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Devolving national pay for performance programmes

Primary health care services are important in establishing an effective, efficient, and equitable health system and in improving population health. This has led governments in many countries to increase their investment in primary care and introduce initiatives to improve quality, such as pay for performance. In the United Kingdom, this includes the Quality & Outcomes Framework (QOF), a national pay for performance programme. There is interest in devolving some aspects of national pay for performance programmes to local primary care organisations, to give greater flexibility and the ability to focus on local priorities. In a recent BMJ paper, Christopher Millett and colleagues discuss one such local programme, QOF+, which was implemented in NHS Hammersmith & Fulham.

The review of the scheme in NHS Hammersmith & Fulham suggests that local pay for performance incentive schemes may allow for opportunities to improve quality, encourage innovation, and tackle local public health priorities. An integrated incentive scheme such as QOF+ could also replace the plethora of disparate incentive schemes currently in place in primary care organisations  However, there are also disadvantages of such schemes. They can require considerable investment in both time and money, and their widespread adoption is unlikely without the government devolving part of the national QOF budget to primary care organisations for local priorities, expediting plans to develop a national menu of quality indicators for local use, and having an information technology infrastructure that allows for the monitoring and evaluation of such schemes.

Hence, there are advantages and disadvantages to such local incentive schemes and their wider roll-out and implementation would need careful monitoring.

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