Motivating general practitioners to change their prescribing: the incentive of working together

Objective: To determine the extent to which GPs were motivated to change th eir prescribing upon joining a Primary Care Commissioning Group (PCCG) and how effective certain interventions planned by the PCCG might be as a means to change prescribing. To define the characteristics of GPs less motivated to change their prescribing. Design: A cross-sectional survey of participating general practitioners lin ked with current prescribing information derived from PACT data. Setting: General practice covering a geographical locality within inner-cit y south London. Subjects: All 72 general practitioners who had joined a GP Commissioning Gr oup. Main outcome measures: questionnaire responses. Results: 93% of GPs entering the GP Commissioning Group expected their pres cribing to change but none expected substantial change. There was no differ ence between fundholders, singlehanders nor training practices in their exp ectation of change. GPs in practices with the lowest quality prescribing, a s measured by a quality index, were least likely to expect change (Spearman 's r = 0.25, P = 0.04). Those in practices with higher prescribing costs we re not more likely to expect their prescribing to change, whereas expensive prescribers who were unaware of their practices' prescribing costs were as sociated with a reduced expectation of prescribing change (P = 0.05). Educa tional interventions were thought to be the most effective means by which p rescribing could be changed, whereas formularies and financial factors were perceived as weaker influences. Conclusions: Acceptance of a cash-limited prescribing budget by GPs is acco mpanied by the expectation of personal prescribing change. The motivation t o change prescribing may be related to a strongly developed collectivist pe rspective amongst GPs who are prepared to consider the prescribing implicat ions for their fellow GPs. It is ironic that those with the least expectati on of change should have the lowest quality prescribing, or be unaware of t heir high cost prescribing. Engendering greater commitment to the professio nal group may be one way of changing their prescribing.