News / Soft pedal on P4P says Nuffield

The Nuffield Trust said that England and the United States were in the global vanguard of using financial incentives to drive up the quality of care – a point underlined last month when prime minister Gordon Brown announced that in future hospital payments would be linked to patient satisfaction and health outcomes.  But the Nuffield Trust said there was little evidence that incentive schemes worked.

In The quest for quality: refining the NHS reforms, the trust said that the impact was often negligible. ‘The equivocal nature of the evidence would be prudently interpreted as a “go-slow” message,’ it added.

Problems in the current system had to be solved – for example, payment by results incentivised increases in activity rather than better outcomes. Once these problems were fixed, the report suggested the NHS could learn lessons from the United States, where some commissioners had taken a step back from P4P. The Medicare programme, for example, had introduced a ‘pay for participation’ initiative to generate outcomes information.

Nuffield Trust director Jennifer Dixon said: ‘Measures of perfor- mance, particularly outcomes, are difficult to come by so it is better to pay providers or clinicians to participate,’ rather than pay for collecting process measures.