The impact of financial incentives on General Practitioner (GP) behaviour: a systematic review protocol

Background Financial incentives are used in National Health Service (NHS) primary care to influence practice, yet their effects on General Practitioner (GP) behaviour and unintended consequences remain unclear. Recent UK GP contract reforms have changed the incentive landscape, highlighting the need for a contemporary, GP-focused synthesis. Aim To synthesise evidence on the impact of financial incentives on GP behaviour in high-income countries with predominantly publicly funded health systems, including incentives at GP, organisational or national level and with an effect on GP behaviour. We will assess whether effects differ across population and practice contexts, including implications for health inequalities. Design & Setting The review focuses on GPs in high-income, predominantly publicly funded healthcare systems where primary care is the first point of contact and gatekeeper to secondary care, and on evidence from 2010 onwards to reflect incentive structures. Method Seven databases will be searched from 2010 onwards. Records will be managed in EPPI-Reviewer using de-duplication, priority screening of titles and abstracts , and dual independent full-text review. Eligible studies include GPs (or outcomes attributable to GP behaviour) and financial incentives at individual, organisational or system level. Data will be extracted and combined by structural narrative synthesis, with meta-analysis if studies are comparable. Risk of bias will be assessed, qualitative evidence synthesised by meta-aggregation; and certainty graded using GRADE where feasible. Conclusion This review will synthesise the evidence on how financial incentives affect GP behaviour and health inequalities, informing clinicians and policy makers locally and nationally as incentive models evolve.