United Kingdom

The article discusses pay-for-performance incentive schemes for primary care physicians and nurses in the United Kingdom, and studies the ‘Next steps towards primary care co-commissioning’ policy document, that signals a move towards greater devolution of the development of pay-for-performance schemes to Clinical Commissioning Groups. The aim of the Quality and Outcomes Framework was to incentivise practices to deliver structured care orientated to the achievement of evidence-based quality targets for patients with predominantly chronic conditions.

This article shows the importance and the role of demand-side RBF strategies in promoting behavior changes. It highlights how, more and more, voucher programs are showing positive effects. The article also emphasizes the usefulness of having a sensitive and specific mechanism for independent verification.

Paying health care providers performance-based incentive payments is one form of results-based financing (RBF). Verifying that providers have reached set performance thresholds is a crucial part of RBF program implementation and key to maintaining the transparency, fairness, and viability of the programs. Since 2004, the United Kingdom's National Health Service (NHS) has been implementing one of the largest RBF initiatives worldwide, the Quality and Outcomes Framework (QOF). The QOF provides incentive payments for primary care providers to improve quality of care and patient experience.

No evidence of serious harm so far, but future changes need evaluation.

Author Cheryl Cashin describes the Quality and Outcomes Framework (QOF) – the UK’s public health care approach that includes voluntary performance-based incentives. QOF is a national program with almost all General Practitioner (GP) practices participating. In 2009 it covered nearly 100% of registered patients.

The study situates the QOF within a broader context of the overall health system reform that has occurred in the last ten years, that resulted in increased spending on public health, improved accountability and well-defined standards for service providers. 

This presentation tells you everything you need to know about P4P, specifically related to paying health care providers. Examples from the USA, UK, Brazil and Haiti are included, as well as:

  • Performance Incentives to Households and/or Providers
  • Paying Providers Based on Performance
  • Types of Measures
  • Different Methods to Pay Based on Performance
  • What is Financial Risk for providers under P4P?


From a World Bank-World Health Organization Strategic Purchasing Workshop in Bangkok in December 2009.

This presentation by Ruth McDonald of Nottingham University demonstrates experience using incentives to improve quality of care, productivity and morale. It was delivered at a National Workshop on RBF in India in January 2010.

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