Is pay for performance promoting inverse inequality in Irish general practice?

Abstract

In 2020, the Chronic Disease Management (CDM) programme was introduced in Ireland. This programme resources GPs to review public (GMS) patients, diagnosed with eight named chronic diseases, twice yearly according to a structured protocol. This pay for performance initiative has been widely adopted by GPs. However, it is hypothesised that private patients (PPs) receive a poorer standard of care, as they may be reluctant to attend due to the cost involved. To assess whether the management of eight chronic diseases named in the CDM programme is to the same standard among both PPs and GMS patients. A retrospective audit of GP practices in the Midwest of Ireland. Data relating to 25 GMS patients and 25 PPs, matched by age, gender, and clinical condition, is collected from each practice. Patients have at least 1 of the eight named chronic diseases. Parameters include vaccination status (influenza, pneumococcal, COVID); body mass index; blood pressure; smoking status; renal function; HbA1c; lipid profile; brain natriuretic peptide (BNP) in patients with heart failure; and lung function tests in patients with COPD or asthma. COVID vaccination status acts as a control because it is freely available for both PPs and GMS patients. Preliminary results from 2 GP practices show large consistent disparities in management between PPs and GMS patients in most parameters. Limiting Pay for Performance to the care of GMS patients only, based on age or income, promotes inverse inequality. We argue that CDM care should be offered to all patients.