Money can inevitably prompt the mind to deliver new forms of action and despite becoming a measure to stimulate the expertise of our GP’s; the bonus scheme effectively shined a light on the quality of service delivered from doctors and explored the success of financial motivation within the health service. At present all evidence has pointed to a failure of improvement on the bonus/treatment relationship which has seen GP’s unable to prevent the increase in hospital admissions and the quality of health treatment available.

The Quality Outcome Framework (QOF) is responsible for the bonus distribution and was introduced by the Labour party in 2004 to measure GP performance on serious diseases such as diabetes and asthma alongside offering extra services in maternity and child health. The logic behind the move was to incentive health services in poorer regions to outperform themselves and bridge a growing disparity. The measure saw GP salaries rise approximately 40% from 2002-2006 stretching from £70 -£110,000 and the financial implications within the scheme point towards a negative loss of billions of pounds.

The independent think tank ‘The Kings Fund’ recently stated ‘There has been little evidence of health improvement from the QOF Framework and health inequality’. The Kings fund carried out their assessment of QOF from a data analysis and interviews with practise and primary care staff in England, and the new system has been recognised as a tick box exercise that failed to encourage doctors to examine the health of the wider community.

The scheme rewarded GP Practise’s that were well managed to begin with and in effect ‘added a lofty bill to NHS treatment which was already taking place’. Aside from adding additional costs for existing services, serious questions have been raised over the motivational element of finance and health and its negative affect on GP’s.

Behavioural economics and social psychology points towards a rise in motivation in manual jobs from financial incentives, but complex cognitive tasks where motivation can be high initially risk becoming undermined by the financial element and specifically with doctors, an unnecessarily intervention of service and health.

This in effect is changing the mind-set for good doctoring based on empathetic rewards and becoming replaced with the flawed financial assumptions GP motivation. Anna Dixon director of the think tank described the outcome as a ‘disappointing return of investment for public money’ which has only lightly captured the mood of public opinion.

As headlines continually dominate the misuse of our global financial system, public money that has been wasted away is unlikely to get noticed in any service of industry, and particularly one designed to provide care and support to our society.

Author Bio – James Barnett is an author on behalf of Pannone, documenting medical research into the NHS and government reforms.

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