Lessons from major initiatives to improve primary care in the United Kingdom

Primary care in the United Kingdom faced a crisis in 2000. General practitioners (GPs) complained of low morale, long hours, and low pay. The quality of care delivered to patients, meanwhile, was highly variable. The U.K. government responded with a program of quality improvement initiatives, a substantial increase in funding, and an ambitious pay-for-performance scheme that introduced publicly reported quality-of-care targets. Following these reforms, GPs' income and morale increased, the number of working hours declined, and the quality of care improved. The reforms, however, presented a serious challenge to medical professionalism, and the long-term effects on patient outcomes remain uncertain.