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Open Access Highly Accessed Research article

The UK Quality and Outcomes Framework pay-for-performance scheme and spirometry: rewarding quality or just quantity? A cross-sectional study in Rotherham, UK

Mark Strong13*, Gail South2 and Robin Carlisle3

Author Affiliations

1 School of Health and Related Research, University of Sheffield, Regent Court, Sheffield, S1 4DA, UK

2 Breathing Space Primary Care Respiratory Centre, Badsley Moor Lane, Rotherham, S65 2QL, UK

3 Rotherham Primary Care Trust, Oak House, Moorhead Way, Rotherham, S66 1YY, UK

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BMC Health Services Research 2009, 9:108  doi:10.1186/1472-6963-9-108

Published: 28 June 2009



Accurate spirometry is important in the management of COPD. The UK Quality and Outcomes Framework pay-for-performance scheme for general practitioners includes spirometry related indicators within its COPD domain. It is not known whether high achievement against QOF spirometry indicators is associated with spirometry to BTS standards.


Data were obtained from the records of 3,217 patients randomly sampled from 5,649 patients with COPD in 38 general practices in Rotherham, UK. Severity of airflow obstruction was categorised by FEV1 (% predicted) according to NICE guidelines. This was compared with clinician recorded COPD severity. The proportion of patients whose spirometry met BTS standards was calculated in each practice using a random sub-sample of 761 patients. The Spearman rank correlation between practice level QOF spirometry achievement and performance against BTS spirometry standards was calculated.


Spirometry as assessed by clinical records was to BTS standards in 31% of cases (range at practice level 0% to 74%). The categorisation of airflow obstruction according to the most recent spirometry results did not agree well with the clinical categorisation of COPD recorded in the notes (Cohen's kappa = 0.34, 0.30 – 0.38). 12% of patients on COPD registers had FEV1 (% predicted) results recorded that did not support the diagnosis of COPD. There was no association between quality, as measured by adherence to BTS spirometry standards, and either QOF COPD9 achievement (Spearman's rho = -0.11), or QOF COPD10 achievement (rho = 0.01).


The UK Quality and Outcomes Framework currently assesses the quantity, but not the quality of spirometry.