title: Incentivizing preventive services in primary care: perspectives on Local Enhanced Services.
abstract: BACKGROUND
  General practitioners in the UK play a key role in prevention but provision of preventive services is variable. The 2004 General Medical Services contract allows Primary Care Trusts (PCTs) to address health needs through providing locally agreed payments for Local Enhanced Services (LESs). This study identifies how this contractual flexibility is used for preventive services and explores its perceived effectiveness.
  
  
  METHODS
  Semi-structured interviews were carried out (2008-09) in 10 purposively selected case study sites in England. Details of LESs for these sites were collected (2009) through Freedom of Information requests or local contacts. A national on-line survey of PCTs (2009) provided a national context for case study findings.
  
  
  RESULTS
  LESs were considered to be effective in incentivizing preventive activity. However, specifications and performance management were often weak, awareness of how to optimize incentives was low and, as optional services, LESs were perceived to be at risk in a financial downturn.
  
  
  CONCLUSIONS
  Using LESs for preventive services highlights gaps in 'core' primary care responsibilities and in the national pay-for-performance framework. Current incentive arrangements are complex, could increase inequalities and provide only a partial, short-term solution to developing a proactive approach to prevention in primary care.
authors.affiliation: School of Medicine and Health, Durham University Queen's Campus, Stockton-on-Tees TS17 6BH, UK. linda.marks@durham.ac.uk
authors.forename: L
authors.initials: L
authors.lastname: Marks
authors.forename: S
authors.initials: S
authors.lastname: Cave
authors.forename: A
authors.initials: A
authors.lastname: Wallace
authors.forename: A
authors.initials: A
authors.lastname: Mason
authors.forename: D J
authors.initials: DJ
authors.lastname: Hunter
authors.forename: J M
authors.initials: JM
authors.lastname: Mason
authors.forename: S
authors.initials: S
authors.lastname: Peckham
mesh_terms: D003153:Community Health Services / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D004739:England; D006801:Humans; D010816:Physician Incentive Plans; D058007:Physicians, Primary Care / Q000191:economics*; D011314:Preventive Health Services / Q000191:economics* / Q000706:statistics & numerical data; D015397:Program Evaluation; D011795:Surveys and Questionnaires