ALTERATIONS IN PRESCRIBING BY GENERAL-PRACTITIONER FUNDHOLDERS - AN OBSERVATIONAL STUDY

Objectives-To compare prescribing in general practices before and afte r they become fundholders to assess whether this affected prescribing patterns. Design-Analysis of prescribing data (PACT) for one year befo re and one year after practices become first, second, or third wave fu ndholders and comparison with practices that were not fundholders duri ng any part of the study. Main outcome measures-Prescribing costs (net ingredient cost per prescribing unit), prescribing volume (items per 1000 prescribing units), net ingredient cost per item, and percentage of generic prescribing. Setting-Former Mersey Regional Health Authorit y. Subjects-100 fundholders (20 first wave, 31 second wave, 49 third w ave) and 312 non-fundholders. Results-Prescribing costs and volume ros e throughout the study in all groups. In all three fundholding waves t he rate of increase of prescribing costs was significantly lower than for non-fundholders. Both cost per item and prescribing volume tended to decrease, the former probably because of a significant increase in generic prescribing: Fundholding and non-fundholding practices differe d in several respects. Conclusion-Fundholding has altered practice pre scribing patterns compared with those of non-fundholders, increasing g eneric prescribing and reducing the rate of increase of prescribing co sts.