in England the Department of Health has proposed that this negotiated threshold is replaced with a value equal to the 75th percentile of national performance to attract maximum payments. This is an investigation of the potential impact of this change on practice income and workload.

Design and setting: Analysis of 2011–2012 QOF dataset (the latest available) which covers 8123 GP practices and 55.5 million patients in England.

Method: The 75th percentile of performance was calculated for 52 clinical indicators and applied to 2011–2012 performance. Estimations were made of financial and workload impacts on practices, and whether practices with different characteristics would be disproportionately affected.

Results: The proposed changes will result in an increase in the upper payment threshold of each clinical indicator by a mean of 7.47% (range 2.16–38.87%). If performance remains static practices would lose a mean of 47.68 (0–108.33) QOF points, equivalent to a mean financial change of −£279.60 (−£35 352.50 to +£19 957.78) per practice for these 52 indicators.

Conclusion: Increasing the QOF upper payment threshold to the 75th percentile of national performance will, if clinical performance remains static, substantially reduce the mean number of QOF points achieved per practice. However, this translates into only a small mean loss of income per practice.


Original languageEnglish
Pages (from-to)e54-e59
JournalBritish Journal of General Practice
Issue number618
Publication statusPublished - 1 Jan 2014


  • incentive, general practice, outcomes, payment, QOF