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Purchasing for all: an alternative to fundholding
1Academic Department of General Practice and Primary Care, Medical College of St Bartholomew's, London.
Insights
General practitioners
Area of Science:
- Health Services Research
- Primary Care Management
- Public Health Policy
Background:
- District health authorities increasingly involve general practitioners (GPs) in purchasing decisions.
- The Hackney General Practitioners' Forum was established to facilitate GP input into health authority purchasing.
- Understanding the effectiveness and representativeness of such forums is crucial for optimizing healthcare resource allocation.
Purpose of the Study:
- To evaluate the participation and effectiveness of general practitioners in a district health authority's purchasing work.
- To assess the perceptions of GPs and health service managers regarding the Hackney General Practitioners' Forum.
- To determine the extent of GP contribution to quality targets and service developments.
Main Methods:
- A questionnaire study surveyed 131 general practitioners and 33 senior health service managers in Hackney.
- Minutes from 28 meetings of the Hackney General Practitioners' Forum were reviewed.
- The contract between City and Hackney Health Authority and St Bartholomew's NHS Trust was analyzed.
Main Results:
- High response rates were achieved (76% of GPs, 82% of managers).
- Both groups perceived the forum as representative, though managers (92%) were more likely than GPs (74%) to find it effective.
- GPs contributed to 75% of quality targets and 55% of service developments, and successfully advocated for specific service resources.
Conclusions:
- General practitioner forums can be representative and effective in influencing healthcare commissioning.
- Achieving consensus and providing administrative support are key for GP involvement.
- Strengthening the relationship between general practice and public health medicine is recommended.
Objective:
To evaluate general practitioner participation in a district health authority's purchasing work.
Design:
Questionnaire study of 131 Hackney general practitioners and 33 senior health service managers; review of the minutes of 28 meetings of the Hackney General Practitioners' Forum and the contract between City and Hackney Health Authority and the St Bartholomew's NHS Trust.
Setting:
Hackney General Practitioners' Forum.
Main Outcome Measures:
General practitioners' and managers' perceptions of how representative and effective the general practitioners' forum is; proportion of new quality targets and service developments contributed by general practitioners; main issues discussed by the forum and impact on district health authority policy.
Results:
99 (76%) general practitioners and 27 (82%) managers responded. Both groups perceived the forum as representative. 92% (24/26) of the managers thought the forum was effective but only 74% (70/95) of general practitioners did so, largely because some doubted that the forum was listened to 75% (103/138) of quality targets and 55% (16/29) of service developments planned in the 1993-4 contract were contributed by general practitioners. They also lobbied successfully for more resources for urology and community mental health services.
Conclusions:
Input into commissioning via a general practitioners' forum can be both representative and effective. General practitioners need to work closely to achieve a consensus and those involved need administrative support. The relation between general practice and public health medicine needs to be strengthened.