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. 2011 Jun 28:342:d3590.
doi: 10.1136/bmj.d3590.

Effect of financial incentives on incentivised and non-incentivised clinical activities: longitudinal analysis of data from the UK Quality and Outcomes Framework

Tim Doran  1 , Evangelos Kontopantelis, Jose M Valderas, Stephen Campbell, Martin Roland, Chris Salisbury, David Reeves
Affiliations

Effect of financial incentives on incentivised and non-incentivised clinical activities: longitudinal analysis of data from the UK Quality and Outcomes Framework

Tim Doran et al. BMJ. .

Erratum in

  • BMJ. 2013;347:f5939

Abstract

Objective: To investigate whether the incentive scheme for UK general practitioners led them to neglect activities not included in the scheme.

Design: Longitudinal analysis of achievement rates for 42 activities (23 included in incentive scheme, 19 not included) selected from 428 identified indicators of quality of care.

Setting: 148 general practices in England (653 500 patients).

Main outcome measures: Achievement rates projected from trends in the pre-incentive period (2000-1 to 2002-3) and actual rates in the first three years of the scheme (2004-5 to 2006-7).

Results: Achievement rates improved for most indicators in the pre-incentive period. There were significant increases in the rate of improvement in the first year of the incentive scheme (2004-5) for 22 of the 23 incentivised indicators. Achievement for these indicators reached a plateau after 2004-5, but quality of care in 2006-7 remained higher than that predicted by pre-incentive trends for 14 incentivised indicators. There was no overall effect on the rate of improvement for non-incentivised indicators in the first year of the scheme, but by 2006-7 achievement rates were significantly below those predicted by pre-incentive trends.

Conclusions: There were substantial improvements in quality for all indicators between 2001 and 2007. Improvements associated with financial incentives seem to have been achieved at the expense of small detrimental effects on aspects of care that were not incentivised.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; MR served as an academic advisor to the government and British Medical Association negotiating teams during the development of the UK pay for performance scheme during 2001 and 2002.

Figures

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Mean achievement rate of 148 general practices for quality of care indicators from 2000-1 to 2006-7. Performance indicators grouped by activity and whether they were incentivised under the QOF scheme, which came into force from 2004-5. (The mean rate is the mean of the adjusted means for the individual indicators within each group)
See this image and copyright information in PMC

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