Incentives work

The role of the press office at a major journal is to try to get the journal into the mainstream press. They can tend to be a little, well, excitable.

So it was in last weeks BMJ that a paper was published on the early years of the QOF. Effect of financial incentives on incentivised and non-incentivised clinical activities: longitudinal analysis of data from the UK Quality and Outcomes Framework is actually quite an interesting paper on the effect of incentivised and non incentivised indicators. The not terribly startling conclusion was that attaching a third of practice income to a set of indicators seems to have concentrated the minds of GPs and influenced practice, or at least the coding of that practice. Incentives work.

The graph above is taken from the paper. You can clearly see the "hump" where QOF starts. The setting up of sytems and templates in a concentrated way has pushed up achievement and this is maintained (or "plateaued" as they say in the paper).

However most of the press attention went onto the green line. Notice how the green line plummets off the bottom of the graph indicating inadequate care? Nope, neither do I. It is still going up. It is not going up quite as fast as before, and that is the point that the paper makes.

It is not a scandalous or surprising conclusion. Paying a third of income and a greater share of profits for certain indicators is bound to put these as top priorities. It is to the credit of general practice that the standards for the lower prority areas have not simply been maintained but continuously improved.

To be startled by the result that incentive payments incentivise some things over others is to question what you thought QOF was actually for.