Veline L'Esperance 1 , Matt Sutton 2 , Peter Schofield 1 , Thomas Round 1 , Umer Malik 1 , Patrick White 1 , Mark Ashworth 1 Show Affiliations »
Abstract
BACKGROUND: In international studies, greater investment in primary health care is associated with improved population health outcomes. AIM: To determine whether investment in general practice is associated with secondary care utilisation, patient satisfaction, and clinical outcomes. DESIGN AND SETTING: Retrospective cross-sectional study of general practices in England, 2014-2015. METHOD: Practice-level data were stratified into three groups according to GP contract type: national General Medical Services (GMS) contracts, with or without the capitation supplement (mean practice income guarantee), or local Personal Medical Services (PMS) contracts. Regression models were used to explore associations between practice funding (capitation payments and capitation supplements) and secondary care usage, patient satisfaction (general practice patient survey scores), and clinical outcomes (Quality and Outcomes Framework [QOF] scores). The authors conducted financial modelling to predict secondary care cost savings associated with notional changes in primary care funding. RESULTS: Mean capitation payments per patient were £69.82 in GMS practices in receipt of capitation supplements (n = 2784), £78.79 in GMS practices without capitation supplements (n = 1672), and £84.43 in PMS practices (n = 3022). The mean capitation supplement was £5.72 per patient. Financial modelling demonstrated little or no relationship between capitation payments and secondary care costs. In contrast, notional investment in capitation supplements was associated with modelled savings in secondary care costs. The relationship between funding and patient satisfaction was inconsistent. QOF performance was not associated with funding in any practice type. CONCLUSION: Capitation payments appear to be broadly aligned to patient need in terms of secondary care usage. Supplements to the current capitation formula are associated with reduced secondary care costs. © British Journal of General Practice 2017.
BACKGROUND: In international studies, greater investment in primary health care is associated with improved population health outcomes. AIM: To determine whether investment in general practice is associated with secondary care utilisation, patient satisfaction, and clinical outcomes. DESIGN AND SETTING: Retrospective cross-sectional study of general practices in England, 2014-2015. METHOD: Practice-level data were stratified into three groups according to GP contract type: national General Medical Services (GMS ) contracts, with or without the capitation supplement (mean practice income guarantee), or local Personal Medical Services (PMS) contracts. Regression models were used to explore associations between practice funding (capitation payments and capitation supplements) and secondary care usage, patient satisfaction (general practice patient survey scores), and clinical outcomes (Quality and Outcomes Framework [QOF] scores). The authors conducted financial modelling to predict secondary care cost savings associated with notional changes in primary care funding. RESULTS: Mean capitation payments per patient were £69.82 in GMS practices in receipt of capitation supplements (n = 2784), £78.79 in GMS practices without capitation supplements (n = 1672), and £84.43 in PMS practices (n = 3022). The mean capitation supplement was £5.72 per patient . Financial modelling demonstrated little or no relationship between capitation payments and secondary care costs. In contrast, notional investment in capitation supplements was associated with modelled savings in secondary care costs. The relationship between funding and patient satisfaction was inconsistent. QOF performance was not associated with funding in any practice type. CONCLUSION: Capitation payments appear to be broadly aligned to patient need in terms of secondary care usage. Supplements to the current capitation formula are associated with reduced secondary care costs. © British Journal of General Practice 2017.
Entities: Chemical
Species
Keywords:
general practice; health care economics; health services research; primary care; primary care funding; secondary care utilisation
Mesh： See more »
Year: 2017
PMID： 28947619 PMCID： PMC5647923 DOI： 10.3399/bjgp17X693101
Source DB: PubMed Journal: Br J Gen Pract ISSN： 0960-1643 Impact factor: 5.386