Payment for performance has been used in the NHS across the UK. In primary care, the QOF (quality and outcomes framework) rewards GP practices for achieving performance indicators such as managing chronic diseases and implementing preventative measures.
Scotland and Wales however have recently announced the end or partial suspension of QOF. Following this, Scotland is considering new payment arrangements for GP practices and Wales has agreed fundamental reforms to QOF going forward.
In England, secondary care schemes include the ‘commissioning for quality and innovation’ framework (CQUIN). Under CQUIN clinical commissioning groups (CCGs) combine national and local performance targets for provider contracts, achievement of which attracts a financial bonus of 2.5% of the contract value.
The national tariff (‘payment by results’) also includes best practice tariffs (BPT) for around 18 areas of clinical care. BPTs incentivise best clinical practice either by increasing tariff prices if services are delivered in a specific way (eg as a day case) or making payment of the tariff contingent on adherence to best-practice care.
Find out more about the national tariff
The ‘advancing quality’ (AQ) programme specific to North West England rewarded hospitals that achieved the top quality scores in the region.
In other parts of England, CCGs have been developing their own, local payment models in order to support greater integration of services based on a mixture of capitation and payment for performance.[i]
NHS England is proposing that the new care models such as multispecialty community providers (MCPs) and primary and acute care systems (PACS) adopt a similar approach by combining a capitated payment approach with an improvement payment scheme and a gain/loss sharing agreement.
For more information on this proposed approach, see our briefing on Payment models for integrated care: A capitated payment approach
For more information on capitation, see another briefing in this series
For more information on MCPs and PACS, see our briefing on Integrated provider models
[i] Addicott R (2014). Commissioning and contracting for integrated care. London: The King’s Fund.