Spending by primary care practices-does it show what we expect?

James, Marilyn; Stokes, Elizabeth

Abstract

Background
Over recent years, a number of policies and financial incentives in primary care have been proposed to tackle issues such as deprivation and health outcomes. This article investigates the association between healthcare spending, deprivation and outcomes. It argues that individual practice data are analysed before blanket application and acceptance that one size fits all in a local area.

Methods
Financial data were analysed alongside key outcome data, including quality and outcomes framework (QOF) indicators for a large urban primary care trust (PCT) in the UK. The PCT had a large population and number of practices, including single-handed practices and an average list size in excess of 5000. The PCT will remain anonymous.

Results
There was no relationship between primary care investment and the practices' deprivation score. There was a strong statistically significant negative correlation between QOF payments and deprivation, (correlation = −0.46, p < 0.001). There were only weak links between primary care investment and health outcomes. There was no relationship between high emergency spending and health outcome.

Conclusions
The data presented suggest that one size does not necessarily fit all—in terms of providing the appropriate incentives in primary care, nor do national incentives and policies always have the desired effect.

Citation

James, M., & Stokes, E. (2014). Spending by primary care practices-does it show what we expect?. International Journal of Health Planning and Management, 29(3), 244-259. https://doi.org/10.1002/hpm.2224

• Journal Article Type: Article
• Acceptance Date: Oct 2, 2013
• Online Publication Date: Nov 7, 2013
• Publication Date: 2014-07
• Deposit Date: Mar 21, 2017
• Publicly Available Date: Mar 21, 2017
• Journal: The International Journal of Health Planning and Management
• Print ISSN: 0749-6753
• Electronic ISSN: 1099-1751
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 29
• Issue: 3
• Pages: 244-259
• DOI: https://doi.org/10.1002/hpm.2224
• Keywords: primary care policy; investment; outcome; QOF indicators; deprivation
• Public URL: https://nottingham-repository.worktribe.com/output/719652
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1002/hpm.2224/abstract
• Contract Date: Mar 21, 2017