A recent systematic review by Riyadh Alshamsan and colleagues assessed the impact of pay for performance programmes, in particular the Quality & Outcomes Framework in the UK, on inequalities in the quality of health care. There was some evidence that the use of financial incentives reduced inequalities in chronic disease management between socio-economic groups. However, inequalities in chronic disease management between age, sex and ethnic groups persisted after the use of pay for performance incentives. They concluded that inequalities in chronic disease management have often persisted after the introduction of pay for performance programmes such as the Quality and Outcome Framework in the UK. The findings of the paper reinforce the need for pay for performance programmes to be designed to reduce inequalities as well as improve the overall quality of care.
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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