Does the proportion of pay linked to performance affect the job satisfaction of general practitioners?

- GPs had, on average, 15% of their income exposed to P4P in 2005 and 26% in 2008.
- Income exposed to P4P had no effect on overall job satisfaction in either year.
- Job satisfaction was affected by the amount of income, not the method it is earned.
- 12 additional measures of working lives were also unaffected by P4P exposure.
- With unchanged incomes, changes in exposure are unlikely to alter GPs working lives.

There is concern that pay-for-performance (P4P) can negatively affect general practitioners (GPs) by reducing their autonomy, increasing their wage dispersion or eroding their intrinsic motivation. This is especially a concern for the Quality and Outcomes Framework (QOF), a highly powered P4P scheme for UK GPs. The QOF affected all GPs but the exposure of their income to P4P varied. GPs did not know their level of exposure before the QOF was introduced and could not choose or manage it. We examine whether changes in GPs' job satisfaction before and after the introduction of the QOF in 2004 were correlated with the proportion of their income that became exposed to P4P. We use data on 1920 GPs observed at three time points spanning the introduction of the QOF; 2004, 2005 and 2008. We estimate the effect of exposure to P4P using a continuous difference-in-differences model. We find no significant effects of P4P exposure on overall job satisfaction or 12 additional measures of working lives in either the short or longer term. The level of exposure to P4P does not harm job satisfaction or other aspects of working lives. Policies influencing the exposure of income to P4P are unlikely to alter GP job satisfaction subject to final income remaining constant.