Exploring the Organisational Impact of the NHS Quality and Outcomes Framework (QOF) in GP Practices

ABSTRACT The NHS Quality and Outcomes Framework (QOF) is a Payment for Performance (P4P) scheme that was launched on 1 April 2004, as a key feature of the new General Medical Service (GMS) contract. Previous research has revealed that GP practices made several organisational changes after the introduction of QOF. However, there is no clear evidence on how the change process was undergone in practices and what factors contributed to this process. Thus, this thesis is interested in exploring the change process from the perspective of organisational memory. The primary aim is to explore how and why QOF served as a trigger for change in influencing the direction of GP practices and the extent of change that was made in GP practices because of QOF. An in-depth qualitative case study was conducted in four large GP practices in the north of England. Semi-structured interviews with thirty nine informants, including 15 GP partners, 2 salaried GPs, 4 practice managers, 9 nurses, 2 healthcare assistants (HCAs) and 7 administration staff were considered as the main source of data. The study was able to provide evidence that the GP practices developed their strategy to respond to QOF, based on their organisational memory and competence. It was also found that organisational structure contributed strongly to the enhancement of organisational memory, which in turn led to better organisational competence. These findings provide insight into practices engaging in an emergent type of change. This was evident through their strategic decision making and the idea of contextualism, which underlay their unique responses during the changes. The study revealed that the practices were engaged in predominantly strategic level change. The significant contribution of this thesis is how organisational memory and competence could be used to understand the phenomenon of change in health care settings.