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 highestachieving 5% of practices and 45.1 % of the lowestachieving 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-forperformance scheme appears to have been to reduce variation in performance, and to reduce the difference between large and small practices. © British Journal of General Practice.
- Primary care