Br J Gen Pract. 2011 Aug 19. [Epub ahead of print]

Letter – Medical professionalism and pay-for-performance.

Chambers J, Tormey W.


In his Editor’s Briefing, Roger Jones opines that the Quality and Outcomes Framework may lead to maladaptive behaviours and deprofessionalisation.1 This begs the question, what exactly constitutes medical professionalism? In 1977, Dr CF Donovan defined clinical competence as the first key responsibility of the doctor.2 A continuing commitment to excellence through the application of current knowledge, and the continuing acquisition of new knowledge are key attributes of medical professionalism.3 However, the population mortality reduction of 11 lives per 100 000 people as a consequence of the pay-for-performance contract in England, and the implication that a similar payment system improved blood pressure control in Scotland, suggests that the ethos of professionalism may not be centre stage in medical education.4,5 Success for the profession will arrive when there is no difference between measured patient outcomes, irrespective of the means of doctor remuneration.