Table 2.

The Impact of the QOF Mapped to the Ten Motivational Values

QOF modifications	Synthesis of the main findings	Influence on ten basic values [18]
Templates Guidelines Indicators Governmental goals	(a) Loss of autonomy, control and ownership Most papers described a sense of decreased clinical autonomy and loss of professionalism [39]. They also described a sense of micromanagement from above [28] and frequently cited the late communication about changes to the wider QOF and year-on-year variability in the occurrence and timing of changes to indicators as politically motivated [28, 39].	Congruent Power Conformity Security Achievement, Conflict Self-direction Stimulation Benevolence, Universalism Hedonism, Tradition
Raised standards in basic care Drove provider care Systemized and standardised care Neglected areas of care targeted	(b) Incentivised conformity In the papers reviewed professionals recognized that QOF had led to considerable extra income at the practice level [29]. As the owners of their organizations, economic factors were more salient and apparent in principals’ accounts. Subsequently the finance and achieving maximum income became an increasingly key issue in participants’ beliefs about QOF and their adherence to QOF work [28].	Congruent Achievement Conformity Security Power Tradition Conflict Self-direction Stimulation Benevolence Hedonism Universalism
Focus on chronic disease management Certain aspects of professionalism threatened Indicators conflict -patient advocate	(c) Continuity of care, holism and the caring role of clinicians in primary care Although participants in the papers reviewed emphasised the importance of traditional general practice values, such as holism and continuity, the majority felt that the 2004 changes had negatively impacted on these values. Participants related that patients now experienced less continuity with their GPs [41].	Congruent Conformity Power Security Achievement power Conflict Benevolence Universalism Self-direction Stimulation Tradition
Information technology (IT) Practice managers Increased skill mix Monitoring systems Recording performance Surveillance	(d) Structural & organisational changes All the practices that were studied in the papers included in the review had changed their modes of operation in response to the QOF [27, 29, 43, 45]. Role of monitoring compliance with the coding regime which feeds into the contract monitoring system and of highlighting deficient coding and recording performance amongst staff, contributed to on-one-hand to increased surveillance and on the other to the doctors sense of self-worth [45].	Congruent Power Conformity Achievement Security Stimulation Self-direction Universalism Conflict Tradition Benevolence Hedonism