Does general practitioner involvement in commissioning maternity care make a difference?
OBJECTIVE
To evaluate the impact of general practitioners' commissioning of maternity services on women's experiences of care and on resource use, and to consider the implications for primary care commissioning.


METHODS
Comparison of women's experiences and resource use between 11 commissioning and 10 non-commissioning general practices. Face-to-face interviews with 212 staff in general practices, National Health Service trusts and health authorities between 1996 and 1998 to establish how maternity care was organised. Women's experience of information, choice, control and resource use obtained by questionnaire mailed 4 weeks post-partum. Data were analysed using multi-level modelling to adjust for case-mix differences.


RESULTS
After two reminders, 1957 women (62%) responded to the questionnaire (inter-practice range 52-81%). There were no significant differences in women's experience of care or their resource use between commissioning and non-commissioning practices. Commissioning practices were more likely to be associated with more vertically integrated models of service organisation, but responses to only three of 21 questions about experience of information, choice and control over care, or about resource use, differed between the four models of service organisation identified.


CONCLUSIONS
The expectation that giving primary care organisations responsibility for commissioning care will result in improved patients' experiences of care or better use of resources should be treated with caution. The presence of strong national policy may be equally important. Models of service organisation are not proxies for quality of care. The most powerful force shaping patients' experiences of care may be health care professionals' ability to translate national policy into local services.
Wyke
S
S
Primary Care Research Group, University of Edinburgh, Edinburgh, UK.
Hewison
J
J
Elton
R
R
Posnett
J
J
Macleod
L
L
Ross-McGill
H
H
D003266:Continuity of Patient Care / Q000458:organization & administration; D003284:Contract Services; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000592:standards* / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011247:Pregnancy; D012017:Referral and Consultation; D013222:State Medicine / Q000458:organization & administration; D011795:Surveys and Questionnaires; D006113:United Kingdom