FAMILY DOCTORS AND CHANGE IN PRACTICE STRATEGY SINCE 1986

Objectives-To investigate the changes in practice strategy that have t aken place since 1986. Design-Comparison of practices in 1986 and 1992 . Setting-93% of group practices (26 practices) in a single family hea lth services authority. Main outcome measures-Changes in staffing, pre mises, equipment, clinic services, and incomes between 1986 and 1992. Results-In 1986, 28% of practices employed a nurse; in 1992, 92% did s o. Between 1986 and 1992, 14 cost-rent schemes costing more than pound 10 000 had been started. Certain practices, designated innovators, we re more likely to possess specified items of equipment than other prac tices. Computer ownership was widespread: 77% of practices had a compu ter, compared with 36% in 1986. In 1992, 16 practices had a manager, c ompared with 10 in 1986. Clinic services provided by more than half of practices were well established services (antenatal, for example), ne w services for which a payment had been introduced (such as diabetes, asthma, minor surgery), or the more readily provided ''new'' clinic se rvices (diet, smoking cessation). Gross income increased, but so did p ractice costs, especially for innovators. Practices in the more afflue nt area of the family health services authority were still more likely to invest in their premises and staff, and to provide more services t han those in the declining area. In the more affluent area, practices had higher costs but also higher incomes. Conclusion-Between 1986 and 1992, practices in this area invested heavily in equipment and service s, but differences remain, depending on the location of the practice. Investment has increased, particularly in the more deprived part of th e area, so that the inconsistency in standards has been much reduced. Practice incomes have risen, but so also have workload and costs.