title: Performance of small general practices under the UK's Quality and Outcomes Framework.
abstract: BACKGROUND
  Small general practices are often perceived to provide worse care than larger practices.
  
  
  OBJECTIVE
  To describe the comparative performance of small practices on the UK's pay-for-performance scheme, the Quality and Outcomes Framework.
  
  
  METHODS
  Longitudinal analysis (2004-2005 to 2006-2007) of quality scores for 48 clinical activities.
  
  
  METHODS
  Family practices in England (n = 7502).
  
  
  METHODS
  Comparison of performance of practices by list size, in terms of points scored in the pay-for-performance scheme, reported achievement rates, and population achievement rates (which allow for patients excluded from the scheme).
  
  
  RESULTS
  In the first year of the pay-for-performance scheme, the smallest practices (those with fewer than 2000 patients) had the lowest median reported achievement rates, achieving the clinical targets for 83.8% of eligible patients. Performance generally improved for practices of all sizes over time, but the smallest practices improved at the fastest rate, and by year 3 had the highest median reported achievement rates (91.5%). This improvement was not achieved by additional exception reporting. There was more variation in performance among small practices than larger ones: practices with fewer than 3000 patients (20.1% of all practices in year 3), represented 46.7% of the highest-achieving 5% of practices and 45.1% of the lowest-achieving 5% of practices.
  
  
  CONCLUSIONS
  Small practices were represented among both the best and the worst practices in terms of achievement of clinical quality targets. The effect of the pay-for-performance scheme appears to have been to reduce variation in performance, and to reduce the difference between large and small practices.
authors.affiliation: National Primary Care Research and Development Centre, University of Manchester, Manchester. tim.doran@manchester.ac.uk
authors.forename: Tim
authors.initials: T
authors.lastname: Doran
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
authors.forename: Catherine
authors.initials: C
authors.lastname: Fullwood
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
authors.forename: Martin
authors.initials: M
authors.lastname: Roland
mesh_terms: D003695:Delivery of Health Care / Q000592:standards; D004739:England; D005194:Family Practice / Q000592:standards*; D006276:Health Facility Size / Q000706:statistics & numerical data; D006801:Humans; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care