Analysis of the Quality and Outcomes Framework Report for the NHS. This policy paper evaluates the progress that QOF has made since its introduction and considers the different ways in which the QOF can be reformed. It specifically looks at the role the QOF can play in tackling health inequalities, which is widely recognised as a persistent health challenge confronting the UK.Using expert opinion and stakeholder analysis, the Bow Group's detailed analysis concludes that one of the major problems informing the QOF is its perverse nature. For a framework that claims to be about quality and outcomes, the QOF is operationally geared towards emphasising process and targets. The report recommends that in order to drive up standards, there is an urgent need for a greater emphasis on outcomes indicators over process. It argues that whilst there is a clear role for process measures in supporting the foundations of the QOF, there is a real danger that a lack of focus on outcomes can drive down standards and result in perverse incentives for healthcare professionals and in turn unintended outcomes. The report also finds that the QOF's performance in reducing health inequalities has been at best mixed and at worst disappointing. Under the QOF, GPs working in inner-city areas may feel they have to work much harder, and invest more practice resources, to perform well against outcome-based quality targets. In order to counter this, the report recommends that the QOF should be reformed to contain an appropriate incentives structure to support GPs working in deprived areas.