Examples of what has been done

Incentives for GPs to refer patients for specialist diagnosis of heart failure


The Quality Outcomes Framework (QOF) is an annual incentive programme for GPs in the UK to achieve improvements in certain health indicators. It includes an incentive to improve the specialist diagnosis of HF patients.

What they did

The QOF is the annual reward and incentive programme detailing GP practice achievement results in the UK. QOF indicator NM116 measures the percentage of people with heart failure who have had their diagnosis confirmed by an echocardiogram or specialist assessment within 12 months. This indicator aligns with the National Institute for Health and Care Excellence (NICE) guidance to provide incentives for practices to ensure that all people with heart failure undergo specialist investigation.

What they achieved?

The effectiveness of QOF in improving quality of care for incentivized conditions are modest, with the impact on costs, professional behavior and patient experience remaining uncertain.1

Resources and other practical implications

Further research is needed on how to improve quality of care in across health care domains. Health care organisations should be cautious of potential adverse effects of incentive schemes.1

Links, references, and key reading


  1. Gillam S, Niroshan Siriwardena A, Steel N. Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework—A Systematic Review. Ann Fam Med 2012;10(5):416-68.