Abstract
OBJECTIVE: To examine the effects of a financial incentive scheme on prescribing in non-fundholding general practices. DESIGN: Observational study. SETTING: Non-fundholding general practices in former Northern region in 1993-4. INTERVENTION: Target savings were set for each group of practices; those that achieved them were paid a portion of the savings. MAIN OUTCOME MEASURES: Financial performance; prescribing patterns in major therapeutic groups and some specific therapeutic areas; rates of generic prescribing; and performance against a measure of prescribing quality. SUBJECTS: 459 non-fundholding general practices, grouped into three bands according to the ratio of their indicative prescribing amount to the local average (band A > or = 10% above average, B between average and 10% above, C below average). RESULTS: 102 (23%) of 442 practices achieved their target savings (18%, 19%, and 27% of bands A, B, and C respectively). Band C practices that achieved their target had a lower per capita prescribing frequency for gastrointestinal drugs, inhaled steroids, antidepressants, and hormone replacement therapy. There were no other significant differences in prescribing frequency, and no reduction in the quality of prescribing in achieving practices. Total savings of pounds 1.54 m on indicative prescribing amounts were achieved. Payments from the incentive scheme and discretionary quality awards resulted in pounds 463,000 being returned to practices for investment in primary care. CONCLUSIONS: The prescribing behaviour of non-fundholding general practitioners responded to financial incentives in a similar way to that of fundholding practitioners. The incentive scheme did not seem to reduce the quality of prescribing.
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- Dunne F. J. Subcortical dementia. BMJ. 1993 Jul 3;307(6895):1–2. doi: 10.1136/bmj.307.6895.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dunne F. J. Subcortical dementia. BMJ. 1993 Jul 3;307(6895):1–2. doi: 10.1136/bmj.307.6895.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Eccles M. P., Soutter J., Bateman D. N., Campbell M., Smith J. M. Influences on prescribing in non-fundholding general practices. Br J Gen Pract. 1996 May;46(406):287–290. [PMC free article] [PubMed] [Google Scholar]
- Maxwell M., Heaney D., Howie J. G., Noble S. General practice fundholding: observations on prescribing patterns and costs using the defined daily dose method. BMJ. 1993 Nov 6;307(6913):1190–1194. doi: 10.1136/bmj.307.6913.1190. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Roberts S. J., Bateman D. N. Prescribing of antacids and ulcer-healing drugs in primary care in the north of England. Aliment Pharmacol Ther. 1995 Apr;9(2):137–143. doi: 10.1111/j.1365-2036.1995.tb00362.x. [DOI] [PubMed] [Google Scholar]
- Roberts S. J., Bateman D. N. Which patients are prescribed inhaled anti-asthma drugs? Thorax. 1994 Nov;49(11):1090–1095. doi: 10.1136/thx.49.11.1090. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stewart-Brown S., Surender R., Bradlow J., Coulter A., Doll H. The effects of fundholding in general practice on prescribing habits three years after introduction of the scheme. BMJ. 1995 Dec 9;311(7019):1543–1547. doi: 10.1136/bmj.311.7019.1543. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilson R. P., Buchan I., Walley T. Alterations in prescribing by general practitioner fundholders: an observational study. BMJ. 1995 Nov 18;311(7016):1347–1350. doi: 10.1136/bmj.311.7016.1347. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilson R., Walley T. Prescribing costs in general practice fundholding. Lancet. 1995 Dec 23;346(8991-8992):1710–1711. doi: 10.1016/s0140-6736(95)92877-4. [DOI] [PubMed] [Google Scholar]