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

L’Esperance, Veline; Sutton, Matt; Schofield, Peter; Round, Thomas; Malik, Umer Feroze; White, Patrick; Ashworth, Mark

doi:10.3399/bjgp17x693101

Cited by 12 publications

(15 citation statements)

References 18 publications

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“…These findings complement those of a previous study which found that increased general practice capitation funding was associated with reduced emergency hospital admissions and Accident and Emergency attendances 12…”

Section: Discussionsupporting

confidence: 89%

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Relationship between general practice capitation funding and the quality of primary care in England: a cross-sectional, 3-year study

et al. 2019

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ObjectiveTo explore the relationship between general practice capitation funding and quality ratings based on general practice inspections.DesignCross-sectional study pooling 3 years of primary care administrative data.SettingUK primary care.Participants7310 practices (95% of all practices) in England which underwent Care Quality Commission (CQC) inspections between November 2014 and December 2017.Main outcome measuresCQC ratings. Ordered logistic regression methods were used to predict the relationship between practice capitation funding and CQC ratings in each of five domains of quality: caring, effective, responsive, safe and well led, together with an overall practice rating.ResultsHigher capitation funding per patient was significantly associated with higher CQC ratings across all five quality domains: caring (OR 1.14, 95% CI 1.04 to 1.23), effective (OR 1.08, 95% CI 1.00 to 1.16), responsive (OR 1.09, 95% CI 1.02 to 1.17), safe (OR 1.11, 95% CI 1.05 to 1.18), well led (OR 1.13, 95% CI 1.06 to 1.20) and overall rating (OR 1.13, 95% CI 1.06 to 1.19).ConclusionHigher capitation funding was consistently associated with higher ratings across all CQC domains and in the overall practice rating. This study suggests that measured dimensions of the quality of care are related to the underlying capitation funding allocated to each general practice, implying that additional capitation funding may be associated with higher levels of primary care quality.

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Section: Discussionsupporting

confidence: 89%

“…Greater capitation spending on general practices has been found to be associated with reductions in secondary care usage and costs, and increased patient satisfaction 12. Studies have also shown that leadership within the practice organisation plays a key role in the delivery of high-quality care 13.…”

Section: Introductionmentioning

confidence: 99%

Relationship between general practice capitation funding and the quality of primary care in England: a cross-sectional, 3-year study

et al. 2019

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“…An earlier 1-year cross-sectional study of English general practices found that higher capitation funding was associated with higher reported patient satisfaction in practices with GMS contracts but that there was no relationship in practices with PMS contracts. 13 The current 4-year longitudinal study has extended these findings to practices with all types of contract and has used other types of funding and a wider set of patient experience measures. Another study used pooled cross-section data and found that higher practice capitation funding is associated with higher Care Quality Commission ratings, including on the ‘responsive and caring’ domain of quality as assessed by on-site practice inspection and consideration of GPPS patient experience scores.…”

Section: Discussionmentioning

confidence: 96%

“… 7 , 11 , 12 Two cross-sectional studies have examined the association of funding and quality in English general practices. One found no consistent relationship between funding and patient satisfaction, 13 and the other found that practices with greater funding were more likely to receive higher-quality ratings from the Care Quality Commission. 14 This study expands on previous research by using a wider set of patient-reported experience measures and a longitudinal design to examine whether changes in the funding of practices are associated with changes in the experience reported by their patients.…”

Section: Introductionmentioning

confidence: 99%

Impact of primary care funding on patient satisfaction: a retrospective longitudinal study of English general practice, 2013–2016

et al. 2020

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BackgroundProviding high-quality clinical care and good patient experience are priorities for most healthcare systems.AimTo understand the relationship between general practice funding and patient-reported experience.Design and settingRetrospective longitudinal study of English general practice-level data for the financial years 2013–2014 to 2016–2017.MethodData for all general practices in England from the General and Personal Medical Services database were linked to patient experience data from the GP Patient Survey (GPPS). Panel data multivariate regression was used to estimate the impact of general practice funding (current or lagged 1 year) per patient on GPPS-reported patient experience of access, continuity of care, professionalism, and overall satisfaction. Confounding was controlled for by practice, demographic, and GPPS responder characteristics, and for year effects.ResultsInflation-adjusted mean total annual funding per patient was £133.66 (standard deviation [SD] = £39.46). In all models, higher funding was associated with better patient experience. In the model with lagged funding and practice fixed effects (model 6), a 1 SD increase in funding was associated with increases in scores in the domains of access (1.18%; 95% confidence interval [CI] = 0.89 to 1.47), continuity (0.86%; 95% CI = 0.19 to 1.52), professionalism of GP (0.47%; 95% CI = 0.22 to 0.71), professionalism of nurse (0.51%; 95% CI = 0.24 to 0.77), professionalism of receptionist (0.51%; 95% CI = 0.24 to 0.78), and in overall satisfaction (0.88%; 95% CI = 0.52 to 1.24).ConclusionBetter-funded general practices were more likely to have higher reported patient experience ratings across a wide range of domains.

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“…Primary health care is often described as the foundation of a strong health care system [ 1 ]. According to the World Health Organization (WHO) “All people, everywhere, deserve the right care, right in their community.…”

Section: Introductionmentioning

confidence: 99%

The Impact of COVID-19 on the Performance of Primary Health Care Service Providers in a Capitation Payment System: A Case Study from Poland

Korneta

Kludacz-Alessandri

Walczak

2021

IJERPH

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In Poland, as in many other countries, the use of capitation payment schemes in primary health care is popular. Despite this popularity, the subject literature discusses its role in decreasing the quality of primary medical services. This problem is particularly important during COVID-19, when medical entities provide telehealth services to patients. The objective of the study is to examine the effects of COVID-19 pandemic on the performance of the primary health care providers in Poland under a capitation payment scheme. In this study the authors use data from interviews with personnel of medical entities and financial and administrative reports of primary health care providers in order to identify how this crisis situation impacts the performance of primary health care entities, under capitation payment system. The performance indicators include both the financial and quality measures. Selected to the case study primary health care service providers significantly improved their profitability due to considerable costs savings and reduction of services provided to patients in a time of COVID-19 pandemic. Capitation payment system proved to be inefficient, in the studied pandemic period, in terms of the services provided by primary health care service providers to patients and the funds paid to them, in exchange, by the government entities.

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

Abstract: 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.

Cited by 12 publications

References 18 publications

Relationship between general practice capitation funding and the quality of primary care in England: a cross-sectional, 3-year study

Relationship between general practice capitation funding and the quality of primary care in England: a cross-sectional, 3-year study

Impact of primary care funding on patient satisfaction: a retrospective longitudinal study of English general practice, 2013–2016

The Impact of COVID-19 on the Performance of Primary Health Care Service Providers in a Capitation Payment System: A Case Study from Poland

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