What financial payment models are used to fund additional services in general practice settings, particularly to improve quality of care and patient outcomes, and support the transfer of services from hospital to community settings: A rapid evidence summary

Edwards, Deborah ORCID: https://orcid.org/0000-0003-1885-9297, Csontos, Judit ORCID: https://orcid.org/0000-0003-4597-3052, Gillen, Elizabeth ORCID: https://orcid.org/0000-0002-3700-3913, Ingram, Beti-Jane, Edwards, Adrian ORCID: https://orcid.org/0000-0002-6228-4446 and Lewis, Ruth 2026. What financial payment models are used to fund additional services in general practice settings, particularly to improve quality of care and patient outcomes, and support the transfer of services from hospital to community settings: A rapid evidence summary. Health and Care Research Wales Evidence Centre. Available at: https://researchwalesevidencecentre.co.uk/financia...

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Abstract

In Wales, there is a clear policy ambition to strengthen community-based care and to shift services traditionally delivered in hospital settings into primary and community care. These reforms require the development of new payment mechanisms and administrative arrangements alongside the General Medical Services (GMS) contract mechanisms This rapid evidence summary (RES) was conducted to inform these plans. This RES aims to summarise evidence form the UK and other international health systems on financial models used to fund additional services in general practice. It is based on a limited search of key resources. Priority is given to studies representing robust evidence synthesis, and no quality appraisal or evidence synthesis was conducted. Included evidence (organisational reports, reviews, evaluation reports and research publications) were published between 2011 to 2025. Evidence was described across four broad categories: models of care / service delivery structures; contracting and governance models; additional payment and reimbursement mechanisms; and incentive, quality, and performance frameworks. We describe the models of care within these categories and the evidence of effectiveness. Findings for models of care / service delivery structures cover accountable care organisations (ACO, e.g. USA), multispecialty community providers (MCP, England), primary care home model (PCH), primary care networks (PCNs), and year of care models. Findings for contracting and governance models include Alliance contracting, prime contracting and outcome-based contracting, Findings for additional payment and reimbursement mechanisms include additional roles reimbursement scheme (ARRS, England), additional capacity funding delivered via Health Boards in Wales, Bundled Payments (OECD countries), directed enhanced services (DES), and local enhanced services (LES). Evidence for incentive, quality and performance frameworks include quality and outcomes framework (QOF), quality assurance and improvement framework (replaced QOF in Wales in 2019), and other quality improvement schemes operating instead of or in addition to QOF. Accountable care organisations may hold some promise, building upon primary care networks and year of care models, potentially using DES mechanisms. Broad models of outcome-based contracting may deliver some positive quality and cost outcomes. Role reimbursement schemes can enhance workforce, access, quality and delivery of services but attention required to supervision and sustainability. Local enhanced services offer flexible mechanisms to address identified local population health needs. Within core GMS, quality improvement schemes lead to very limited benefits, and the QOF improved some elements of quality, although sustained benefits are harder to demonstrate. Further research is needed including on the effective transfer of services to primary and community care and on the impact of different financial models or payment schemes to fund additional services in general practice

Item Type:	Report (Other)
Date Type:	Publication
Status:	Published
Schools:	Schools > Healthcare Sciences Schools > Medicine
Publisher:	Health and Care Research Wales Evidence Centre
Date of First Compliant Deposit:	2 June 2026
Last Modified:	02 Jun 2026 14:15
URI:	https://orca.cardiff.ac.uk/id/eprint/187378

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