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12-12-2011 | Article

Performance payments

I have often thought that the way we are paid influences the way we practise medicine. I believe this to be especially true in general practice, where many GPs are independent contractors and partners are typically self-employed. Just consider all the QOF points that we chase and targets with financial inducements that we strive to achieve!

This raises an important matter: should we be receiving financial inducements to encourage us to do our job to the best of our ability? I suppose the Government would not be offering cash prizes if they thought it wasn't good value. Furthermore, performance-related bonuses are not uncommon in the private sector, so why should medicine be any different?

Irrespective of how GPs are remunerated, it is essential that both taxpayers and consumers of healthcare feel that they are getting value for money. This is not easy to quantify, but that should not preclude efforts to analyse performance against payment methods.

Recently, an article published in the Canadian Medical Association Journal and reported in the Univadis GP News service (click here) looked at the effect of funding models. The article stated: "The way primary care is funded seems to have little impact on the delivery of preventative care, research from Canada shows."

But there was more. The article continued: "In contrast, the team found that three factors were strongly associated with superior delivery of the preventative measures. These were the presence of at least one female doctor, having fewer than 1600 patients per full-time GP and the use of electronic reminders for recommended care or electronic health records."

Thus, superior delivery of certain services was not associated with hard cash but with a more optimal working environment. These data notwithstanding, I would not support withdrawing all cash incentives to GP - not least because primary care depends on them to survive.

Furthermore, without a properly functioning primary care service, more medical activity would move to secondary care, which is the more expensive provider. Indeed, primary care in the UK is highly regarded and competes well with other countries, as set out in this article in GP Online (click here).

The way in which GPs are paid is complex and I'd guess that many GPs would struggle to understand the finer points of their remuneration. But primary care provides a good service and - while there is always room for improvement - mess with it at your peril!

Best wishes,


Dr Harry Brown, editor-in-chief univadis

By Dr Harry Brown