Does paying for performance in primary care save lives?

Like most of us, health planners can’t resist an occasional look into a neighbour’s backyard. Sometimes the view is compelling enough to launch study tours, delegations, and professional exchanges. And there have been plenty of those sent to the National Health Service (NHS) since its inception in 1949. Outsiders have sought to learn from NHS innovations in team based care, commissioning, clinical governance,1 and, more recently, the “grand experiment” that became the Quality and Outcomes Framework (QOF).2 Forged by the tools, and inspired by the philosophies of evidence based medicine, the QOF has, since its introduction in 2003, dwarfed other attempts to bring pay for performance into primary care.3

In a linked paper (doi:10.1136/bmj.h904)—which may well turn out to be a seminal study of the impact of the QOF on population health—Kontopantelis and colleagues asked whether QOF performance at the practice level was associated with either all-cause mortality or with premature mortality attributed to incentivised conditions such as diabetes, hypertension, ischaemic heart disease, stroke, and chronic kidney disease.4 The authors used …