SynthesisAnnals of family medicine
Pay-for-performance in the United Kingdom: impact of the quality and outcomes framework: a systematic review.
Synthesis in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 130 papers, 9 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
130 citing papers in PubMed, 9 syntheses or guidelines pooled it.
- General practice incentives: a review of the international literature.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Pooled it
- The impact of primary care funding on health inequalities: an umbrella review.Primary health care research & development · 2025Pooled it
- What drives general practitioners in the UK to improve the quality of care? A systematic literature review.BMJ open quality · 2021Pooled it
- Payment methods for healthcare providers working in outpatient healthcare settings.The Cochrane database of systematic reviews · 2021Pooled it
- Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review.Health technology assessment (Winchester, England) · 2020Pooled it
- Design and effects of outcome-based payment models in healthcare: a systematic review.The European journal of health economics : HEPAC : health economics in prevention and care · 2019Pooled it
- The impact of patient feedback on the medical performance of qualified doctors: a systematic review.BMC medical education · 2018Pooled it
- Characterization and effectiveness of pay-for-performance in ophthalmology: a systematic review.BMC health services research · 2017Pooled it
- Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review.BMC public health · 2016Pooled it
- Promoting physical activity with self-management support for those with multimorbidity: a randomised controlled trial.The British journal of general practice : the journal of the Royal College of General Practitioners · 2021Trial
- A real-world stepped wedge cluster randomized trial of practice facilitation to improve cardiovascular care.Implementation science : IS · 2015Trial
- Impact of pay for performance on prescribing of long-acting reversible contraception in primary care: an interrupted time series study.PloS one · 2014Trial
- Trends in type 2 diabetes incidence and BMI at diagnosis by age, sex, and ethnicity, 2011-2024: a population-based analysis of the English National Diabetes Audit.The Lancet regional health. Europe · 2026Article
- From exception to insight: a phenomenological study of quality managers' perspectives on the individual appeals in the National Healthcare Quality Program.Israel journal of health policy research · 2026Article
- Financial incentives and information provision for post-pandemic primary care quality recovery: a longitudinal study in Catalonia.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Article
- Payment mechanisms to improve prevention spending in health care settings: A policy-focused evidence brief.Public health in practice (Oxford, England) · 2026Article
- How does the quality of outcomes framework impact on the quality of life of adult patients with diabetes? A cross-section study in England using GP Patient Survey data.BMC primary care · 2025Article
- All Quality Metrics are Wrong; Some Quality Metrics Could Become Useful.Annals of family medicine · 2025Article
- Drivers of primary care appointment volumes before and after the COVID-19 pandemic: a longitudinal study.BMC health services research · 2025Article
- Performance-based payment systems for general practitioners and specialists in selected countries: a comparative study.Journal of preventive medicine and hygiene · 2025Article
70 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposePrimary care practices in the United Kingdom have received substantial financial rewards for achieving standards set out in the Quality and Outcomes Framework since April 2004. This article reviews the growing evidence for the impact of the framework on the quality of primary medical care.
methodsFive hundred seventy-five articles were identified by searching the MEDLINE, EMBASE, and PsycINFO databases, and from the reference lists of published reviews and articles. One hundred twenty-four relevant articles were assessed using a modified Downs and Black rating scale for 110 observational studies and a Critical Appraisal Skills Programme rating scale for 14 qualitative studies. Ninety-four studies were included in the review.
resultsQuality of care for incentivized conditions during the first year of the framework improved at a faster rate than the preintervention trend and subsequently returned to prior rates of improvement. There were modest cost-effective reductions in mortality and hospital admissions in some domains. Differences in performance narrowed in deprived areas compared with nondeprived areas. Achievement for conditions outside the framework was lower initially and has worsened in relative terms since inception. Some doctors reported improved data recording and teamwork, and nurses enhanced specialist skills. Both groups believed that the person-centeredness of consultations and continuity were negatively affected. Patients' satisfaction with continuity declined, with little change in other domains of patient experience.
conclusionsObserved improvements in quality of care for chronic diseases in the framework were modest, and the impact on costs, professional behavior, and patient experience remains uncertain. Further research is needed into how to improve quality across different domains, while minimizing costs and any unintended adverse effects of payment for performance schemes. Health care organizations should remain cautious about the benefits of similar schemes.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.