Lessons from the London Initiative Zone Educational Incentives funding: associations between practice characteristics, funding and courses undertaken

Background Following the Tomlinson report of 1992, London Initiative Zone E ducational Incentives (LIZEI) funding was introduced for a three-year perio d to improve recruitment, retention, and educational opportunities for gene ral practitioners working within inner London. Aim. To test the hypothesis that general practices that show evidence of go od organisation achieved better access to LIZEI funding than less organised practices. Method. Observational practice-based study involving all 764 general practi ces in East London and the City Health Authority during the first two years of the scheme, April 1995 to March 1997. Results. Univariate analysis showed that higher levels of LIZEI funding wer e associated with practices where there was evidence of good organisation, including higher targets for cervical cytology screening and immunisation r ates for under two-year-olds, better asthma prescribing, and training statu s. Using ten practice and population explanatory variables, multiple regres sion models were developed for fundholding and non-fundholding practices. A mong non-fundholding practices, the asthma prescribing ratio was the variab le with the greatest predictive value, explaining 14.7% of the variation in LIZEI funding between practices. Strong: positive associations existed bet ween taking further degrees and diplomas, practice size, training, and non- fundholding status. Conclusion. Larger practices, training practices, and those that demonstrat ed aspects of good practice organisation gained more LIZEI funding: an exam ple of the 'inverse funding law'. Practices within a multifund, based in th e Newham locality, gained LIZEI funding regardless of practice organisation . Networks of practices, and, potentially, primary care groups, have a role in equalising the opportunities for education and development between prac tices in east London.