Today, we’re speaking to Matt Conroy. Matt is a PhD fellow at the University of Manchester and also works for NHS Greater Manchester (ICB) as the Head of Primary Care Intelligence.
Title of paper: Impact of local enhanced incentive schemes on the performance of general practices within the United Kingdom: a systematic review
Available at: https://doi.org/10.3399/BJGP.2025.0377
Most local commissioning bodies in England, known as Integrated Care Boards (ICBs), have developed their own additional local pay-for-performance (P4P) incentive schemes alongside the Quality and Outcomes Framework (QOF). To our knowledge this is the first review to date to summarise existing evidence on the scope and effectiveness of local incentive schemes implemented in general practice in the UK with a focus on the indicators and their alignment with national schemes.
Transcript
This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.
Speaker A
00:00:00.480 - 00:01:01.140
Hi and welcome to BJGP Interviews.
I'm Nada Khan and I'm the Senior Research Editor here at the bjgp.
Thanks for taking the time today to listen to this podcast.
Today we're talking to Matt Conroy.
Matt is a PhD fellow based at the University of Manchester and he also works for NHS Greater Manchester ICB as the Head of Primary Care Intelligence.
We're here to talk about the paper he's recently published in the bjgp, which is titled the Impact of Local Enhanced Incentive Schemes on the Performance of General Practices within the United A Systematic Review.
So, hi, Matt, it's really nice to meet you and to talk about this work and I wonder if, just to start with, if you could explain a bit about what we mean by local incentive schemes in general practice and why you wanted to look at them, and I wonder if you wanted to draw a little bit on your additional role working for the Greater Manchester ICB as well here.
Speaker B
00:01:01.220 - 00:01:54.400
Thanks.
I guess by a local deep incentive scheme, we mean something that's kind of locally designed or locally commissioned within a ICB footprint to try and address any particular population health challenges or local nuances that go over and above national policy, things like the Quality and Outcomes Framework.
I guess what was really insightful for us through doing this piece of work was actually through an FOI that we undertook.
Like 90, 98% of ICBs actually have their own local gene for incentive schemes, but we only identified 17 schemes through the published literature, the last one being from 2018.
So getting on for 10 years ago, and the fact that we know that so many ICVs are doing these things, but there's not the evidence body there, there's not the learning and sharing of best practice to really inform policy and help ICVs all try and address their local challenges.
Speaker A
00:01:55.210 - 00:02:10.650
Yeah.
And you've mentioned qof and I guess a lot of people are really familiar with qof, and as you mentioned, there are lots of local schemes sitting alongside it.
And I wonder if you have an idea of just what sort of things they're trying to incentivize, just from sort of the background to your work.
Speaker B
00:02:11.210 - 00:04:48.850
Yes.
So, as part of my day job, I help design and deliver the local GP incentive scheme in Greater Manchester.
It's roughly valued about £17 million for this year.
And I think what we try to do is use QOF as a bit of a body of evidence, but also look at a lot of our local and national data to really highlight where we think we can make a difference with these local incentive schemes.
So, for the 26, 27 financial year, we've done a piece of work to really home in on CBD and diabetes as one area, respiratory as another area, elective care.
So we can get the interface between primary and secondary care and also antimicrobial stewardship.
I think one of the things that's really fleshed out from that is the impact of non attenders on things like qof.
So through qaff, if patients have two or one invites seven days apart, they automatically get exception reported if they don't necessarily attend.
But what we found through our local data is actually there's a really strong link between those people and actually poorer CBD control and wide use of healthcare systems.
So.
So through our local GP insentive scheme, we've really designed almost a narrow cohort that looks at people's individual disease control, looking at things like blood pressure, HbA1c, but also where people haven't attended a review in more than 18 months.
So really trying to hone in on specific cohort, acknowledging that those people are really difficult to engage with by proxy.
The fact that they've had two invites and not responded.
But actually through having a local GP incentive scheme that really highlights these as a specific target cohort group and having dedicated funding alongside it, we can see that from our QOF data, we've had a reduction in exception reporting and actually it's led to these people being targeted and then we can see slow improvements in overall disease control.
So whilst it's being funneled through the local GP incentive scheme, there's this wider spillover effect in things like QOF as well.
I think that's something that we're looking to evaluate in particular and really draw out, actually, not to say that it's easy to do this exceptional reporting and we know that patients are difficult to engage with, but actually by having a really dedicated piece of work, targets these patients with the body of evidence that these are the people who are more likely to not attend their yearly GP review, but are more likely to end up using emergency care services at that point of contact, that if there's dedicated funding and almost a dedicated cohort, to say these are the people that, as an icb, we've agreed on that we really need to focus on that we can see that those improvements are being yielded and that that is actually having a secondary impact of increasing coif achievement as well.
Speaker A
00:04:49.010 - 00:05:03.310
Yeah.
So really important work, I guess, being done in local area and this review tried to bring together all of the existing evidence on this, on these different schemes.
So what did you find overall in your, in your review?
Speaker B
00:05:03.550 - 00:07:48.730
So we found overall that there was 17 schemes that have been reviewed.
Of those there was a range of different indicator types, the most of them aligning to the existing indicator types of quaff where they have a lower and upper threshold and achievement scales based on fixed cohort and payment alongside that, which isn't surprising.
And I think what surprised me is that so many of the schemes almost piggybacked off QUAFF and just gave more money for existing cough indicators, which was quite surprising in a sense of well, if quaff is already there and as well bodied there was almost that assumption, well, if we provide more money that we're going to get greater achievement on the same indicators that's already there.
I think this is the part of the, the push and pull of incentive schemes is that we're all aware that general practice has finite capacity and finite resource and there's almost an assumption that by providing more money you're going to get more outcomes.
And it's a bit crude but the analogies, it's a bit like whack a mole and that if you try and do something over here then implicitly means that something there isn't the time and dedicated effort to do something else around the system.
I think that's the real challenge with designing these schemes is that acknowledging that where there's already work that's gone in, but how do you address your local challenges and populations and that part of this might be the acceptance, that part of the money is just to give practices the time and the headspace and the workforce to deliver some of this.
I think that's one of the things that we've found really locally within our scheme that when we've scaled it up in some areas quite drastically in the first couple of years, you might not see the achievement that you want because there's a lot of time to get around these schemes, to embed them and really employ the workforce to actually start to deliver them.
I think the other thing that surprised me is that how little of them actually had an inequalities focus.
I think that's partly down to the access to data that's available.
I think through undertaking the literature review in a lot of cases people were just using aggregated EMIS extracts that just had a single denominator or numerator for an indicator.
And that's something that I think we're really keen to explore throughout the rest of my PhD and that how can we really apply a, a rigorous inequalities lens to some of this and looking at tools like the index of disparity as a way of helping us understand are we in a position where it might look on the surface like achievements going up?
And that's great, but is that because we sweep in generalization, are we actually targeting the white British affluent worried well and actually
