TY - JOUR T1 - Performance of small general practices under the UK's Quality and Outcomes Framework JF - British Journal of General Practice JO - Br J Gen Pract SP - e335 LP - e344 DO - 10.3399/bjgp10X515340 VL - 60 IS - 578 AU - Tim Doran AU - Stephen Campbell AU - Catherine Fullwood AU - Evangelos Kontopantelis AU - Martin Roland Y1 - 2010/09/01 UR - http://bjgp.org/content/60/578/e335.abstract N2 - Background Small general practices are often perceived to provide worse care than larger practices.Aim To describe the comparative performance of small practices on the UK's pay-for-performance scheme, the Quality and Outcomes Framework.Design of study Longitudinal analysis (2004–2005 to 2006–2007) of quality scores for 48 clinical activities.Setting Family practices in England (n = 7502).Method Comparison of performance of practices by list size, in terms of points scored in the pay-for-performance scheme, reported achievement rates, and population achievement rates (which allow for patients excluded from the scheme).Results In the first year of the pay-for-performance scheme, the smallest practices (those with fewer than 2000 patients) had the lowest median reported achievement rates, achieving the clinical targets for 83.8% of eligible patients. Performance generally improved for practices of all sizes over time, but the smallest practices improved at the fastest rate, and by year 3 had the highest median reported achievement rates (91.5%). This improvement was not achieved by additional exception reporting. There was more variation in performance among small practices than larger ones: practices with fewer than 3000 patients (20.1% of all practices in year 3), represented 46.7% of the highest-achieving 5% of practices and 45.1% of the lowest-achieving 5% of practices.Conclusion Small practices were represented among both the best and the worst practices in terms of achievement of clinical quality targets. The effect of the pay-for-performance scheme appears to have been to reduce variation in performance, and to reduce the difference between large and small practices. ER -