ArticleBJGP open2025
General practice characteristics associated with pay-for-performance in the UK: a systematic review.
Article in BJGP open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Quality and Outcomes Framework (QOF), a pay-for-performance programme, has been the most widespread quality initiative in NHS general practice since 2004. It has contributed between 25% and 8% of practices' income during this time, but concerns about its effect on equity have been raised.
aimTo understand which practice characteristics are associated with QOF performance. DESIGN AND
settingA systematic review was conducted, focusing on NHS general practice in the UK.
methodMEDLINE, Embase, CINAHL+, Web of Science, and grey literature were searched for studies examining the association between general practice characteristics and QOF performance.
resultsTwenty-two studies, published between 2006 and 2022, exploring the relationship between six population and 15 organisational characteristics and QOF measures were found. Most studies were cross-sectional, of English general practices, and used data from the early years of QOF. A negative association was frequently found between overall QOF performance and socioeconomic deprivation; increasing proportion of registered patients aged >65 years; increasing list size; increasing mean GP age; and Alternative Provider Medical Services contracts. Group practices (versus single-handed), more full-time equivalent (FTE) GPs, and being a training practice were frequently associated with better overall QOF performance. The associations of most other characteristics with performance were inconsistent.
conclusionAssociations with characteristics both within and outside practices' control were identified. Pay-for-performance instruments may systematically disadvantage practices serving those at greatest risk of ill-health such as older and more deprived populations. Given the cross-sectional design of many studies and focus on the early years of QOF, more up-to-date evidence is needed to understand if and why these relationships persist.
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