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At the heart of general practice since 1960

Pay GPs directly for their performance, urge researchers

Practice-level rewards for achieving outcomes targets - such as QOF - do not work as well as rewarding individual GPs, a new study suggests.

The study of financial incentives for carrying out guideline-recommended hypertension care showed individual rewards resulted in greater blood pressure control or appropriate response to uncontrolled blood pressure but practice-level or a combination of incentives did not.

The US research involved paying 83 primary care physicians and 42 nurses and pharmacists at 12 health centres to follow hypertension guidelines. Health centres were randomised to receive payments at an individual doctor level, at practice level, both or none.

Payment to individuals was made on the basis of $9.10 (£5.75) per guideline measure achieved. For practice level payments, the aggregated totals of individual payments were distributed equally among practice staff.

The adjusted estimated absolute difference over the study in the change between the proportion of the physician’s patients achieving blood pressure control or receiving an appropriate response for the individual incentive group and the controls was 8.36%.

The researchers concluded: ‘A typical study physician in the individual group with a panel size of 1,000 patients with hypertension would be expected to have about 84 additional patients achieving blood pressure control or receiving an appropriate response after one year of exposure to the intervention.’

Readers' comments (6)

  • I'd relish this, I earn far more QOF points than my partners!

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  • So who gets the money ? The GP who started the drug or the one who measured the BP two weeks later ?

    Please spare us from having to coerce reluctant patients or the thankless task of looking after a deprived population who have other priorities than their blood pressure measurement.

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  • GPs work best in teams, it stops discrimination against venerable/ difficult patients as everyone has their fair share.

    A system like this will make GPs very slippery and the most vulnerable patients shifted from GP to GP.

    Alternatively practices will score the targets as a individuals and share the money as a group, ensuring one senior GP takes the worst patients on paper to maximise the practice profits as a whole.

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  • Nhsfatcat

    Not sure from the detail in the article -'Pay GPs directly for their performance, urge researchers' is the conclusion I'd come to but as this SOS for Health acts on poor evidence and research - brace brace brace.
    Medicine is not about achieving universal targets.

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  • Given that the NHS doesnt employ any GPs Im struggling to see how this would work

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  • This is simply a way of breaking up general practice which is what they want. A senior partner may not tick so many QOF boxes but he may be doing a great job looking after an elderly population he has looked after for 30 years or more. Reject this or knock another nail into the coffin of general practice as we have known it. Yet another example of how politicians have no understanding of what general practice is all about

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