ArticleBMJ (Clinical research ed.)2007
Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study.
Article in BMJ (Clinical research ed.), 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 2 of them syntheses that pooled it.
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Who cites it
60 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Identifying primary care quality indicators for people with serious mental illness: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017Pooled it
- Health Care Professionals' Perceptions of Pay-for-Performance in Practice: A Qualitative Metasynthesis.Inquiry : a journal of medical care organization, provision and financingPooled it
- A cluster randomised stepped wedge trial to evaluate the effectiveness of a multifaceted information technology-based intervention in reducing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets in primary medical care: the DQIP study protocol.Implementation science : IS · 2012Trial
- Organisational and social work-environment experiences after care manager implementation: a repeated cross-sectional study in Swedish primary care.Scandinavian journal of primary health care · 2026Article
- Seven lessons for financial incentivisation schemes in healthcare: a qualitative study of NHS Resolution's Maternity Incentive Scheme.Journal of the Royal Society of Medicine · 2026Article
- Article
- The impact of remuneration, extrinsic and intrinsic incentives on interprofessional primary care teams: results from a rapid scoping review.BMC primary care · 2025Article
- Effect of Performance-Based Nonfinancial Incentives on Data Quality in Individual Medical Records of Institutional Births: Quasi-Experimental Study.JMIR medical informatics · 2024Article
- Analysis of the concept of nurses' autonomy in intensive care units: A hybrid model.Investigacion y educacion en enfermeria · 2023Review
- Framework for identification and measurement of spillover effects in policy implementation: intended non-intended targeted non-targeted spillovers (INTENTS).Implementation science communications · 2022Article
- Current practice and attitudes towards vaccination during pregnancy: a survey of GPs across EnglandThe British journal of general practice : the journal of the Royal College of General Practitioners · 2020Article
- Observational
- Incentive schemes to increase dementia diagnoses in primary care in England: a retrospective cohort study of unintended consequences.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019Article
- The development and validation of a scale to explore staff experience of governance of economic efficiency and quality (GOV-EQ) of health care.BMC health services research · 2018Article
- Managerial strategies to make incentives meaningful and motivating.Journal of health organization and management · 2017Article
- Analysis of the policymaking process in Burkina Faso's health sector: case studies of the creation of two health system support units.Health research policy and systems · 2017Article
- Impact of financial incentives on alcohol intervention delivery in primary care: a mixed-methods study.BMC family practice · 2016Article
- Quality and Outcomes Framework: what have we learnt?BMJ (Clinical research ed.) · 2016Article
- Can pay for performance improve the quality of primary care?BMJ (Clinical research ed.) · 2016Article
- Effective health care for older people living and dying in care homes: a realist review.BMC health services research · 2016Review
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo explore the impact of financial incentives for quality of care on practice organisation, clinical autonomy, and internal motivation of doctors and nurses working in primary care.
designEthnographic case study.
settingTwo English general practices.
participants12 general practitioners, nine nurses, four healthcare assistants, and four administrative staff.
main outcome measureObservation of practices over a five month period after the introduction of financial incentives for quality of care introduced in the 2004 general practitioner contract.
resultsAfter the introduction of the quality and outcomes framework there was an increase in the use of templates to collect data on quality of care. New regimens of surveillance were adopted, with clinicians seen as "chasers" or the "chased," depending on their individual responsibility for delivering quality targets. Attitudes towards the contract were largely positive, although discontent was higher in the practice with a more intensive surveillance regimen. Nurses expressed more concern than doctors about changes to their clinical practice but also appreciated being given responsibility for delivering on targets in particular disease areas. Most doctors did not question the quality targets that existed at the time or the implications of the targets for their own clinical autonomy.
conclusionsImplementation of financial incentives for quality of care did not seem to have damaged the internal motivation of the general practitioners studied, although more concern was expressed by nurses.
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