US-style efficiency target threat for GMS

Adding financial targets to the quality framework could be a more effective way to reduce NHS spending than practice-based commissioning (PBC).

Dr Ruth McDonald, of the National Primary Care Research and Development Centre, is researching how US primary care targets could work in the UK.

GP practices in California have adopted a system similar to the GMS quality framework, dubbed ‘Pay for Performance’.

The system pays practices for hitting disease management targets but it also measures how efficient each practice is offering incentives to manage costs.

Dr McDonald said efficiency targets forced all practices to consider the cost of referrals and treatment, and would have a  more immediate effect than PBC.

Dr McDonald said the UK quality framework was an incentive to do things regardless of the cost.

‘Linking clinical quality to efficiency is an opportunity to see whether practices are doing well on quality because they are spending too much,’ she said.

Under the US system, a predicted healthcare cost is calculated for each practice based on the characteristics of its patients. Practices’ efficiency ratings are based on how they perform against this prediction.

Dr McDonald said potential perverse incentives to under-refer may be cancelled out by the impact this would have on clinical quality scores.

GPC deputy chairman Dr Laurence Buckman said: ‘There is no evidence that any referral pattern is better than another.’

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