ArticleBMJ (Clinical research ed.)2023
Estimated impact from the withdrawal of primary care financial incentives on selected indicators of quality of care in Scotland: controlled interrupted time series analysis.
Article in BMJ (Clinical research ed.), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- Effect of UK Quality and Outcomes Framework pay-for-performance programme on quality of primary care: systematic review with quantitative synthesis.BMJ (Clinical research ed.) · 2025Pooled it
- Trial
- Primary Care Physicians' Knowledge and Self-Perceived Competence Regarding Chronic Kidney Disease Management in Jazan Province, Saudi Arabia: A Questionnaire-Based Cross-Sectional Study.Healthcare (Basel, Switzerland) · 2026Article
- Observational
- Payment mechanisms to improve prevention spending in health care settings: A policy-focused evidence brief.Public health in practice (Oxford, England) · 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
- Effect of the English National Enhanced Service on weight management referral rate: an interrupted time-series analysis.BMJ open · 2026Article
- Microneedle Strategies for Diabetic Wound Management: A Comprehensive Review of Materials, Mechanisms, and Therapeutic Outcomes.Materials today. Advances · 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
- 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
- Does pay for performance promote inverse inequality in chronic disease management?Family practice · 2025Article
- Observational
- 'Flattened, fattened, and forgotten': the 'dis-integrated' care of patients prescribed antipsychotics in the UK.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- Information provision and financial incentives in Catalonia's public primary care (2010-2019): an interrupted time series analysis.The Lancet regional health. Europe · 2024Article
- Chronic kidney disease: detect, diagnose, disclose-a UK primary care perspective of barriers and enablers to effective kidney care.BMC medicine · 2024Review
- Younger but sicker? Cohort trends in disease accumulation among middle-aged and older adults in Scotland using health-linked data from the Scottish Longitudinal Study.European journal of public health · 2024Article
- Does shortage of GPs matter? A cross-sectional study of practice population life expectancy.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024Article
- Article
- Impact of data source choice on multimorbidity measurement: a comparison study of 2.3 million individuals in the Welsh National Health Service.BMC medicine · 2023Article
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6 authors.
Funding
Abstract
objectiveTo determine whether the withdrawal of the Quality and Outcomes Framework (QOF) scheme in primary care in Scotland in 2016 had an impact on selected recorded quality of care, compared with England where the scheme continued.
designControlled interrupted time series regression analysis.
settingGeneral practices in Scotland and England.
participants979 practices with 5 599 171 registered patients in Scotland, and 7921 practices with 56 270 628 registered patients in England in 2013-14, decreasing to 864 practices in Scotland and 6873 in England in 2018-19, mainly due to practice mergers.
main outcome measuresChanges in quality of care at one year and three years after withdrawal of QOF financial incentives in Scotland at the end of the 2015-16 financial year for 16 indicators (two complex processes, nine intermediate outcomes, and five treatments) measured annually for financial years from 2013-14 to 2018-19.
resultsA significant decrease in performance was observed for 12 of the 16 quality of care indicators in Scotland one year after QOF was abolished and for 10 of the 16 indicators three years after QOF was abolished, compared with England. At three years, the absolute percentage point difference between Scotland and England was largest for recording (by tick box) of mental health care planning (-40.2 percentage points, 95% confidence interval -45.5 to -35.0) and diabetic foot screening (-22.8, -33.9 to -11.7). Substantial reductions were, however, also observed for intermediate outcomes, including blood pressure control in patients with peripheral arterial disease (-18.5, -22.1 to -14.9), stroke or transient ischaemic attack (-16.6, -20.6 to -12.7), hypertension (-13.7, -19.4 to -7.9), diabetes (-12.7, -15.0 to -12.4), or coronary heart disease (-12.8, -14.9 to -10.8), and for glycated haemoglobin control in people with HbA
conclusionThe abolition of financial incentives in Scotland was associated with reductions in recorded quality of care for most performance indicators. Changes to pay for performance should be carefully designed and implemented to monitor and respond to any reductions in care quality.
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