Pay-for-performance programs in family practices in the United Kingdom

Area of Science:

• Health Services Research
• Health Economics
• Primary Care Medicine

Background:

• The UK National Health Service implemented a pay-for-performance (PFP) contract for family practitioners in 2004.
• This PFP contract aimed to improve quality of care through financial incentives tied to 146 quality indicators.

Purpose of the Study:

• To evaluate the initial impact of the PFP contract on family practice performance in England.
• To investigate the role of exception reporting in achieving high performance scores.

Main Methods:

• Analysis of clinical computing system data from 8105 English family practices (April 2004-March 2005).
• Examination of reported achievement and population achievement metrics.
• Multiple regression analysis to assess the influence of exception reporting on performance.

Main Results:

• Median reported achievement was 83.4%, with moderate effects from patient and practice characteristics.
• Exception reporting, though not extensive (median 6%), was a strong predictor of achievement.
• A small percentage of practices (1%) excluded over 15% of patients via exception reporting.

Conclusions:

• English family practices achieved high performance levels in the first year of the PFP contract.
• A subset of practices may have attained high scores by excluding patients through exception reporting.
• Further research is required to ascertain the clinical validity of patient exclusions for income maximization.