ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2013
Implementation of pay for performance in primary care: a qualitative study 8 years after introduction.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Payment methods for healthcare providers working in outpatient healthcare settings.The Cochrane database of systematic reviews · 2021Pooled 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
- Self-reported acceptability and feasibility of a multimodal intervention to reduce antibiotic prescriptions for urinary tract infections in primary care: a process evaluation of the RedAres trial among general practitioners and medical practice assistants.BMC health services research · 2025Trial
- 'It's what we should be doing anyway': using financial incentives to promote relational continuity in Australian General Practice-a nested case study analysis.Family practice · 2025Trial
- Enhancing System Empathy Within a UK Emergency Department: A Feasibility Interprofessional Priority Setting Exercise.Journal of evaluation in clinical practice · 2026Article
- Article
- Quality indicators for improved cardiovascular care: learnings from the National Institute for Health and Care Excellence.European heart journal. Quality of care & clinical outcomes · 2025Article
- Do compensation models affect family physician job satisfaction? Scoping review.Canadian family physician Medecin de famille canadien · 2025Article
- The impact of remuneration, extrinsic and intrinsic incentives on interprofessional primary care teams: results from a rapid scoping review.BMC primary care · 2025Article
- Embedded values-like shape ethical reasoning of large language models on primary care ethical dilemmas.Heliyon · 2024Article
- The introduction of a value-based reimbursement programme-Alignment and resistance among healthcare providers.The International journal of health planning and management · 2023Article
- Evaluation of the introduction of QOF quality improvement modules in English general practice: early findings from a rapid, qualitative exploration of implementation.BMJ open quality · 2022Article
- Incentivizing performance in health care: a rapid review, typology and qualitative study of unintended consequences.BMC health services research · 2022Review
- Article
- A pay for performance scheme in primary care: Meta-synthesis of qualitative studies on the provider experiences of the quality and outcomes framework in the UK.BMC family practice · 2020Article
- Awareness of, attitude toward, and willingness to participate in pay for performance programs among family physicians: a cross-sectional study.BMC family practice · 2020Article
- Article
- 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
- Paying for what matters most: the future of outcomes-based payments in healthcare.Future healthcare journal · 2018Article
- Reports of unintended consequences of financial incentives to improve management of hypertension.PloS one · 2017Observational
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPay for performance is now a widely adopted quality improvement initiative in health care. One of the largest schemes in primary care internationally is the English Quality and Outcomes Framework (QOF).
aimTo obtain a longer term perspective on the implementation of the QOF. DESIGN AND
settingQualitative study with 47 health professionals in 23 practices across England. Method Semi-structured interviews.
resultsPay for performance is accepted as a routine part of primary care in England, with previous more individualistic and less structured ways of working seen as poor practice. The size of the QOF and the evidence-based nature of the indicators are regarded as key to its success. However, pay for performance may have had a negative impact on some aspects of medical professionalism, such as clinical autonomy, and led a significant minority of GPs to prioritise their own pay rather than patients' best interests. A small minority of GPs tried to increase their clinical autonomy with further unintended consequences.
conclusionPay for performance indicators are now welcomed by primary healthcare teams and GPs across generations. Almost all interviewees wanted to see a greater emphasis on involving front line practice teams in developing indicators. However, almost all GPs and practice managers described a sense of decreased clinical autonomy and loss of professionalism. Calibrating the appropriate level of clinical autonomy is critical if pay for performance schemes are to have maximal impact on patient care.
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