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Effects of payment for performance in primary care: qualitative interview study
Susan Maisey1, Nick Steel, Roy Marsh
1School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK. s.maisey@uea.ac.uk
Journal of Health Services Research & Policy
|June 25, 2008
Summary
The Quality and Outcomes Framework (QOF) improved care for incentivized conditions but shifted focus from patient needs. Primary care teams experienced significant organizational changes, with potential neglect of non-incentivized issues.
Area of Science:
- Health Services Research
- Primary Care Medicine
- Health Policy Analysis
Background:
- The English National Health Service implemented a large-scale 'payment for performance' scheme, the Quality and Outcomes Framework (QOF).
- This initiative aimed to incentivize and standardize primary care delivery through financial rewards.
- Understanding its impact on clinicians' roles and patient care is crucial.
Purpose of the Study:
- To evaluate the effects of the QOF on professional roles within primary care.
- To assess how the QOF influences the delivery of primary care services in England.
Main Methods:
- A qualitative study involving semi-structured interviews with 24 clinicians (GPs and practice nurses).
- Interviews were conducted in 12 general practices in eastern England with diverse characteristics.
- Data collection occurred in 2006, capturing early impacts of the QOF.
Main Results:
- Clinicians reported improved organization and recording for incentivized conditions, but not others.
- Focus shifted from 'patient-led' consultations; continuity of care and patient choice were concerns.
- Nurses gained autonomy; doctors noted improved disease management but disliked 'box-ticking' and data manipulation.
Conclusions:
- The QOF significantly alters primary care team roles and organization in England.
- Non-incentivized care and patient concerns may be deprioritized.
- Clearer communication of evidence for QOF indicators is needed for practitioner buy-in.
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