Financial rewards and incentives to improve GP services risk being overused in the NHS and are not the best way to encourage lasting change and widespread reform, a new briefing from the Nuffield Trust says today. Policymakers instead need to supplement these financial incentives with a more enabling approach to improving general practice.
Transforming general practice: What are the levers for change? argues that this approach should involve developing new skills and working practices across the whole GP workforce, investing properly in equipping organisations to change and ensuring that better data is available to evaluate impact.
Putting the Forward View into action will require policymakers to adopt a far more sophisticated approach to reform than the narrow use of financial rewards and contract changes.
Dr Rebecca Rosen, briefing author
The briefing, authored by Dr Rebecca Rosen, examines how policymakers and regulators can support change in general practice in the context of national policies aimed at improving and developing GP services including the Five Year Forward View and the Prime Minister’s Challenge Fund. It draws on academic evidence on the use of financial incentive schemes - such as the Quality and Outcomes Framework (QOF) – and other approaches to driving change, as well as expert testimonials and case studies.
The briefing concludes that the current combination of national and local incentive schemes and contract performance measures risk overwhelming GPs and limiting their ability to engage with efforts to achieve sustainable change.
Dr Rosen, a Greenwich GP and Senior Policy Fellow at the Nuffield Trust said:
“The history of reforming general practice in England is littered with initiatives aimed at achieving small-scale change through financial rewards. These can work well if the goal is to improve narrow areas of care. But they are blunt instruments, which can distort priorities and detract from patient care. “
The experience of four case study sites examined in the briefing suggests that the ingredients of successful service change include strong inter-professional relationships, capable leaders, time to experiment, and the willingness to take risks and sometimes fail."
Dr Rosen continued:
“Nobody disputes that there is a pressing need to reform general practice. But the challenges facing GPs – from meeting the needs of frail older people, to working at scale across larger areas – require us to think differently.
“Putting the Forward View into action will require policymakers to adopt a far more sophisticated approach to reform than the narrow use of financial rewards and contract changes. They need to be supplementing the use of these measures by building skills, understanding impact and creating the headspace that GPs need to fundamentally transform services.”
The Nuffield Trust concludes such an approach to reforming GP services should be based on:
- Better equipping the GP workforce to meet the changing needs of patients, including the development of specialist skills within primary care and cultivating strong leaders;
- Ensuring that time to redesign and transform services is built into change programmes;
- Insisting on the development of a minimum dataset for general practice to permit a better understanding of impact.
Notes to editors
- The Nuffield Trust’s briefing was informed by a seminar held at the Nuffield Trust in 2014, attended by academics, GPs, commissioners and senior policy makers.
- The seminar heard evidence from Matt Sutton, Professor of Economics at the University of Manchester, on the use of financial incentives; Kecia Werry, formerly of US healthcare organisation ChenMed on achieving change without relying on financial incentives; and the experiences of four case study sites that have achieved service change - from delivering general practice at scale, to introducing care planning and multidisciplinary team working.
- The briefing is accompanied by a literature review of the evidence of levers for change in general practice and primary care.