• Henricus van den Heuvel, Peter Mand, Susanne Heim, and Eva Hummers-Pradier.
• Institute of General Practice, Hanover Medical School, Hanover, Germany. rickvandenheuvel@doctors.org.uk
• Qual Prim Care. 2010 Jan 1;18(2):85-92.

BackgroundThe Quality and Outcomes Framework (QOF) has had a major impact on chronic care provision in British general practice. Various countries are looking at whether a similar initiative could be used in their primary care systems. An extensive quality indicator system like the QOF does not exist in German general practice.AimTo describe and explore the views of German general practitioners (GPs) on the clinical indicators of the QOF.MethodsQualitative study based on focus group discussions and a framework approach for data analysis. Fifty-four German GPs were involved in seven focus groups in German primary care practices.ResultsGerman GPs expressed mixed views regarding the validity of the QOF clinical indicators to measure the quality of primary care. Most thought that these indicators covered areas that were relevant for German general practice and which were only partially covered by German quality initiatives. Participants had mixed opinions regarding linking pay and performance. Many thought that in deprived areas it would be difficult to achieve targets. Exception reporting would make achieving these targets easier, however, some believed it could lead to manipulation of figures. Many GPs saw QOF clinical indicators as a helpful structure, yet feared that introducing something similar would increase the administrative workload and be a threat to patient-centred care. Many participants were anxious that a QOF-like system could be influenced by sickness funds or the pharmaceutical industry. A few feared data protection problems if such a system were to be implemented. Several GPs expressed concerns on who would set and control such quality initiatives, feared for their autonomy and expected that in the future similar systems would be imposed upon them.ConclusionsParticipating German GPs had various concerns regarding the QOF clinical indicators and the idea of implementing a system like the QOF in German primary care. These concerns were mainly related to the validity of the indicators, the link between pay and performance, structured care versus patient centredness and the fear of external influences.

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