Study Finds Limited Long-Term Impact of GP Performance Pay on Quality of Care
A comprehensive review reveals that performance-related pay for UK general practices leads to short-term improvements in care quality, but these gains are not sustained long-term, especially after incentives are withdrawn. The findings highlight the need for more effective strategies in healthcare quality improvement.
A recent study published in The BMJ has revealed that implementing performance-based pay for UK general practices initially improved the quality of healthcare services, but these gains did not last beyond the expected trends. The research focused on the UK's Quality and Outcomes Framework (QOF), a pay-for-performance scheme introduced in 2004 to incentivize high-quality care across various health conditions such as cancer, diabetes, heart disease, mental health, and obesity. In 2014, many indicators were removed from the program, and by 2016, Scotland had abolished the scheme altogether.
The review analyzed 11 studies assessing the impact of incentives for 83 indicators and the withdrawal for 31 indicators at multiple time points. Findings showed that, on average, quality improvements in care recorded during QOF's implementation were about 6.1% higher than predicted after one year, but this effect diminished significantly to only 0.7% after three years. Conversely, the removal of incentives led to notable declines—approximately 10.7% after one year and 12.8% after three years—indicating that the positive effects of financial incentives are often not sustainable without ongoing motivation.
More complex health process indicators, such as foot screenings in diabetic patients, suffered larger declines compared to simpler metrics like blood pressure measurement, and some non-incentivized areas of care also experienced small declines after three years. The authors highlighted that these observational findings cannot definitively establish causality, and distinguishing between actual changes in care versus data recording was challenging. Additionally, some indicators were already near maximum levels before being incentivized, limiting potential improvement.
The study concludes that financial incentives might play a role in engaging practices in broader quality initiatives, but their long-term effectiveness is questionable. As health systems worldwide strive to improve care quality amid financial constraints, these findings suggest that sustainable strategies are needed beyond pay-for-performance schemes. Developing more integrated approaches utilizing technological advances could be vital for reducing health inequalities and enhancing outcomes.
For more details, the original research can be found in The BMJ (2025). Source: https://medicalxpress.com/news/2025-06-gp-pay-quality.html
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