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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 July 21; 335(7611): 121.
PMCID: PMC1925207
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Pay for performance linked to better care for some primary care patients in UK

UK patients with type 2 diabetes or asthma have had better quality primary care since the government introduced pay for performance incentives in 2004, a study has found. Their care was improving before the new contract, but the trend accelerated significantly soon afterwards in 42 representative practices. Care of patients with coronary heart disease has also improved recently, but the authors found no sharp increase in quality after pay for performance was introduced.

It is hard to know for certain whether particular events are responsible for trends in care, but the authors think that UK general practitioners probably did respond to the financial incentives introduced in 2004. Even before the change, quality of care was highest for patients with coronary heart disease, leaving less room for improvement. In 2001 and 2002, 98% of primary care trusts already had quality initiatives for coronary heart disease in place.

If the new contract did improve general practitioners' performance, the effect was only modest and the government accepts it paid a high price, say the authors. Officials are currently busy amending the details. Doctors may soon have to work harder for their rewards.


  • N Engl J Med 2007;357:181-90

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