Impact of local enhanced incentive schemes on the performance of general practices within the UK: a systematic review.

Background: To drive improvements in healthcare quality and to reduce inequalities, pay-for-performance (P4P) schemes have become widespread internationally. In recent years, most local commissioning bodies in the 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.

Design and setting: Systematic review of quantitative studies related to local incentive schemes with a P4P structure within UK general practice published after 2004.

Method: Searches were conducted via Ovid across the Embase and MEDLINE databases. Risk of bias was assessed using the Cochrane Effective Practice and Organisation of Care criteria and a narrative synthesis was undertaken.

Results: In total, 17 studies were identified, which were focused on 14 local incentive schemes. All studies were from England, except one from Scotland. Five studies included only tailored indicators, and seven studies included both aligned and tailored indicators. Quality assessment suggested the current evidence was of mixed quality. All studies that reported on process measures (n = 15) demonstrated positive impacts, but health outcome measures were only evaluated in nine studies showing inconsistent findings. Eight 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.