Elsevier

The Lancet

Volume 388, Supplement 2, November 2016, Page S66
The Lancet

Meeting Abstracts
Association between general practice funding and practice achievement: a cross-sectional study

https://doi.org/10.1016/S0140-6736(16)32302-9Get rights and content

Abstract

Background

In the past decade, general practice funding has decreased from 11% to 8% of total National Health Service (NHS) spending, while workload has increased by 19%. To date, the impact of broader aspects of practice funding on performance has not been examined. Using newly released primary care financial data, we aimed to explore the association between NHS payments made to general practices in England that are not part of the quality and outcomes framework (QOF) and primary care performance.

Methods

Practice funding data were extracted from the National Health Applications and Infrastructure Services. We confined our analysis to practices with the nationally determined contract, General Medical Services (n=4298); data were not available for the locally determined contracts offered to Personal Medical Services practices. We constructed regression models to explore the association between practice funding and QOF outcomes, secondary care usage (outpatient, accident and emergency [A&E], and inpatient rates per 1000 registered patients), and patient satisfaction, adjusted for practice and demographic variables. We then conducted financial modelling to predict the impact of a hypothetical 10% funding increase on secondary care costs, for which we used standard cost estimates.

Findings

The mean funding was £75·71 per patient (95% CI 66·86–87·58). Higher funding was significantly associated with lower emergency admissions (regression coefficient β=0·24), lower A&E attendances (−1·04), and higher patient satisfaction (overall satisfaction 0·002). We found no significant association with outpatient attendance or QOF performance. In our financial model, a 10% increase in primary care funding would cost an additional £7571 per 1000 registered patients, which would be partly offset by a £5323 reduction in emergency admissions and £1031 reduction in A&E attendances.

Interpretation

General Medical Services practices with higher levels of funding had lower secondary care usage and higher patient satisfaction. The lack of association between funding and QOF achievement might be attributable to the different funding stream and incentives for QOF. Our findings support the case for greater investment in primary care which would largely be offset by reduced secondary care costs and associated with higher levels of patient satisfaction.

Funding

VSL is funded by a National Institute for Health Research academic clinical fellowship.

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