While the use of pay for performance as a quality improvement tool in health care is increasing, little is known about the impact of these programs on the quality of care delivered to patients with multiple conditions. Pay for performance schemes, such as the Quality and Outcomes Framework in the UK, could impact the quality of care delivered to patients with complex medical problems in several ways. A study published by myself and colleagues in the Journal of the Royal Society of Medicine suggested that introduction of pay-for-performance in primary care in the UK has not had a negative impact on the quality of care delivered to patients with multiple medical conditions. Rather, patients with co-morbid medical conditions seem to have benefited more than those without co-morbidity. This is reassuring given that previous studies have found that patients with multiple medical conditions are more likely to be excluded from performance reporting in pay for performance programs. Our findings provide no support for setting lower treatment targets for patients with multiple conditions within quality improvement programs and pay-for-performance schemes. This is important given that the longer-term benefits of good diabetes control are now firmly established and that associated health gain may be greatest in high-risk groups with existing co-morbid conditions such as coronary heart disease and hypertension.
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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