MINOR SURGERY BY GENERAL-PRACTITIONERS UNDER THE 1990 CONTRACT - EFFECTS ON HOSPITAL WORKLOAD

Objective-To determine the extent to which minor surgery undertaken by general practitioners after the introduction of the 1990 contract sub stituted for hospital outpatient workload. Design-Before and after obs ervational study. Setting-Four English family health services authorit ies. Subjects-Patients in 22 practice populations who were operated on by their general practitioner or referred to hospital for minor surge ry during April to June 1990 or April to June 1991. Main outcome measu res-Numbers of minor surgical procedures undertaken in general practic e and in hospital, numbers of referrals to hospitals for conditions tr eatable by a minor surgical procedure, and the mix of diagnoses and pr ocedures undertaken in each setting. Results-General practitioners cla imed reimbursement for 600 minor surgical procedures during April to J une 1990 and for 847 during April to June 1991, an increase of 41%. Re ferrals to hospital for comparable conditions showed no compensatory d ecrease (385 during April to June 1990 and 388 during April to June 19 91, 95% confidence interval for change in referrals -51 to 57), and th e number of hospital Procedures resulting from those referrals also re mained constant (187 in the first period, 189 in the second, 95% confi dence interval for change in procedures -36 to 40). The mix of procedu res did not change significantly from one study period to the next in either setting: Conclusions-Many or all of the additional patients rec eiving minor surgery under the terms of the 1990 contract may not have previously been referred to hospital. General practitioners seem not to have systematically shifted towards treating the more trivial cases . The overall increase in minor surgical activity may reflect an impro vement in accessibility of care or changes in patients' perceptions an d attitudes.