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Motivating general practitioners to change their prescribing: the incentive of working together
M Ashworth1, D Armstrong, S Colwill
1GKT Department of General Practice, Kings College London, 5 Lambeth Walk, London SE11 6SP, U.K. mashworth@drsdesk.sthames.nhs.uk
Objective:
To determine the extent to which GPs were motivated to change their 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 linked with current prescribing information derived from PACT data.
Setting:
General practice covering a geographical locality within inner-city south London.
Subjects:
All 72 general practitioners who had joined a GP Commissioning Group.
Main Outcome Measures:
questionnaire responses.
Results:
93% of GPs entering the GP Commissioning Group expected their prescribing to change but none expected substantial change. There was no difference between fundholders, singlehanders nor training practices in their expectation of change. GPs in practices with the lowest quality prescribing, as 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 were not more likely to expect their prescribing to change, whereas expensive prescribers who were unaware of their practices' prescribing costs were associated with a reduced expectation of prescribing change (P = 0.05). Educational interventions were thought to be the most effective means by which prescribing could be changed, whereas formularies and financial factors were perceived as weaker influences.
Conclusion:
Acceptance of a cash-limited prescribing budget by GPs is accompanied by the expectation of personal prescribing change. The motivation to change prescribing may be related to a strongly developed collectivist perspective amongst GPs who are prepared to consider the prescribing implications for their fellow GPs. It is ironic that those with the least expectation of change should have the lowest quality prescribing, or be unaware of their high cost prescribing. Engendering greater commitment to the professional group may be one way of changing their prescribing.