Axing GPs’ incentives linked to performance

HEALTH: Study indicates removal of financial spur leads to ‘immediate decline’ in care delivered to patients

A major new study by researchers at Dundee University has discovered a link between scrapping financial incentives for GPs and a decline in performance.

Questions remain over whether these pay-for-performance schemes improve patient outcomes when introduced.

But the landmark study discovered an “immediate decline” in performance across 12 quality measures studies when they are withdrawn.

Bruce Guthrie, professor of primary care medicine at Dundee University, said the decline in performance could be partly attributed to changes in methods of documentation.

The research was carried out by Dundee University, Cambridge University and staff from the National Institute for Health and Care Excellence (Nice).

Financial incentives were removed in Scotland in 2016 and have been subject to a major review in England.

Professor Guthrie said: “Our research shows removal of financial incentives is associated with an immediate decline in performance on 12 quality measures.

“Although some of that decline may just be that clinicians have changed how they document the care that they give, declines in measures involving laboratory testing suggest the removal of incentives did change the actual care delivered to patients. A key implication is that reductions in quality are likely after incentives are removed.”

Researchers analysed medical record data from almost 3,000 practices in England, with more than 20 million patients between 2010 and 2017.

They looked at 12 QOF quality-of-care indicators for which financial incentives were removed in 2014 and six indicators for which incentives were maintained.

Compared with previous years, there were immediate reductions in the documented quality of care for all 12 indicators where financial incentives were removed, the study found.

Reductions in “clinical-process” measures were generally smaller, ranging from a reduction of 9.2% for thyroid-function testing in patients with hypothyroidism, to a reduction of 37.5% for glycated hemoglobin testing in patients with serious mental illness.

In contrast, six indicators for which incentives were maintained showed no “clinically important” changes in documented quality three years after 2013-2014 for four indicators, including cholesterol control in patients with diabetes and blood pressure control in patients with coronary heart disease.

Mark Minchin, associate director at Nice, said: “This study suggests payers planning to remove financial incentives should monitor the quality of care after removal. In doing so, they face the same conundrum involved in introducing incentives: the uncertainty about whether changes in documented quality represent true changes in patient care.”

A key implication is that reductions in quality are likely after incentives are removed. PROF BRUCE GUTHRIE

Professor Bruce Guthrie of Dundee University said a key implication of the new research is that reductions in quality are likely after incentives for GPs are removed.