What drives general practitioners in the UK to improve the quality of care? A systematic literature review
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Author(s)
Type
Journal Article
Abstract
Background
In the United Kingdom the NHS has various incentivisation schemes in place to improve the provision of high quality care. The Quality Outcomes Framework (QOF) and other Pay for Performance (P4P) schemes are incentive frameworks that focus on meeting predetermined clinical outcomes. However, the ability of these schemes to meet their aims is debated.
Objectives
1. To explore current incentive schemes available in general practice in the UK, their impact and effectiveness in improving quality of care.
2. To identify other types of incentives discussed in the literature
Methods
This SLR was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases were searched: Cochrane, PubMed, NICE Evidence, Health Management Information Consortium (HMIC), Embase and Health Management. Articles were screened according to the selection criteria, evaluated against critical appraisal checklists and categorised into themes.
Results
35 articles were included from an initial search result of 22087. Articles were categorised into the following three overarching themes: financial incentives, non-financial incentives and competition.
Discussion
The majority of the literature focused on QOF. Its positive effects included reduced mortality rates, better data recording and improved socio-demographic inequalities. However, limitations involved decreased quality of care in non-incentivised activities, poor patient experiences due to tick-box exercises and increased pressure to meet non-specific targets. Findings surrounding competition were mixed, with limited evidence found on the use of non-financial incentives in primary care.
Conclusion
Current research looks extensively into financial incentives, however we propose more research into the effects of intrinsic motivation alongside existing P4P schemes to enhance motivation and improve quality of care.
In the United Kingdom the NHS has various incentivisation schemes in place to improve the provision of high quality care. The Quality Outcomes Framework (QOF) and other Pay for Performance (P4P) schemes are incentive frameworks that focus on meeting predetermined clinical outcomes. However, the ability of these schemes to meet their aims is debated.
Objectives
1. To explore current incentive schemes available in general practice in the UK, their impact and effectiveness in improving quality of care.
2. To identify other types of incentives discussed in the literature
Methods
This SLR was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases were searched: Cochrane, PubMed, NICE Evidence, Health Management Information Consortium (HMIC), Embase and Health Management. Articles were screened according to the selection criteria, evaluated against critical appraisal checklists and categorised into themes.
Results
35 articles were included from an initial search result of 22087. Articles were categorised into the following three overarching themes: financial incentives, non-financial incentives and competition.
Discussion
The majority of the literature focused on QOF. Its positive effects included reduced mortality rates, better data recording and improved socio-demographic inequalities. However, limitations involved decreased quality of care in non-incentivised activities, poor patient experiences due to tick-box exercises and increased pressure to meet non-specific targets. Findings surrounding competition were mixed, with limited evidence found on the use of non-financial incentives in primary care.
Conclusion
Current research looks extensively into financial incentives, however we propose more research into the effects of intrinsic motivation alongside existing P4P schemes to enhance motivation and improve quality of care.
Date Issued
2021-02-11
Date Acceptance
2021-01-21
Citation
BMJ Open Quality, 2021, 10 (1)
ISSN
2399-6641
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open Quality
Volume
10
Issue
1
Copyright Statement
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Publication Status
Published
Article Number
ARTN e001127
Date Publish Online
2021-02-11