Pay for performance schemes in primary care: what have we learnt?

Pay-for-performance (P4P) schemes have become increasingly popular withcommissioners of primary care and other health services and this has generatedquestions about their effect on improving quality. In this chapter, we draw on relevantliterature and primary research to reflect on how the Quality and OutcomesFramework has impacted on general practice in the United Kingdom, while reflectingupon the relationship between P4P schemes and quality improvement moregenerally. We argue that, although evidence for the effect of P4P on quality is limited,P4P schemes do have an effect on the behaviour of physicians and can leadto better clinical management of disease, but that there is cause for concern abouttheir impact on the wider aspects of quality of care. We conclude that P4P schemesneed to take more account of broader definitions of quality since, while schemescan have a positive impact on incentivised clinical processes, it is not clear that thistranslates into improving the experience and outcome of care for patients.