Table 3

Organisation measure example:Quality and Outcomes Framework

CriteriaMeasure suitability
InstrumentNHS England 2019/20 General Medical Services contract Quality and Outcomes Framework, End-of-life care88
DescriptionMetric designed to facilitate improved care, explicitly linked to funding. Current metric focuses on the identification of patients on an end-of-life care register, and the recording of advance care planning conversations.
Care settingGeneral practice only, although criteria assessed may have relevance for care provision in other settings (eg, advance care planning may facilitate improved awareness of end-of-life patients in hospital through better identification of needs).
Patient populationAll patients recognised to be close to the end of life known to general practitioners. Excludes patients not formally recognised as end of life, likely to be those with uncertain or non-cancer terminal diagnoses.
Measure feasibilityAs part of a nationally recognised payment incentive scheme, completion across English general practices is high. Collated with other QOF metrics, findings are processed and available via NHS England.
Care qualityMetrics assessed are only proxies of end-of-life care quality. While both timely identification of end-of-life patients and advance care planning are associated with good care provision, neither guarantee good care nor demonstrate that appropriate care has been enacted.