Preferences of healthy and ill patients for style of general practitioner care: implications for workload and financial incentives under the new contract.

Seven hundred and sixty patients from four general practices in an urban health centre were asked to evaluate the relative importance of 20 statements describing different aspects of general practice. Significant differences were observed between sub-groups of the patients, in particular those who would be likely to make greater use of the general practitioner--the elderly and the ill. Patients who reported not good or poor health status were more likely to value second opinions and, conversely, undervalue efficient prescribing, and an emphasis on vaccinations, cervical smears and check ups. Elderly patients placed greater emphasis on second opinions, protection in their relationship with the hospital, routine visits to the elderly and friendly staff, and similarly undervalued an emphasis on vaccinations, cervical smears and check ups. This means that practices which increase their list size to benefit from higher capacitation payments might, depending on their characteristics, attract predominantly healthy people and increase patient numbers without a commensurate increase in workload. Other facets of the payment system, in particular fees for health promotion work, further support this bias against ill patients.