Pay for performance

We have a longstanding programme of research on pay for performance in the UK, including evaluations of initiatives in both primary and secondary care. Our research on the GP Quality and Outcomes Framework shows that the introduction of the scheme was associated with modest improvements in quality of care and some reduction in inequalities in delivery of care. Furthermore, the incentives scheme also appears to have stemmed the rise in emergency admissions for conditions that were incentivised. However, there were also some adverse consequences, including slowing down improvements in quality for aspects of care that were not incentivised. We summarised the impact of the Quality and Outcomes Framework in one of a series of articles in the New England Journal of Medicine. We also evaluated the ‘Advancing Quality’ initiative which gave hospitals in North West England an incentive to improve care and found that this was associated with a marked reduction on mortality for those conditions in the next 18 months. However, the gains compared to other regions had been lost by four years, in part because other regions had adopted the measures and partly because quality improvements appeared to have spilled over into conditions not originally incentivised.