Pay-for-Performance in the NHS: What the Debate Means for Patients

Eric C. Schneider, a doctor and health policy researcher, has raised concerns about the limits of pay-for-performance programmes — schemes that link financial rewards to measurable quality targets — in an interview published by the New England Journal of Medicine (NEJM). Speaking with NEJM Executive Managing Editor Stephen Morrissey, Schneider also discussed alternative approaches to supporting quality improvement in health services.

Pay-for-performance has been a feature of NHS contracting for years, most visibly through the Quality and Outcomes Framework (QOF), which ties a portion of GP practice income to hitting clinical targets — things like blood pressure checks, diabetes reviews, and cancer screening rates. The NEJM discussion does not address the NHS directly, but the underlying questions about whether target-based payments genuinely change patient outcomes are ones that NHS England and integrated care boards, including NHS Kent and Medway, grapple with when designing local contracts.

Schneider’s interview does not conclude that pay-for-performance is without value. But it does point to limitations — including the risk that services focus on what is measured rather than what matters most to patients, and that smaller or under-resourced practices may struggle to meet targets regardless of the quality of care they provide.

The alternatives he discusses are not detailed in the available summary, so their specifics cannot be reported here.

For Kent residents, the practical takeaway is modest but real. If you have questions about the care you receive from a GP practice or NHS service, NHS 111 can advise on where to go. For concerns about the quality of a specific service, NHS Kent and Medway Integrated Care Board handles local oversight. The Care Quality Commission (CQC) is the independent body that inspects and rates NHS providers across England.