Financial rewards affect GPs’ performance

Financial performance related schemes do not motivate GPs and result in a drop in standards of primary care, researchers claim.

Professor Steffie Wollhandler from the New York School of Public Health warns that financially related systems are based on “flawed assumptions” about medicine, measurement and motivation.

She added that providing financial rewards for hitting set targets “changes the mindset needed for good doctoring”.

The DH’s Quality Outcomes Framework currently rewards doctors who hit set targets. But Professor Wollhandler said that while more “straightforward manual tasks” are completed, complex cognitive tasks are overlooked.

“A growing body of evidence from behavioural economics and social psychology indicates that rewards can undermine motivation and worsen performance on complex cognitive tasks, especially when motivation is high to begin with,” said Professor Wollhandler in an editorial with the BMJ.

“Highly detailed prescriptive contracts may be perceived as controlling and may undermine the intrinsic motivation crucial to maintaining quality when nobody is looking.

“Offering financial incentives to doctors, rather than enhancing their intrinsic motivation, may reduce their desire to perform an activity for its inherent rewards (such as pride in excellent work, empathy with patients).”