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


METHODS
This article was based on an in-depth qualitative case study approach in two general practices in England.


RESULTS
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.


CONCLUSIONS
The sample was small and opportunistic. Further research is required to examine the longer-term effects as new contractual arrangements evolve.


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


CONCLUSIONS
The paper highlights the emergence of new tensions within and between existing professional groupings.
McDonald
Ruth
R
National Primary Care Research and Development Centre, University of Manchester, Manchester, UK. ruth.mcdonald@manchester.ac.uk
Harrison
Stephen
S
Checkland
Kath
K
D001291:Attitude of Health Personnel; D003284:Contract Services; D003625:Data Collection; D004649:Employee Incentive Plans; D004739:England; D005194:Family Practice / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D019982:Organizational Case Studies; D015279:Organizational Culture; D011785:Quality Assurance, Health Care / Q000379:methods*