Performance related pay does not lead to better long-term health care

Offering general practices more money according to the number of people with long-term health conditions like diabetes, cancer or dementia they treat does not lead to improved care.

The study, led by Dr Lindsay Forbes from the University’s Centre for Health Services Studies (CHSS) and commissioned by NHS England, assessed the Quality and Outcomes Framework (QOF), the world’s largest pay-for-performance scheme in primary care.

Around 99% of GPs in England are part of the QOF, which was introduced in 2004 to try and create a more uniform standard of care across surgeries, and on average around 10-15% of income for general practices is derived from the scheme. However, this has led to criticism that many GPs over-prioritise QOF related activities because they are so reliant on the additional income it provides.

Furthermore, there is an increased focus within the NHS to better manage and treat people with long-term conditions, who take up some 70% of health service resources. As such there is a concern the QOF is no longer suitable as it does not encourage GPs to manage people holistically and in a way that encourages them to be involved in decisions and coordinates care across different services.

To assess this, the study by CHSS looked at a range of prior peer-reviewed, quantitative research that examined the effect the QOF has on a broad range of patient outcomes such as personalised care, self-care, patient experience, coordination of care and mortality rates, among others.

Based on the evidence the study found the QOF may be associated with some very modest positive effects in limited areas, such as slowing the increase in emergency admissions, an increase in consultations in severe mental illness and improving diabetes care.

However, the study found no evidence that the QOF leads to better coordinated care, more holistic care, better encouragement to self-care, or improved patient experience or involvement in decisions. It also had no effect on mortality rates.

As a result the paper says the NHS must consider more broadly what constitutes long-term high quality care and find other ways of motivating GPs and primary care teams beyond monetary rewards.

The full paper, entitled The role of the Quality and Outcomes Framework in the care of long-term conditions: a systematic review, has been published in the British Journal of General Practice.