Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Sep-Oct;10(5):461-8.
doi: 10.1370/afm.1377.

Pay-for-performance in the United Kingdom: impact of the quality and outcomes framework: a systematic review

Stephen J Gillam  1 , A Niroshan Siriwardena, Nicholas Steel
Affiliations

Pay-for-performance in the United Kingdom: impact of the quality and outcomes framework: a systematic review

Stephen J Gillam et al. Ann Fam Med. 2012 Sep-Oct.

Abstract

Purpose: Primary care practices in the United Kingdom have received substantial financial rewards for achieving standards set out in the Quality and Outcomes Framework since April 2004. This article reviews the growing evidence for the impact of the framework on the quality of primary medical care.

Methods: Five hundred seventy-five articles were identified by searching the MEDLINE, EMBASE, and PsycINFO databases, and from the reference lists of published reviews and articles. One hundred twenty-four relevant articles were assessed using a modified Downs and Black rating scale for 110 observational studies and a Critical Appraisal Skills Programme rating scale for 14 qualitative studies. Ninety-four studies were included in the review.

Results: Quality of care for incentivized conditions during the first year of the framework improved at a faster rate than the preintervention trend and subsequently returned to prior rates of improvement. There were modest cost-effective reductions in mortality and hospital admissions in some domains. Differences in performance narrowed in deprived areas compared with nondeprived areas. Achievement for conditions outside the framework was lower initially and has worsened in relative terms since inception. Some doctors reported improved data recording and teamwork, and nurses enhanced specialist skills. Both groups believed that the person-centeredness of consultations and continuity were negatively affected. Patients' satisfaction with continuity declined, with little change in other domains of patient experience.

Conclusions: Observed improvements in quality of care for chronic diseases in the framework were modest, and the impact on costs, professional behavior, and patient experience remains uncertain. Further research is needed into how to improve quality across different domains, while minimizing costs and any unintended adverse effects of payment for performance schemes. Health care organizations should remain cautious about the benefits of similar schemes.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow of information through the review.
See this image and copyright information in PMC

References

    1. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502 - PMC - PubMed
    1. Roland M. Linking physicians’ pay to the quality of care—a major experiment in the United kingdom. N Engl J Med. 2004;351(14): 1448–1454 - PubMed
    1. Siriwardena AN. Should the quality and outcomes framework be abolished? No. BMJ. 2010;340:c2794. - PubMed
    1. NHS Employers Quality and outcomes framework. http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContra...
    1. NHS Employers Quality and Outcomes Framework guidance for GMS contract 2011/12. Delivering investment in general practice. NHS Employers. April 2011. http://www.nhsemployers.org/Aboutus/Publications/Documents/QOF_guidance_...

Publication types

MeSH terms