Effectiveness of UK provider financial incentives on quality of care: a systematic review

Rishi Mandavia, Nishchay Mehta, Anne Schilder and Elias Mossialos. Effectiveness of UK provider financial incentives on quality of care: a systematic review. Br J Gen Pract 9 October 2017; bjgp17X693149. DOI: https://doi.org/10.3399/bjgp17X693149

Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency.

Aim To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care.

Design and setting Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.

Method MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as ‘positive’, those that were ‘intermediate’ showed improvement in some measures, and those classified as ‘negative’ showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist.

Results Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points.

Conclusion The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives — if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK.

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Collaboration in general practice

Collaboration in general practice: Surveys of GP practices and clinical commissioning groups | Nuffield Trust |  Royal College of General Practitioners

This report summarises the results of two surveys, sent to general practice staff and to CCG staff, aimed at finding out what had changed in the landscape of general practice since the previous surveys two years ago and to explore what GPs feel the future holds for them.

Key findings include:

  • The scaling up of general practice continues apace with 81% of general practice-based respondents reporting that they were part of a formal or informal collaboration, up from 73% in 2015.
  • However, the landscape is complex. Practices often belong to multiple collaborations that operate at different levels in the system, having been set up to fulfil different purposes.
  • The main priorities of all collaborations over the last year were: increasing access for patients, improving sustainability, and shifting services into the community. The priorities differed by size of collaboration. Both providers and commissioners reported that time and work pressures were the biggest challenge to collaborations achieving their aims.
  • When asked about developments in their local area, over half of GP staff and one-third of CCG staff surveyed felt practices and collaborations had not been at all influential in shaping the local sustainability and transformation partnership (STP). Only one-fifth of GPs thought STPs would deliver meaningful change in primary care. CCGs were more optimistic, with 61% reporting that meaningful change was probable.
  • When questioned about future models of care, around half of practice partners (53%) said they would be ‘unwilling’ or ‘very unwilling’ to give up their current GMS/PMS/APMS contract1 to join a new models contract (e.g. MCP or PACS contract2). The most common reason they gave was that they did not want to lose control of decision-making and leadership in their practice.

The report can be downloaded here

Nine in 10 GPs rated good or outstanding following CQC inspection

Care Quality Commission (CQC) report finds that at the end of its first inspection programme of general practices 4% were rated ‘outstanding’, 86% were ‘good’, 8% were ‘requires improvement’ and 2% were ‘inadequate’.

state of cqc

Image source: http://www.cqc.org.uk

The state of care in general practice 2014 to 2017 presents findings from CQCs  programme of inspections of GP practices. This detailed analysis of the quality and safety of general medical practice in England has found that nearly 90% of general practices in England have been rated as ‘good’, making this the highest performing sector CQC regulates.

Full document: The state of care in general practice 2014 to 2017

Large scale general practice

Rosen, R. Kumpunen, S. Curry, N. Davies, A. Pettigrew, L. Kossarova, L. (2017) Summary booklets on lessons for large-scale general practice. | Nuffield Trust

In July 2016, the Nuffield Trust published Is bigger better? Lessons for large-scale general practice  which examined the factors affecting the evolution of general practice and its impact on quality, staff and patient experience.

The Nuffield Trust has now released four booklets which sit alongside this main report covering:

 

Electronic NHS referrals

Two hospital trusts and their referring GP practices have become the first in the country to adopt a digital process for booking patient hospital appointments

Sherwood Forest Hospitals NHS Foundation Trust and County Durham & Darlington NHS Foundation Trust are now processing all of their hospital referral appointments electronically via the NHS e-Referral Service. Patients are also able to change or cancel their appointments through the system with analysis showing that use of electronic referrals has halved the rate of patients missing appointments from 10% to 5%.

Roll out of NHS Wi-Fi to GP surgeries begins

NHS Digital has begun roll out of NHS WiFi to GP surgeries in England and it should be completed by the end of the year.

wifi.png

Using NHS WiFi, patients will be able to access the internet free of charge in their GP’s waiting room, via their smart phone or tablet. It will enable patients to link in with local health clinics and services and is paving the way for future developments in digital patient care.

NHS WiFi will provide a secure, stable, and reliable WiFi capability, consistent across all NHS settings. It will allow patients and the public to download health apps, browse the internet and access health and care information.

Local Clinical Commissioning Groups (CCGs) are responsible for choosing a supplier that can provide an NHS WiFi compliant system which suits their needs, and working with them to implement it across their local NHS sites. The chosen system must be based on a set of policies and guidance defined by NHS Digital.

Guidance available via NHS Digital relates to implementing NHS WiFi in GP practices. Hospitals and secondary care will follow in 2018.

Further details available here