Osteoporosis quality and outcomes framework.

In November 2011 it was announced that osteoporosis would be included in the quality and outcomes framework (QOF) for general practice (GP) in the UK. Will this make any difference? For the international reader the answer is probably none at all but within the health system of the UK it just might. The reason being that it will financially encourage primary care to pay more attention to this disease area. Primary care funding within the national health service (NHS) is complex. For anyone who is not a GP the details are likely to baffle and bore in equal measure. Some explanation is however justified in order to determine whether this will be a mechanism for promoting better care of women at and beyond menopause. General practices are usually small to medium sized, independent businesses contracted to provide services to the NHS. Payment to practices has elements that recognize the numbers of registered patients with an adjustment for deprivation, payments for ‘enhanced services’ that are over and above the core job of the GP and quality payments for meeting targets in defined clinical or organizational areas. In April 2008 osteoporosis was included in the primary care funding envelope as a designated enhanced service (DES). This funding stream encouraged practices to do extra things that they would not have done before (a ‘carrot’ approach). In return for the additional money the regulation at the time stipulated that: