Quality and outcomes framework

GP taking blood pressure

The quality and outcomes framework (QOF) is part of the General Medical Services (GMS) contract for general practices and was introduced on 1 April 2004.

The QOF rewards practices for the provision of 'quality care' and helps to fund further improvements in the delivery of clinical care.

Practice participation in QOF is voluntary but most practices with GMS contracts, as well as many with Personal Medical Services (PMS) contracts, take part in QOF. 

When QOF was first introduced, the following principles were agreed on where QOF standards should apply:

  • where responsibility for ongoing management of the patient rests primarily with the GP and the primary care team
  • where there is evidence of health benefits resulting from improved primary care
  • where the disease is a priority in a number of the four nations.

From 2013/14 the QOF agreement in England is different to the agreements in Scotland, Northern Ireland and Wales.

Access the 2016/17 QOF guidance.

Download a summary of the changes to QOF for 2016/17.

A set of FAQs has been developed to support commissioners in delivery of the GMS contract, these FAQs can be found on our QOF FAQs page.

Details of QOF changes by year can be found on these pages:

Changes to QOF 2016/17

Changes to QOF 2015/16

Changes to QOF 2014/15 

Changes to QOF 2013/14

Changes to QOF 2012/13

Changes to QOF 2011/12

Changes to QOF 2010/11

Changes to QOF 2009/10

Changes to QOF 2008/09

Changes to QOF 2006/07

Introducing QOF 2004

Developing QOF

How QOF works

QOF domains and indicators

The QOF has a range of national quality standards, based on the best available, research-based evidence covering three domains.  Each domain has measures of achievement, known as indicators, against which practices score points according to their level of achievement. Practice payments are calculated on the points achieved and prevalence (see prevalence below).

The three domains are:

  • Clinical - this domain has indicators across different clinical areas e.g. coronary heart disease, heart failure and hypertension.
  • Public health (PH) -  this domain has indicators across clinical and health improvement  areas e.g. smoking and obesity.
  • PH including additional services sub domain - this sub domain has indicators across the two service areas of cervical screening and contraceptive services.

QOF points

For 2015/16, there are a maximum of 559 points available to practices across QOF, which in turn determine payments. The key payment dates each year are:

  • on 31 March data is collected from practice systems for which practices are paid retrospectively for points achieved in the previous year. The pound per point for 2015/16 is £160.15. The value of a QOF point differs across Wales, Scotland and Northern Ireland.
  • by the end of June - payments should be completed, although they can be made earlier when they have been agreed by the practice and commissioner.

Payments are subject to certain thresholds (targets) and take account of the national prevalence of diseases, by applying a standard calculation to all practices.


A practice's achievement payments, are based on the number of patients on each disease register, known as ‘recorded disease prevalence’.  In certain cases, practices can exclude patients which is known as ‘exception reporting’ - more details are available in the Statement of Financial Entitlements.  Strict criteria are used for this process and practices may be required to provide evidence of any patient that is ‘exception reported’.

Further information

The full set of indicators of achievement are outlined in the latest QOF guidance, published by NHS Employers, which is updated for each year.

QOF results are published annually for the following countries, by the following organisations:

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