BMJ  2007;334 (30 June), doi:10.1136/bmj.39260.443970.3A

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The side effects of "P4P"

The first 150 words of the full text of this article appear below.

General practitioners in the United Kingdom are now three years into an ambitious quality improvement program called the quality and outcomes framework. Under this program, they receive financial rewards when they meet specified targets in delivering preventive care and treatments to their patients. Several studies have documented that the targeted services have increased in response to this "pay for performance" program. In a qualitative ethnographic study, Ruth McDonald and colleagues observed and questioned office staff in two general practices to better understand how the program has affected the processes of care and staff attitudes (doi: 10.1136/bmj.39238.890810.BE).

There was concern that the financial incentives might conflict with doctors' professional values; that they would bring about undesirable changes to practices; and that the resulting surveillance would have a negative impact. To examine these issues, the investigators interviewed most of the doctors, nurses, healthcare assistants, and front office staff in two English . . . [Full text of this article]

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