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GPs care more about their reputation than revenue, researchers claim

GPs care more about their reputation than financial incentives, according to new research.

Academics from the University of Manchester and the Manchester Centre for Health Economics looked at how practices performed against QOF indicators, and found that GPs were more motivated by their reputation in comparison to other practices than financial incentives.

The researchers suggested that as reputational rewards cost less than financial incentives, future performance policies should focus more on increasing competition between practices to get better results.

The study, published in the BJGP, analysed how nearly 9,000 practices in England performed against 42 QOF indicators between 2004 and 2013. It looked at the financial rewards offered (measured in £100s) and the reputational reward - measured in points per additional patients treated for each indicator.

The researchers compared how the percentage of eligible patients treated responded to changes in these financial and reputational rewards.

Under the QOF, practices are rewarded financially based on their performance on a range of quality indicators, but they are also given a quality score - measured in points - which is published online and could act as a reputational incentive, since other practices, patients and third-parties can use this information to compare how well practices are doing.

The team found that in 2004/05, the associations with the percentage of patients treated were −0.121 and 0.797 for the offered reputational and financial rewards, respectively.

However, over time the influence of reputational rewards increased, while the impact of financial rewards declined. By 2012/13, the associations were 0.209 for the offered reputational rewards, and 0.092 for the offered financial rewards.

The paper said: 'In the long term, general practices appeared to divert their focus towards the reputational reward, once benchmarks of performance became established.'

The authors added: 'If reputational rewards can be induced at much lower costs, efforts to make the reputational elements stronger could be effective. Reputational rewards require an initial investment in the means to measure and report performance, but they do not require regular and frequent payments.'

'Although the QOF may be withdrawn in England, it has provided valuable lessons, and the key suggestion from this study is that existing or future pay-for-performance policies should consider encouraging and facilitating comparisons between practices,' they added.

A Pulse survey earlier this year found that nearly half of GPs want to see the QOF scrapped, with many feeling that the pay-for-performance scheme is ‘toxic’ and ‘onerous’.

In July, NHS England announced that a quarter of QOF indicators could be scrapped under new proposals following a review of the framework earlier this year.

These changes come after NHS chief executive Simon Stevens said in 2016 that QOF is 'now nearing the end of its useful life' and admitted that it has 'descended into too much of a box ticking exercise'.

Readers' comments (5)

  • A 30% pay cut in real terms over the past decade,I would disagree ivory tower academics.

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  • It’s Friday and I’m tired but they seem to be arguing that as we care for our patients and work hard anyway, we don’t need to be paid but merely pitted against each other in order to obtain more work out of us for nothing. I know they are “academics” but really.....?

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  • David Banner

    Don’t think for 1 minute that scrapped QOF monies will stay in your global sum. It will be “reinvested” in nebulous enhanced services that will involve far more work and inevitable drops in profits.

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  • Tom Caldwell

    Reputation does not really help with the tax bill from HMRC. Frankly sick of this ongoing desire to screw GP for even more.

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  • The reality is that GPC has seen a fall in income per item [ in decreased profit and increased workloads]of over 60% in 14 years. Our accountant pointed this to us as he does over 50 GP practices.If we are prepared to continue working for less and less, then, to put it simply, the folks in charge of public monies WILL pay less and less. Why on earth should they pay more?

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