Background To drive improvements in healthcare quality and to reduce inequalities, pay-for-performance (P4P) schemes have become widespread internationally. In recent years, most local commissioning bodies in the UK have developed their own local general practice incentive schemes. Aim To examine the use and effectiveness of local incentive schemes and their alignment to the national Quality and Outcomes Framework. Design and setting Systematic review of quantitative studies related to local incentive schemes with a P4P structure within UK general practice published after 2004. Method Searches were conducted via Ovid across the Embase and MEDLINE databases. Risk of bias was assessed using the Cochrane Effective Practice and Organisation of Care criteria and a narrative synthesis was undertaken. Results In total, 17 studies were identified, which were focused on 14 local incentive schemes. All studies were from England, except one from Scotland. Five studies included only tailored indicators, and seven studies included both aligned and tailored indicators. Quality assessment suggested the current evidence was of mixed quality. All studies that reported on process measures ( n = 15) demonstrated positive impacts, but health outcome measures were only evaluated in nine studies showing inconsistent findings. Eight studies addressed impact on health inequalities and no studies addressed cost-effectiveness, patient-reported outcomes, or experience measures. Conclusion There is an emerging evidence base that local incentive schemes in general practice lead to improvements in process measures, although methodological quality of studies is mixed. Future studies should utilise more robust methods to evaluate effectiveness and examine impacts on health inequalities, cost-effectiveness, and variation by practice.

Background Recurrent urinary tract infections (rUTI), i.e. 2 or more UTIs in last 6 months or 3 or more in last 12 months, are common, have substantial impact on quality of life and cause major antibiotic use. Design Overview of systematic reviews of randomised controlled trials (RCTs) of non-pharmaceutical and pharmaceutical (non-antibiotic) interventions for preventing rUTI in women. Methods We searched MEDLINE, EMBASE, CINAHL, Google Scholar and Cochrane from January 2014 to May 2025 for systematic reviews of RCTs assessing effectiveness of community-based non-antibiotic interventions for preventing UTI in women aged 16 or over with rUTI. We excluded studies in intensive care units, people with indwelling catheters or comparing different oral antibiotic regimens. There were no limitations regarding outcome measures or language. Findings 27 systematic reviews met inclusion criteria evaluating probiotics (9), D-mannose (7), vaginal oestrogen (7), cranberry (6), methenamine hippurate (3), herbal medicine (3), increased fluid intake (2), systemic oestrogen (4), acupuncture (2), vaccines (2). Eight examined combination strategies. Cranberry and methenamine hippurate use are supported by systematic reviews, as is vaginal oestrogen amongst postmenopausal women, although questions remain around dose, duration and treatment adherence. Reviews of probiotics, D-mannose, herbal medicine, acupuncture and vaccines concluded that stronger evidence is needed. Increased fluid intake benefits women with low intake, but further research is needed on optimal intake. There was little information on treatment adherence or acceptability for many interventions. Conclusions For effective interventions, questions remain about optimal use and for many stronger evidence is needed.

Background Adverse pregnancy outcomes (APOs) affect approximately 30% of pregnancies and confer lifelong elevated cardiovascular disease (CVD) risk. Behavioural interventions may mitigate this risk. Aim To systematically review qualitative literature on women’s experiences of behavioural change for cardiovascular risk reduction following APOs, with a focus on health equity. Design and setting Qualitative systematic review, limited to high-income countries with universal access to health care. Method A systematic search of PubMed, Embase, and CINAHL from inception to March 2025 identified primary studies. Thematic synthesis followed Thomas and Harden’s three-stage approach. Themes were mapped onto the COM-B (Capability, Opportunity, Motivation-Behaviour) framework to theoretically ground and structure analysis. Results Eighteen studies involving 339 women met inclusion criteria. Women who were minority ethnic formed the majority in only two studies. Demographic data regarding socioeconomic status, ethnicity, or both were absent from five. Experiences shaping behaviour change aligned with COM-B domains. Delayed physical and psychological recovery after APOs reduced women’s capability to initiate changes. Competing demands, including childcare, household responsibilities, and work, restricted opportunity to focus on long-term cardiovascular health. Opportunities improved when behaviour changes were easily integrated into family life and offered shared benefits. Motivation was strengthened by awareness of increased CVD risk, the responsibilities of parenthood, and personalised advice from healthcare professionals. Tailored, proactive follow-up supported engagement, especially for minority ethnic and socioeconomically disadvantaged groups. Conclusion Prevention of CVD after APOs requires structured, system-level support to prioritise family-based behaviour change. High-risk groups are underrepresented in research; coproducing interventions with these groups may help to avoid widening health inequalities.

OBJECTIVE: To assess the effectiveness of nurse-led or nurse-integrated interventions in improving maternal health outcomes, particularly antenatal care (ANC) attendance, in resource-constrained setti...