A PRESCRIBING INCENTIVE SCHEME FOR NON-FUNDHOLDING GENERAL PRACTICES - AN OBSERVATIONAL STUDY

Objective-To examine the effects of a financial incentive scheme on pr escribing in non-fundholding general practices. Design-Observational s tudy. Setting-Non-fundholding general practices in former Northern reg ion in 1993-4.Intervention-Target savings were set for each group of p ractices; those that achieved them were paid a portion of the savings. Main outcome measures-Financial performance; prescribing patterns in major therapeutic groups and some specific therapeutic areas; rates of generic prescribing; and performance against a measure of prescribing quality. Subjects-459 non-fundholding general practices, grouped into three bands according to the ratio of their indicative prescribing am ount to the local average (band A greater than or equal to 10% above a verage, B between average and 10% above, C below average). Results-102 (23%) of 442 practices achieved their target savings (18%, 19%, and 2 7% of bands A, B, and C respectively). Band C practices that achieved their target had a lower per capita prescribing frequency for gastroin testinal drugs, inhaled steroids, antidepressants, and hormone replace ment therapy. There were no other significant differences in prescribi ng frequency and no reduction in the quality of prescribing in achievi ng practices. Total savings of pound 1.54m on indicative prescribing a mounts were achieved. Payments from the incentive scheme and discretio nary quality awards resulted in pound 463 000 being returned to practi ces for investment in primary care. Conclusions-The prescribing behavi our of non-fundholding general practitioners responded to financial in centives in a similar way to that of fundholding practitioners. The in centive scheme did not seem to reduce the quality of prescribing.