Problems with performance related pay in primary care

doi:10.1136/bmj.39329.384329.BE

BMJ 2007;335:523 (15 September), doi:10.1136/bmj.39329.384329.BE

Editorials

Problems with performance related pay in primary care

Payments should be simplified and based more on disease treatmentand prevention and less on risk factor measurement

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

General practice in the United Kingdom has the largest healthcarepay for performance programme in the world—the qualityand outcomes framework (QOF).¹ By earning the maximum numberof performance indicator "points," an average sized practicecan earn about £125 000 ( ${euro}$ 185 000; $252 000) in additionto its usual sources of income. In this week's BMJ, Guthrieand colleagues discuss the effectiveness of the system in relationto the management of cardiovascular disease. They show how generalpractices can earn many points and extra payments without thisnecessarily indicating a reduction in the risk of cardiovasculardisease.²

For example, a practice could receive nine points (each worthabout £125) for generating a list of patients with hypertension.The completeness and accuracy of this list might be subjectto external audit by the Primary Care Organisation. An extra30 points would be earned if 90% or more of such . . . [Full text of this article]

David S Wald, consultant cardiologist and senior lecturer

Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, London EC1M 6BQ

d.s.wald@qmul.ac.uk

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This article has been cited by other articles:

Stange, K. C., Ferrer, R. L. (2009). The Paradox of Primary Care. Ann Fam Med 7: 293-299 [Full text]
Twisselmann, B. (2007). Summary of responses. BMJ 335: 627-628 [Full text]

Rapid Responses:

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QOF funds core practice work not just GP pay: Richard M Vautrey
bmj.com, 14 Sep 2007 [Full text]
Is this well informed editorial??: john sharvill
bmj.com, 15 Sep 2007 [Full text]
Vested interests and performance related pay.: Ian G Quigley
bmj.com, 15 Sep 2007 [Full text]
Non-medical viewpoint: Mark Davies
bmj.com, 16 Sep 2007 [Full text]
Payment produces change: Rupert Gude
bmj.com, 17 Sep 2007 [Full text]
suggestions for others' pay: Owen J Powell
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Quality and Outcomes Framework: David M Shaw
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QoF funds golden minutes for risk assessment and prevention: Mark A Rickenbach
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problems with editorial writer selection: David J Shepherd
bmj.com, 18 Sep 2007 [Full text]
Unduly Negative Editorial on Performance Related Pay: Andrew Wijnberg
bmj.com, 18 Sep 2007 [Full text]
Debate: David Partridge
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Measure what matters � The Patient�s Health Experience: Joachim Sturmberg, et al.
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