Ending performance-related payments for NHS GPs in Scotland was associated with a decline in the quality of some aspects of care, compared with England where financial incentives have continued, finds a study published by The BMJ today.

The NHS Quality and Outcomes Framework (QOF) pay-for-performance scheme began in 2004. It was designed to remunerate general practices for providing good quality care across a range of key areas such as cancer, diabetes, heart disease, mental health, and obesity.

In 2016, Scotland abolished the QOF to reduce the bureaucratic burden on GPs and to free up their time for patients, but continued collecting performance data for some QOF indicators for the next three years. Researchers were therefore able to use this data to evaluate the impact of QOF withdrawal on the quality of care in Scotland compared with England over the same period.

Compared with England, the researchers found a significant decrease in performance for 12 of the 16 quality-of-care indicators in Scotland one year after QOF was abolished and for 10 of the 16 indicators three years after QOF was abolished.

Reductions at one year ranged from 30 percentage points for recording of mental health care planning to 3 percentage points for flu vaccination in people with heart disease.

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