The Article in Brief

Background In 2004, the United Kingdom introduced a pay-for-performance plan in which family doctors are financially rewarded for meeting goals pertaining to clinical care, organizational factors, and patients' experiences. This article describes the beliefs and concerns of family doctors and nurses about the pay-for-performance plan.

What This Study Found Participating doctors and nurses believe the pay-for-performance plan motivates them to achieve the program's goals, including improving processes of care for specific diseases, increasing physician income, and capturing medical data. It also leads to unintended effects, however, such as different agendas for patients and doctors, potential loss of skills among doctors as a result of the nurses' increased role, a decline in the ongoing relationship between doctors and patients, resentment by members of the medical team who are not benefiting financially from the plan, and concerns about an ongoing culture of performance monitoring.

Implications

• The new pay-for-performance plan has changed the way doctors and nurses work together and the nature of patient visits.
• Further research will observe the development and effects of the pay for performance plan.