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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.’