The government wants to reward better GP care. But what happens when targets take priority?

Health Minister Simeon Brown announced a $40 million funding scheme in New Zealand to reward General Practitioner (GP) clinics that meet specific performance targets. These targets include immunising 90% of infants, maintaining cervical screening rates, offering smoking cessation support, and implementing an online booking system. The goal is to recognize clinics providing "results for their patients." However, concerns arise about potential unintended consequences when funding is tied to performance-based targets.

GPs practicing in various care settings support improving immunisation, cancer screening, and smoking cessation. Yet, GP clinics across New Zealand face diverse challenges, questioning whether the same targets are suitable for all. International evidence suggests performance-based funding can improve some aspects of care while potentially compromising others.

Clinics in different regions encounter varying difficulties. Those serving transient, complex health populations like the Calder Centre in Auckland's City Mission may struggle to meet cervical screening targets due to resource constraints. Similarly, Northland practices with lower immunisation rates, workforce shortages, and trust issues face significant barriers. Conversely, Canterbury practices nearing the 90% target may find the immunisation goal more attainable.

The smoking cessation target may also vary in difficulty. Smokers' rates differ by deprivation and ethnicity, meaning wealthier areas with fewer smokers might find reaching the 25% target easier and qualify for funding. Online patient portals present practical challenges, particularly in understaffed practices. Triaging to prioritize urgent cases and directing patients to the appropriate care provider could be undermined by a direct online booking system.

Unreliable internet and mobile coverage in rural areas could also limit the usefulness of such portals.

Patient-doctor relationships and continuity of care are crucial in general practice. Performance-based funding risks prioritizing measurable targets over these essential aspects, often referred to as "tick-box medicine." This approach, criticized in other countries like the UK, may focus on measurable tasks rather than individual patient needs.

Research shows improvements in care for certain chronic conditions under such schemes, but care for other conditions not linked to financial incentives may decline. Moreover, continuity of care, which improves health outcomes, can suffer under these schemes.

Performance targets typically emphasize measurable aspects, potentially overlooking crucial elements of high-quality care. Patients may assume targets reflect overall care quality, but trust, communication, managing multiple health conditions, shared decision-making, and understanding social circumstances are harder to quantify.

While researchers have developed ways to measure continuity of care, the current scheme does not link these measures to funding decisions. Therefore, the scheme's success in improving outcomes equitably will depend on accounting for the diverse challenges faced by GP practices, particularly those serving communities with greater health needs.