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‘Although the QOF may be withdrawn in England, it has provided valuable lessons, and the key suggestion from this study is that existing or future pay-for-performance policies should consider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.
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’.