Br J Gen Pract. 2026 Jul 7:BJGP.2025.0377. doi: 10.3399/BJGP.2025.0377. Online ahead of print.
ABSTRACT
Background To drive improvements in health care quality and to reduce inequalities, pay-for-performance (P4P) schemes have become widespread internationally. In recent years, most local commissioning bodies in the United Kingdom (UK) have developed their own local general practice incentive schemes. Aim To examine the use and effectiveness of local incentive schemes and their alignment to the national Quality and Outcomes Framework (QOF). Design and Setting This was a systematic review of qualitative studies related to local incentive schemes with a P4P structure within UK general practice in the UK after 2004. Methods Searches were conducted via OVID across the Embase and MEDLINE databases. Risk of bias was assessed using the EPOC criteria and a narrative synthesis was undertaken. Results 17 studies were identified focused on 14 local incentive schemes. All studies were from England, except one from Scotland. 5 studies included only tailored indicators, and 7 studies included both aligned and tailored indicators. Quality assessment suggested the current evidence was of mixed quality. All studies demonstrated positive impacts on process measures but health outcome measures were only evaluated in 9 studies showing inconsistent findings. 8 studies addressed impact on health inequalities and no studies addressed cost-effectiveness, patient reported outcomes or experience measures. Conclusion There is an emerging evidence base that local incentive schemes in general practice lead to improvements in process measures, although methodological quality of studies is mixed. Future studies should utilise more robust methods to evaluate effectiveness and examine impacts on health inequalities, cost-effectiveness and variation by practice.
PMID:42414056 | DOI:10.3399/BJGP.2025.0377