Effects of payment for performance in primary care: Qualitative interview study

Maisey, Susan; Steel, Nick; Marsh, Roy; Gillam, Stephen; Fleetcroft, Robert; Howe, Amanda

doi:10.1258/jhsrp.2008.007118

Cited by 97 publications

(145 citation statements)

References 20 publications

(26 reference statements)

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“…11 A qualitative study by Maisey et al explored English GPs' and practice nurses' views on the effects of pay for performance in primary care and found that staff believed consistency and recording of care had improved for conditions that were incentivised in the scheme, but not for nonincentivised conditions. 12 An early ethnographic study of the impact of the QOF found that GPs were generally positive about it, with little threat to internal motivation of their core values. 10 However, other qualitative research with family doctors and nurses highlighted concerns about a decline in relational continuity of care, deskilling of doctors due to enhanced nurse roles, and the emerging presence of a dual agenda in consultations, due to the need to prioritise and record incentivised aspects of care alongside addressing the patient's concerns and reasons for attendance.…”

Section: Introductionmentioning

confidence: 99%

“…12,13 In recent qualitative studies, evidence of unintended consequences has also been found in relation to indicators including the presence of 'measure fixation', where inappropriate attention on isolated aspects of care or a dual agenda can conflict with patient-centred care. 22,23 This study also adds to the concerns that non-incentivised conditions or aspects of care may receive less attention by practice staff.…”

mentioning

confidence: 99%

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Patients' views of pay for performance in primary care: a qualitative study

Hannon

Lester²,

Campbell³

2012

Br J Gen Pract

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BackgroundMany countries use pay-for-performance schemes to reward family practices financially for achieving quality indicators. The views of patients on pay for performance remain largely unexplored. AimTo gain the views of family practice patients on the United Kingdom pay-for-performance Quality and Outcomes Framework (QOF). Design and settingInterviews with 52 patients were conducted in 15 family practices across England. All patients had at least one long-term condition that had been diagnosed before the introduction of the QOF in 2004. MethodSemi-structured interviews analysed using open explorative thematic coding. ResultsFew patients had heard of the QOF or had noticed changes to the structure or process of their care. However, where they were noted, changes to consultations such as increased use of computers and health checks initiated by the GP or practice nurse were seen as good practice. The majority of patients were surprised to hear their practice received bonuses for doing 'simple things'. Some patients also raised concerns over potential unintended consequences of pay-forperformance frameworks, such as a reduced focus on non-incentivised areas. ConclusionThis study adds a unique patient perspective to the debate around the impact of pay-forperformance schemes and consequences on patient care. Patients' views, experiences, and concerns about pay for performance mostly chime with previously described opinions of primary care staff. Patient surprise and concern around incentivising basic processes of care shows how patient views are vital when monitoring and evaluating a scheme that is designed to improve patient care. Keywordspatients; pay for performance; qualitative research. e322

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Patients' views of pay for performance in primary care: a qualitative study

Hannon

Lester²,

Campbell³

2012

Br J Gen Pract

View full text Add to dashboard Cite

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“…Although the government underestimated the quality of care before introducing the QOF, 10 so that the scheme was more expensive than anticipated, it seems that pay-for-performance, at least in the UK, is here to stay, not least because evidence is accumulating to show that standards of care in some QOF domains are rising more rapidly than they were before the QOF was introduced. [11][12][13][14] Although the QOF is regularly updated and expanded, it does not cover all important clinical problems and has not yet included any recognition of chronic gastrointestinal disorders managed in primary care. The QOF has been criticised, with some justification, for focusing on the 'what' rather than the 'how' of quality improvement, and on readily measured metrics that relate to processes of care and to proxy outcomes.…”

Section: Introductionmentioning

confidence: 99%

Management of common gastrointestinal disorders: quality criteria based on patients' views and practice guidelines

Jones¹,

Hunt²,

Stevens³

et al. 2009

Br J Gen Pract

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“…The QOF was regarded as being successful in improving and standardising clinical care for patients across general practice but was felt to have led to unintended consequences. 13,21 The findings do highlight, however, that GP principals were perceived by some as too QOF focused and that this could lead to negative implications for patient care. Although differences in pay were recognised, most felt fairly rewarded and that the disparity fairly reflected differences in responsibility.…”

Section: Discussionmentioning

confidence: 80%

Experience of contractual change in UK general practice: a qualitative study of salaried GPs

Cheraghi-Sohi

McDonald²,

Harrison³

et al. 2012

Br J Gen Pract

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BackgroundGeneral practice in the UK underwent major change in 2004, with the introduction of new contracts and a significant element of pay for performance. Although salaried GPs form an increasing proportion of the general practice workforce, little is known of their experiences. AimTo explore the views and experiences of salaried GPs working in English general practice. Design and settingQualitative study using semi-structured interviews in 17 practices across England, between July 2007 and September 2009. MethodInterviews were conducted with 23 salaried GPs. A topic guide included questions on motivations for a career in general practice, descriptions of their daily working environment and duties, practice relationships, and future aspirations. ResultsThe new ability to opt out of out-of-hours responsibilities was deemed positive for the profession but not a major driver for choosing medical speciality. Views regarding the impact of the Quality and Outcomes Framework were ambivalent. Differences in pay were regarded as largely reflective of differences in responsibility between salaried GPs and principals. Most participants reported conducting varied work in collaborative practices. Participants held varying career aspirations. ConclusionSalaried GPs' working experiences were dependent upon personal aspirations and local context. Most salaried GPs were reportedly content with their current position but many also had aspirations of eventually attaining GP principal status. The current lack of available partnerships threatens to undo recent positive workforce progress and may lead to deep dissatisfaction within the profession and a future workforce crisis. Further large-scale quantitative work is required to assess the satisfaction and future expectations of those in salaried posts. Keywordsgeneral practice; primary care; workforce.

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Effects of payment for performance in primary care: Qualitative interview study

Cited by 97 publications

References 20 publications

Patients' views of pay for performance in primary care: a qualitative study

Patients' views of pay for performance in primary care: a qualitative study

Management of common gastrointestinal disorders: quality criteria based on patients' views and practice guidelines

Experience of contractual change in UK general practice: a qualitative study of salaried GPs

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