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27-01-2011 | Cardiology | Article

GP financial incentives fail to improve patients’ BP outcomes


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MedWire News: Results from a UK study suggest that the implementation of a pay-for-performance scheme in which general practitioners (GPs) receive financial incentives for monitoring and treating patients with high blood pressure (BP), has had no impact on hypertension-related patient outcomes.

The authors suggest that this may be because "the quality of care for hypertension was improving and already close to the threshold set for maximum payment in the pay-for-performance initiative.

"Some performance thresholds may have been set too low for the financial incentives to be effective."

The pay-for-performance scheme (the Quality and Outcomes Framework [QOF]), an ongoing voluntary scheme launched in April 2004, offers financial rewards to GPs who meet some, or all of 136 pre-defined quality-of-care indicators (five hypertension-specific).

Using data from The Health Improvement Network - a database containing the primary care medical records of patients from 358 UK general practices - Stephen Soumerai (Harvard Medical School, Boston, Massachusetts, USA) and team analyzed the outcomes of 470,725 hypertensive patients between 2000 and 2007.

As reported in the BMJ, no significant change was observed in the rate of BP monitoring and treatment 3 years after the scheme's implementation, compared with the 4-year period prior to the start of the scheme.

Indeed, BP monitoring fell by a rate of 0.04% each month before the scheme's launch and continued to do so after the scheme was initiated, while the number of patients receiving new drug treatment increased by 0.05% per month prior to the scheme and persisted at this level after the scheme's implementation.

The rates of hypertension-related adverse outcomes, namely myocardial infarction, stroke, heart failure, and renal failure, were also unaffected by the scheme.

Soumerai and team report that the combined rates of these outcomes increased by 0.04% per month before the scheme and continued to increase by the same rate 3 years after the scheme's implementation.

"The lack of impact of the pay-for-performance initiative on these long-term adverse clinical outcomes is not surprising given its failure to affect the more intermediate outcome of BP control," remark Soumerai and colleagues.

In a related commentary, John Reckless from the University of Bath in the UK wrote: "The current model in the UK is not necessarily the right one or the only one."

Indeed, Soumerai and co-authors suggest that the resources devoted to the QOF scheme may be better spent on alternative interventions, such as the use of allied health professionals to co-manage patients with hypertension.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Lauretta Ihonor

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