Many countries are considering paying primary care physicians to improve the quality of care they provide to their patients (commonly known as 'pay for performance' or P4P). A recent study in the Journal of General Internal Medicine found very little association between quality scores in a pay for performance scheme in England and admission rates for coronary heart disease. This suggests that improving the quality of primary care may not reduce demands on the hospital sector.
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...
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