RT Journal Article SR Electronic T1 Implementation of pay for performance in primary care: a qualitative study 8 years after introduction JF British Journal of General Practice JO Br J Gen Pract FD British Journal of General Practice SP e408 OP e415 DO 10.3399/bjgp13X668203 VO 63 IS 611 A1 Helen Lester A1 Tatum Matharu A1 Mohammed A Mohammed A1 David Lester A1 Rachel Foskett-Tharby YR 2013 UL http://bjgp.org/content/63/611/e408.abstract AB Background Pay for performance is now a widely adopted quality improvement initiative in health care. One of the largest schemes in primary care internationally is the English Quality and Outcomes Framework (QOF).Aim To obtain a longer term perspective on the implementation of the QOF.Design and setting Qualitative study with 47 health professionals in 23 practices across England.Method Semi-structured interviews.Results Pay for performance is accepted as a routine part of primary care in England, with previous more individualistic and less structured ways of working seen as poor practice. The size of the QOF and the evidence-based nature of the indicators are regarded as key to its success. However, pay for performance may have had a negative impact on some aspects of medical professionalism, such as clinical autonomy, and led a significant minority of GPs to prioritise their own pay rather than patients’ best interests. A small minority of GPs tried to increase their clinical autonomy with further unintended consequences.Conclusion Pay for performance indicators are now welcomed by primary healthcare teams and GPs across generations. Almost all interviewees wanted to see a greater emphasis on involving front line practice teams in developing indicators. However, almost all GPs and practice managers described a sense of decreased clinical autonomy and loss of professionalism. Calibrating the appropriate level of clinical autonomy is critical if pay for performance schemes are to have maximal impact on patient care.