Policymakers implementing pay-for-performance schemes within general practice should seek to design schemes which work with rather than against the professional values and goals of general practitioners. In this way, schemes are more likely to enhance the practitioners' engagement. The purpose of this paper is to show how this was done in two case studies of pay-for-performance design and present the lessons from this study for policymakers.
A Most Similar Systems collective case study of the design of two pay-for-performance schemes for general practitioners, the United Kingdom's Quality and Outcomes Framework (QOF) and the New Zealand’s Performance Management Programme (PMP) was undertaken, involving 26 semi-structured interviews with policymakers, documentary and literature analysis.
Innovation in processes was found in both case studies which facilitated engagement by general practitioners in the formulation and implementation of these schemes. These were careful selection of highly skilled design teams, use of principle-based negotiation techniques and academic mediation of indicator selection. In addition, in England the majority of members in the combined QOF design team were general practitioners. The evidence from these two case studies reinforces approaches to scheme design which seek to harness rather than challenge medical professional values and which maximise the participation of general practitioners in the design process. Achieving funder/practitioner collaboration should be a key goal in the policymaking process.
Pay-for-performance scheme designers can improve their ability to engage general practitioners in scheme design and scheme uptake by adopting approaches which actively engage general practitioners as designers and users of such schemes.
This study compares two contemporaneous processes of pay-for-performance scheme design and implementation in similar systems of general practice funding and delivery at the national level, offering a rare quasi-experimental opportunity for learning lessons from comparative analysis.
