{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:14:58Z","timestamp":1787030098771,"version":"build-2736575974"},"reference-count":83,"publisher":"Royal College of General Practitioners","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BJGP Open"],"accepted":{"date-parts":[[2024,11,4]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Quality and Outcomes Framework (QOF), a pay-for-performance programme, has been the most widespread quality initiative in NHS general practice since 2004. It has contributed between 25% and 8% of practices\u2019 income during this time, but concerns about its effect on equity have been raised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To understand which practice characteristics are associated with QOF performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>A systematic review was conducted, focusing on NHS general practice in the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>MEDLINE, Embase, CINAHL+, Web of Science, and grey literature were searched for studies examining the association between general practice characteristics and QOF performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-two studies, published between 2006 and 2022, exploring the relationship between six population and 15 organisational characteristics and QOF measures were found. Most studies were cross-sectional, of English general practices, and used data from the early years of QOF. A negative association was frequently found between overall QOF performance and socioeconomic deprivation; increasing proportion of registered patients aged &gt;65 years; increasing list size; increasing mean GP age; and Alternative Provider Medical Services contracts. Group practices (versus single-handed), more full-time equivalent (FTE) GPs, and being a training practice were frequently associated with better overall QOF performance. The associations of most other characteristics with performance were inconsistent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Associations with characteristics both within and outside practices\u2019 control were identified. Pay-for-performance instruments may systematically disadvantage practices serving those at greatest risk of ill-health such as older and more deprived populations. Given the cross-sectional design of many studies and focus on the early years of QOF, more up-to-date evidence is needed to understand if and why these relationships persist.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3399\/bjgpo.2024.0174","type":"journal-article","created":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T13:25:22Z","timestamp":1732109122000},"page":"BJGPO.2024.0174","source":"Crossref","is-referenced-by-count":1,"title":["General practice characteristics associated with pay-for-performance in the UK: a systematic 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