Impact of primary care funding on secondary care utilisation and patient outcomes: a retrospective cross-sectional study of English general practice

摘要

Background In international studies, greater investment in primary healthcare is associated with improved population health outcomes.Aim To determine whether investment in general practice is associated with secondary care utilisation, patient satisfaction and clinical outcomes. Design and setting Retrospective cross-sectional study of general practices in England, 2014/15. Methods Practice level data were stratified into three groups according to GP contract type: national General Medical Services (GMS) contracts, with or without the capitation supplement (termed, ‘Mean Practice Income Guarantee’), or local Personal Medical Services (PMS) contracts. Regression models were used to explore associations between practice funding (capitation payments and capitation supplements) and secondary care usage, patient satisfaction (General Practice Patient Survey scores) and clinical outcomes (QOF scores). We conducted financial modelling to predict secondary care cost savings associated with notional changes in primary care funding.Results Mean capitation payments per patient: £69.82 in GMS practices in receipt of capitation supplements (n=2784); £78.79 in GMS practices without capitation supplements (n=1672); £84.43 in PMS practices (n=3022). Mean capitation supplement: £5.72 per patient. Financial modelling demonstrated little or no relationship between capitation payments and secondary care costs. In contrast, notional investment in capitation supplements was associated with modelled savings in secondary care costs. The relationship between funding and patient satisfaction was inconsistent; QOF performance was not associated with funding in any practice type. Conclusions Capitation payments appear to be broadly aligned to patient need in terms of secondary care usage. Supplements to the current capitation formula are associated with reduced secondary care costs.