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Table 3 Coding schedule

From: `Just another incentive scheme’: a qualitative interview study of a local pay-for-performance scheme for primary care

Deductive coding to areas taken from literature

Inductive codes emerging from interviews

Iterative refining of deductive and inductive codes and themes

Final themes

Influences on behaviour:

Motivation:

Practitioner motivation:

Influences on behaviour

Ownership of change

Support among practices

Patient benefit

Financial reward

 

Motivation (intrinsic and extrinsic)

Financial reward

 

Patient benefit

 

Competition with other practices

 

Social comparison

    

Organisational means

    

Relevance:

Opinions:

Attitudes towards the scheme:

 

Clinical benefit

Clinical value

Don’t agree with localisation

Role of general practice

 

Local population needs

Credibility

Lack of knowledge/interest in evidence

Acceptance/rejection of an externally defined way of working

 
 

Prevalence

 

Faith in the evidence

 

Fairness:

   

Distribution of workload

Uneven workload

   

Scope for gaming

Minimal change

   

Implications for tackling inequalities

The bigger picture

   
 

Failed to address inequalities

   
 

Adjusting role of general practice

   

Appropriateness of incentivised targets:

Credibility:

 

Credibility of the locally negotiated indicators

Robustness of evidence base

Conflict with professional identity

Other guidelines

  

Costs

Conflict among practice staff

Clinical value

  
 

Conflict with patient benefit

Conflict with/supported by prevalence in population

  
 

Funding improves credibility

   

Acceptability:

Effect on professionals:

Effects of implementing a local scheme:

Exacerbating tensions

Compare to national QOF

Just another income stream

Created an uneven workload

Allowed local issues to be addressed

 
 

Conflicting credibility with NQOF

 

Caused inequalities

 

Consequences:

Effect on patients:

Consultation consequences

 

Effect on practice staff

Adapt consultations

Standardised care

Target became routine practice

 
  

Effect on consultations:

  
  

Adapt templates as aids

  

Effect on patients and patient care

Impact on patient experience

Embedded behaviour

  
 

Time pressure

Required minimal change

  
 

Conflicting agendas

   
 

Distracting in consultations

   
 

Embedded behaviour

   
 

Standardised care

   

Recommendations:

Recommendations:

Experience of engagement

Ownership

How it should be introduced

Evolving assessment process

LoQOF champion

Highlight available external support for data extraction and management

 

Local versus national benefits and harms

Extension of NQOF

Patient involvement

Familiarisation period before data collection

 
 

Conflict with NQOF

Bottom up approach

  
 

Bottom up approach

Based at cluster level

  
 

Setup time

Outside support

  
  

Protected learning time for all staff

  
  

Data support