A new systematic review of the UK Quality and Outcomes Framework (QOF) is published in the Annals of Family Medicine today. The QOF, a controversial program of financial incentives and information technology to promote structured and team-based care, is the most comprehensive national primary care pay-for-performance (P4P) program in the 
world.
The authors, Steve Gillam (University of Cambridge), Niro Siriwardena (University of Lincoln) and Nick Steel (University of East Anglia) found, despite an annual investment of over a billion pounds per year in incentives, only modest improvements since the QOF was introduced in 2004. The systematic review follows on from a book, co-edited by Steve Gillam and Niro Siriwardena entitled ‘The QOF: transforming general practice’ published in 2010.
The QOF has also contributed to reduced continuity of care and may have detracted from patient-centred care. In view of the findings policy makers should be cautious about implementing similar P4P programs. Systems need to be developed which improve quality while minimizing costs and unintended consequences.