Researcher looks west on GP contracts
February 2007Dr Ruth McDonald from the National Primary Care Research and Development Centre has been awarded a prestigious Harkness Fellowship by the Commonwealth Fund. The Fellowships allow researchers to spend a year in the US, conducting original research and working with leading health policy experts.
The funding will allow her to continue her work on the UK’s GP contracts by studying the ‘pay for performance’ system in California, which includes incentives for GPs to note the costs of the treatments and referrals they order for patients.
The UK contract encourages GPs to meet quality targets, often relating to the management of long-term conditions like diabetes, asthma and heart disease. It has cost more than expected since being introduced in April 2004 as GPs have out-performed expectations, with some evidence that they are now paid more for doing less.
“If a GP is encouraged to order more services this leaves less in the pot for others, and this is a finite resource,” Ruth said. “The contract contains no incentives for GPs to look at the costs of what they are doing.
“It is not just a case of only doing necessary things, but asking ‘could these things be done more efficiently?’ This is in patients’ interests, as the more efficient their treatment, the more can be treated.
US GPs work in a range of settings, from salaried doctors working in large groups to those working alone and paid according to their volume of work. By looking at these Ruth hopes to build up an understanding of the factors that motivate doctors, and the things that help or hinder them in delivering high quality care.
“The California scheme offers incentives for doctors to meet quality targets, and encourages them to consider the cost consequences of their actions,” she said. “Studying the way doctors respond to these incentives will help us learn about the benefits and risks associated with encouraging doctors to balance the needs of the community with the needs of the patient in front of them.”
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