The quality and outcomes framework has been criticised as offering 'inappropriate financial incentives' to GPs that can 'distract' them from offering the best care.

A report from right of centre think tank Civitas uses a review of recent academic research on the framework to argue that the scheme should be "downsized and downscaled sooner rather than later".

The scheme rewards GPs with bonus pay for treating or monitoring patients with certain diseases in specified ways.

Civitas health unit director James Gubb said: "Medicine is an inexact science. In encouraging more of a 'medicine by numbers' approach, there is a real risk that in the long run the QOF could inadvertently cause a decline in general practice's ability to probe symptoms, explore probabilities and give proper attention to the concerns of patients."

The report queries whether the framework can provide appropriate incentives for caring for particular patients, especially older patients, and says allowing GPs to "exception report" patients from the framework "opens it up to abuse".

But Laurence Buckman, chair of the British Medical Association's GPs committee, defended the framework and described the report as "short on evidence and long on opinion".

He added: "A lot of government health targets have distorted clinical care. Yet the QOF is different. It was never intended as just an incentive payment; its introduction marked a huge step forward in the government's promise to address health inequalities across the UK."

Earlier this year, HSJ exposed the GP practices with the highest rates of exception reporting.