Incentives and control in primary health care: findings from English pay-for-performance case studies

J Health Organ Manag. 2008;22(1):48-62. doi: 10.1108/14777260810862407.


Purpose: The authors' aim was to investigate mechanisms and perceptions of control following the implementation of a new "pay-for-performance" contract (the new General Medical Services, or GMS, contract) in general practice.

Design/methodology/approach: This article was based on an in-depth qualitative case study approach in two general practices in England.

Findings: A distinction is emerging amongst ostensibly equal partners between those general practitioners conducting and those subject to surveillance. Attitudes towards the contract were largely positive, although discontent was higher in the practice which employed a more intensive surveillance regime and greater amongst nurses than doctors.

Research limitations/implications: The sample was small and opportunistic. Further research is required to examine the longer-term effects as new contractual arrangements evolve.

Practical implications: Increased surveillance and feedback mechanisms associated with new pay-for-performance schemes have the potential to constrain and shape clinical practice.

Originality/value: The paper highlights the emergence of new tensions within and between existing professional groupings.

MeSH terms

  • Attitude of Health Personnel*
  • Contract Services
  • Data Collection
  • Employee Incentive Plans*
  • England
  • Family Practice / organization & administration*
  • Health Services Research
  • Humans
  • Interviews as Topic
  • Organizational Case Studies
  • Organizational Culture
  • Quality Assurance, Health Care / methods*