Has pay for performance improved the management of diabetes in the UK?

A recent article in Primary Care Diabetes examines the question of whether pay for performance has improved the management of diabetes in the United Kingdom. Over the past decade, the UK government has introduced a number of major policy initiatives to improve the quality of health care. One such initiative was the introduction of the Quality and Outcomes Framework (QOF), a pay for performance programme for general practices launched in April 2004. The QOF aimed to improve the primary care management of common chronic conditions including diabetes. The introduction of QOF has been associated with improvements in the quality indicators for diabetes care included in the framework. However, it is difficult to disentangle the impact of QOF from other quality initiatives as few studies have adjusted for underlying trends in quality. QOF may also have reduced inequalities in diabetes care between affluent and deprived areas. Less is known about the impact of QOF on aspects of diabetes care not included in the framework, including self-management and continuity of care.