CHANGES IN PAYMENTS FOR GENERAL-PRACTICE CONSULTATIONS 1989-93

Aims. Information generated by the computer systems of general practit ioners was examined to determine whether general practitioners fee str uctures during 1993 were different from those reported in 1989. Method s. Copies of the general medical services (GMS) claims and actual cons ultation charges to patients were examined to determine whether patien ts had been charged the doctors' regular fee or an amount greater or l ess than this, in 1993. These data were compared with results from a p revious study describing charging data in 1989. Results. Information o n 59 215 consultations was collected in 1993 and compared with informa tion on 97 869 consultations collected in 1989. The proportion of cons ultations which resulted in a regular fee being charged had reduced fr om 47.0% in 1989 to 34.1% in 1993 (p < 0.001). The proportion of cases in which a less than normal fee was charged had risen 7.9 times from 3.5% in 1989 to 27.5% in 1993 ip < 0.001). The contribution of Acciden t Compensation (ACC) funding for general practitioner consultations ha d reduced from 17.5% of consultations in 1989 to 10.1% of 1993 consult ations (p < 0.001), Excluding consultations in which a maternity or im munisation claim was made, 19.4% of consultations in 1993 generated no fee to the patient. Conclusion. In the 4 years between these two data collections, changes in the contribution of different agencies fundin g general practice care is marked. Public agencies have diminished inp ut and both patients and practitioners are carrying more of the financ ial burden for access to primary care.