Implementing pay-for-performance in Australian primary care: lessons from the United Kingdom and the United States

In reply: Our article, which related to clinical care, not non-clinical standards, was intended to generate debate, and the points raised by Morgan and Dunbar are important ones. We address the central issue, which relates to the intended purpose of introducing a pay-for-performance scheme, similar to the Quality and Outcomes Framework (QOF) in the United Kingdom, into Australian general practice. Morgan and Dunbar state in their letter, “Now that 95% of GPs use computers for prescribing”; this emphasises that it would not be a level playing field. Even if all indicators only related to prescribing, at least 5% of practices would be disenfranchised. That statement also appears to presume that 95% of practices use compatible and comparable clinical codes. The UK witnessed years of computerisation and clinical code usage across a wide range of clinical issues before the introduction of the QOF. Elliot-Smith and Morgan adapted “the in-built search facility of a commonly used medical records program”, and introducing a QOF-like scheme in Australia would involve this investment in all practices.