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Pay for performance

Research into primary care conducted at The University of Manchester has shaped the design of pay-for-performance schemes in GP surgeries, where surgeries are rewarded for meeting certain quality and efficiency performance measures.

Recommendations from work undertaken by staff at the National Primary Care Research and Development Centre (NPCRDC) have impacted on every GP practice in the UK.

The Manchester research findings informed the design of the Quality and Outcomes Framework (QOF) for primary care, introduced as part of the new GP contract in 2004. The main objective of QOF was to drive up the quality of primary care.

Professor Stephen Campbell, Dr David Reeves and colleagues in NPCRDC evaluated the impact of QOF on the clinical quality of care and patient experience in general practice.

Their work led to improvements in clinical quality whilst minimising the adverse consequences of pay-for-performance schemes in general practice.

The team developed innovative methodologies to:

  • design and test new indicators of care quality;
  • revise and retire existing indicators;
  • structure the pay-for-performance scheme to maximise quality and minimise harm for patients.

In 2009-2010 the National Institute for Health and Care Excellence (NICE) formally adopted the protocols developed by the team.

The methodologies developed by the team for designing and testing new indicators have influenced policy and practice in the USA, Germany and other European countries.

QOF is now the annual reward and incentive programme for GP surgeries. QOF awards achievement points for, e.g., managing some of the most common chronic diseases, such as asthma and diabetes, offering extra services, receiving positive patient feedback, and running the surgery efficiently.

“The Manchester research findings informed the design of the Quality and Outcomes Framework (QOF) for primary care, introduced as part of the new GP contract in 2004. The main objective of QOF was to drive up the quality of primary care.”

Stephen Campbell / Professor of Primary Care Research