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Incentivizing preventive services in primary care : perspectives on Local Enhanced Services.

Marks, L. and Cave, S. and Wallace, A. and Mason, A. and Hunter, D.J. and Mason, J.M. and Peckham, S. (2011) 'Incentivizing preventive services in primary care : perspectives on Local Enhanced Services.', Journal of public health., 33 (4). pp. 556-564.

Abstract

Background: General practitioners in the UK play a key role in prevention but provision of preventive services is variable. The 2004 General Medical Services contract allows Primary Care Trusts (PCTs) to address health needs through providing locally agreed payments for Local Enhanced Services (LESs). This study identifies how this contractual flexibility is used for preventive services and explores its perceived effectiveness. Methods: Semi-structured interviews were carried out (2008–09) in 10 purposively selected case study sites in England. Details of LESs for these sites were collected (2009) through Freedom of Information requests or local contacts. A national on-line survey of PCTs (2009) provided a national context for case study findings. Results: LESs were considered to be effective in incentivizing preventive activity. However, specifications and performance management were often weak, awareness of how to optimize incentives was low and, as optional services, LESs were perceived to be at risk in a financial downturn. Conclusions: Using LESs for preventive services highlights gaps in ‘core’ primary care responsibilities and in the national pay-for-performance framework. Current incentive arrangements are complex, could increase inequalities and provide only a partial, short-term solution to developing a proactive approach to prevention in primary care.

Item Type:Article
Keywords:Population based and preventative services, Primary care.
Full text:PDF - Accepted Version (313Kb)
Status:Peer-reviewed
Publisher Web site:http://dx.doi.org/10.1093/pubmed/fdr016
Publisher statement:This is a pre-copy-editing author-produced PDF of an article accepted for publication in Journal of public health following peer review. The definitive publisher-authenticated version Marks, L. and Cave, S. and Wallace, A. and Mason, A. and Hunter, D.J. and Mason, J.M. and Peckham, S. (2011) 'Incentivizing preventive services in primary care : perspectives on Local Enhanced Services.', Journal of public health., 33 (4). pp. 556-564 is available online at: http://dx.doi.org/10.1093/pubmed/fdr016
Record Created:28 Oct 2011 09:50
Last Modified:10 Jul 2012 14:59

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