BACKGROUND: Small general practices are often perceived to provide worse care than larger practices. AIM: To describe the comparative performance of small practices on the UK's pay-for-performance scheme, the Quality and Outcomes Framework. DESIGN OF STUDY: Longitudinal analysis (2004-2005 to 2006-2007) of quality scores for 48 clinical activities. SETTING: Family practices in England (n = 7502). METHOD: Comparison of performance of practices by list size, in terms of points scored in the pay-for-performance scheme, reported achievement rates, and population achievement rates (which allow for patients excluded from the scheme). RESULTS: In the first year of the pay-for-performance scheme, the smallest practices (those with fewer than 2000 patients) had the lowest median reported achievement rates, achieving the clinical targets for 83.8% of eligible patients. Performance generally improved for practices of all sizes over time, but the smallest practices improved at the fastest rate, and by year 3 had the highest median reported achievement rates (91.5%). This improvement was not achieved by additional exception reporting. There was more variation in performance among small practices than larger ones: practices with fewer than 3000 patients (20.1% of all practices in year 3), represented 46.7% of the highest-achieving 5% of practices and 45.1% of the lowest-achieving 5% of practices. CONCLUSION: Small practices were represented among both the best and the worst practices in terms of achievement of clinical quality targets. The effect of the pay-for-performance scheme appears to have been to reduce variation in performance, and to reduce the difference between large and small practices.
BACKGROUND: Small general practices are often perceived to provide worse care than larger practices. AIM: To describe the comparative performance of small practices on the UK's pay-for-performance scheme, the Quality and Outcomes Framework. DESIGN OF STUDY: Longitudinal analysis (2004-2005 to 2006-2007) of quality scores for 48 clinical activities. SETTING: Family practices in England (n = 7502). METHOD: Comparison of performance of practices by list size, in terms of points scored in the pay-for-performance scheme, reported achievement rates, and population achievement rates (which allow for patients excluded from the scheme). RESULTS: In the first year of the pay-for-performance scheme, the smallest practices (those with fewer than 2000 patients) had the lowest median reported achievement rates, achieving the clinical targets for 83.8% of eligible patients. Performance generally improved for practices of all sizes over time, but the smallest practices improved at the fastest rate, and by year 3 had the highest median reported achievement rates (91.5%). This improvement was not achieved by additional exception reporting. There was more variation in performance among small practices than larger ones: practices with fewer than 3000 patients (20.1% of all practices in year 3), represented 46.7% of the highest-achieving 5% of practices and 45.1% of the lowest-achieving 5% of practices. CONCLUSION: Small practices were represented among both the best and the worst practices in terms of achievement of clinical quality targets. The effect of the pay-for-performance scheme appears to have been to reduce variation in performance, and to reduce the difference between large and small practices.
Authors: Pieter van den Hombergh; Yvonne Engels; Henk van den Hoogen; Jan van Doremalen; Wil van den Bosch; Richard Grol Journal: Fam Pract Date: 2005-01-07 Impact factor: 2.267
Authors: Tim Doran; Catherine Fullwood; Hugh Gravelle; David Reeves; Evangelos Kontopantelis; Urara Hiroeh; Martin Roland Journal: N Engl J Med Date: 2006-07-27 Impact factor: 91.245
Authors: Evangelos Kontopantelis; Tim Doran; Hugh Gravelle; Rosalind Goudie; Luigi Siciliani; Matt Sutton Journal: Health Serv Res Date: 2011-12-15 Impact factor: 3.402
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