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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 July 14; 335(7610): 60.
PMCID: PMC1914516
Financial incentives and GPs

What about the impact on patient health?

Mark Strong, clinical lecturer and John Radford, director of public health

McDonald et al's report of general practitioners' and nurses' views of the quality and outcomes framework (QOF) highlights the “box ticking” nature of this pay-for-performance contract.1 We have therefore proposed that incentives are linked more directly to positive health outcomes.

Rotherham practices achieved highly on the smoking related QOF indicators in both 2005 and 2006, costing the primary care trust (PCT), which has a population of 250 000, about £276 000 in 2005 and £500 000 in 2006. Despite this, the smoking prevalence among those on Rotherham's QOF chronic disease registers remained essentially unchanged.

We have proposed to the PCT executive and the local medical committee that the QOF contract be renegotiated. We suggested for the smoking related indicators that the four week quit target set for us as a PCT is allocated proportionally between practices; then, at year end, practices are rewarded a proportion of the 68 QOF points allocated for the current smoking indicators according to the number of quitters relative to their target.

Moving away from tick box based incentives towards outcome based incentives could seem to be penalising GPs for their patients' unhealthy behaviours. However, as a PCT, we are responsible for the health of our population, and we believe that this is a sentiment shared by our GPs. We are held accountable as a PCT through the quit target for decisions made by our population, an accountability it seems only fair to share.

Committing NHS resources through a financial incentive scheme is justifiable only if quantifiable health benefits result. The current smoking indicators do not seem to deliver this benefit.


Competing interests: None declared.


1. McDonald R, Harrison S, Checkland K, Campbell SM, Roland M. Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study. BMJ 2007;334:1357-9. (30 June.) [PMC free article] [PubMed]

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