The English NHS should “proceed cautiously” in introducing payment for performance schemes aimed at improving quality, researchers have warned.
This scheme is scheme is called the commissioning for quality and innovation framework (CQUIN) and is being piloted in the NHS North West region.
It’s modelled on a US scheme and offers rewards to trusts - not clinical teams - for meeting clinical targets. Hospitals in the top two performing quartiles are offered 4% and 2% increases in tariff payments and there are no penalties for those with low scores.
CQIUIN follows the introduction of the quality and outcomes framework in primary care, which provided financial incentives to GPs. But, researchers from the University of York believe that the effects of incentive schemes on healthcare systems are still unclear and that the cost of implementing them may not be justified.
They point to possible problems such as its effects on motivation and increasing financial instability in a time of funding constraint in the NHS.
Although early data show good clinical engagement with the scheme in the North West, there is still uncertainty about the impact of rolling out the new scheme for NHS hospitals, they say on bmj.com. The authors argue that evidence of the effectiveness of the US incentive scheme is weak.
Clearly the costs and benefits of using rewards and penalties alone or in combination to induce clinical and organisational performance improvement needs to be evaluated, they write. This should include consideration of the possible problems of bias or gaming, as well as inadequate data collection.
Professor Alan Maynard, director at the department of health sciences, University of York, said: “The lesson learnt from the quality and outcomes framework is that we need to find out what the opportunity costs are of implementing the new scheme.
“If clinicians and hospitals allocate scarce resources to incentive schemes aimed at improving a particular set of conditions, there is a risk that other clinical conditions and procedures will get less attention and their outcomes will not be improved.”

