Source: The Conversation (Au and NZ)
Last month, Health Minister Simeon Brown announced new funding to reward GP clinics that meet a series of performance targets.
They include fully immunising 90% of enrolled infants at eight and 24 months, keeping 80% of enrolled women up to date with cervical screening, offering quitting support to 25% of smokers, and providing an approved online booking portal.
A total $40 million is tied to the scheme this year, with GP clinics eligible for payments when they hit the targets or make progress towards them.
Brown says the move is about recognising those clinics that get “results for their patients”. But what if linking funding to performance-based targets comes with unintended consequences?
As GPs practising in a range of care settings, we support efforts to improve immunisation, cancer screening and smoking cessation.
But clinics across New Zealand face very different challenges, raising questions about whether the same targets are appropriate for all. International evidence also suggests performance-based funding can improve some aspects of care at the expense of others.
An uneven playing field
There have already been concerns about whether changes to GP funding adequately reflect differences in patient needs around the country.
Research suggests performance targets can disadvantage practices serving communities with greater health, social and economic challenges, even when they deliver high-quality care. Differences in patient circumstances can also make progress difficult to measure fairly.
Take the Calder Centre at Auckland’s City Mission, which serves a transient population with high and complex health needs. Meeting the cervical screening target could require considerably more resources.
Similarly, practices in Northland, where the average immunisation rate is 64%, face barriers involving health-care access, workforce shortages, deprivation and trust.
By comparison, Canterbury’s average of 88% is already close to the 90% target.
The smoking cessation target may also be easier for some practices to meet than others. Smoking rates vary considerably by deprivation and ethnicity, meaning practices in wealthier areas with fewer smokers may find it easier to reach the 25% target and qualify for funding.
Then there are the practical challenges posed by online patient portals. In understaffed practices especially, triaging helps ensure those requiring the most urgent care are seen first and directed to the appropriate healthcare professional.
Direct online booking could bypass this process, while unreliable internet and mobile coverage may also limit the usefulness of patient portals in rural areas.
The risks of ‘tick-box’ medicine
Patient-doctor relationships and continuity of care are vital parts of general practice. But pay-for-performance funding risks prioritising measurable targets over other important aspects of patient care.
This is sometimes called “tick-box medicine”, and similar concerns have arisen with performance-based funding schemes overseas.
One notable example is the United Kingdom’s Quality and Outcomes Framework, introduced to general practices in 2004. Under the scheme, practices received financial rewards for meeting 146 quality indicators covering chronic disease management, public health and organisational quality.
The framework, which was eventually abolished in Scotland but still operates in England, has been criticised for encouraging GPs to focus on measurable tasks rather than individual patient needs.
It was also largely built around single diseases, whereas modern general practice increasingly involves caring for patients with multiple or complex health conditions. Disease-specific targets may not reflect the challenges of treating these patients.
Research found the scheme initially improved care for patients with two of three chronic conditions studied. But these improvements slowed once targets were reached, while care declined for two conditions not linked to financial incentives.
Notably, patients were also less likely to see the same GP over time following the scheme’s introduction. Research has linked this continuity of care to better health outcomes.
Seeing the same GP regularly allows doctors to become familiar with patients’ medical histories, personal circumstances and treatment preferences, helping them provide more individualised care.
What performance targets can miss
Performance targets tend to focus on what is easiest to measure. But this means some important elements of high-quality care may be overlooked.
Patients may assume these targets reflect the overall quality of care they receive.
Yet trust, communication, managing multiple health conditions, shared decision-making and understanding patients’ social circumstances are harder to quantify, despite being valued by patients and linked to better health outcomes.
These aspects of care can still be assessed. Researchers have, for example, developed ways to measure continuity of care.
The government has said it will monitor continuity of care and patient experience, although neither measure will be linked to funding this year.
As the scheme develops, there may be scope to include these measures in funding decisions.
Whether the scheme improves outcomes equitably will depend partly on how it accounts for the different challenges GP practices face – especially those serving communities with greater health needs.
The authors acknowledge the contribution of Chris Bullen, Ngaire Kerse, Ruth Teh, Fiona Moir, Janine Paynter and Nikki Turner.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
Original source: https://analysis1.mil-osi.com/2026/10/21/the-government-wants-to-reward-better-gp-care-but-what-happens-when-targets-take-priority/