The effects of fundholding in general practice on prescribing habits three years after introduction of the scheme

Abstract

Objectives-To observe changes in prescribing practice that occurred after the introduction of fundholding in first wave practices and to contrast these with changes occurring in similar nonfundholding practices.Design-Prospective observational study. Setting-Oxford region fundholding study. Subjects-Eight first wave fundholding practices and five practices that were not interested in fundholding in 1990-1, which were similar in terms of practice size, training status, locality, and urban rural mix. Three of the fundholding and none of the non-fundholding practices were dispensing practices.Main outcome measures-Changes in prescribing practice as measured by net cost per prescribing unit, cost per item, number of items prescribed, and substitution rates for generic drugs three years after the introduction of fundholding. Data for fundholding practices were analysed separately according to whether they were dispensing or nondispensing practices.Results-Prescribing costs rose by a third or more in all types of practice. The patterns of change observed in this cohort after one year offundholding were reversed. No evidence existed that fundholding had controlled prescribing costs among nondispensing fundholders; costs among dispensing fimdholders rose least, but the differences were small compared with the overall increase in costs.Conclusions-Early reports of the effectiveness of fundholding in curbing prescribing costs have not been confirmed in this longer term study. IntroductionThe 1991 NHS reforms were introduced to address the problem of escalating NHS costs; prescribing costs constituted an important component of this problem.' In the reforms, general practice fundholders were

A systematic review of the literature comparing the practices of dispensing and non-dispensing doctors

“…Of the remaining, one paper was excluded as only the abstract was in English [6]; six papers were excluded as the studies were not designed to specifically evaluate the practices of DD [7][8][9][10][11][12] (for example effects of fundholding on practices across catchments). Nine papers were excluded due to the absence of an adequate comparison group [13][14][15][16][17][18][19][20][21] (for example comparing dispensing general practitioners vs. non-dispensing medical specialists); and two papers did not describe their methodology [22,23].…”

The prevalence and nature of recent self-reported changes in general dental practice in a sample of English general dental practitioners

“…In accordance with research into changes made by general medical practitioners, [24][25][26] this study assessed change within general dental practice based upon self reports. Such an approach has some limitations.…”

Audit of Prescribing Patterns in Saudi Primary Health Care: What Lessons Can be Learned?

“…35 Regardless of the type of study, the majority have shown positive effects on savings. The benefits of the intervention studies, namely the use of fewer and cheaper prescriptions, are shown to disappear over time, 36,37 which suggests the need for repeating the intervention at frequent intervals. Rational prescribing messages should be promoted at national and local medical meetings and the input from local practitioners should be considered.…”