Spence calls for hard end points such as cardiovascular mortality for the quality and outcomes framework (QOF). Other correspondents suggest that important but less measurable aspects of care have declined since the new general practice contract. Soft end points are important, but so are hard ones. In recent years UK life expectancy has steadily increased by around one year every five years, cardiovascular mortality in men under 75 fell by 38% between 1998 and 2006, and cancer survival has increased. These changes are no doubt due to a combination of societal factors and improvements in both primary and secondary care. In general practice some aspects of clinical care have dramatically improved since 1998.
展开▼
