Paying doctors by salary: a controlled study of general practitioner behaviour in England.
The study aim was to evaluate the impact of the experimental introduction of salaried contracts in England on general practitioner (GP) behaviour and the quality of care. A controlled before-and-after design was implemented involving ten practices of standard contract GPs, paid largely by capitation and fee-for-service, and ten salaried GP practices. Diaries and routinely available data were used to assess GP workload, and patient assessments of the quality of care were obtained by postal questionnaire. GPs in salaried practices spent less time on practice administration but more working out-of-hours and in direct patient care, allowing more patients to be seen. Total list sizes were smaller in salaried compared with standard contract practices, but lists per GP were higher because of staffing policies. Salaried GPs tended to provide shorter consultations compared with standard contract GPs, prescribe in fewer consultations, but referral rates were similar. Quality was rated as higher for seven out of thirteen aspects of care examined in salaried practices and two in standard contract practices. However, none of these differences were statistically significant. To conclude, salaried contracts did not adversely affect GP productivity and had little impact on other aspects of GP behaviour or the quality of care provided.
National Primary Care Research and Development Centre, 5th Floor Williamson Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
Toby
T
Gosden
Bonnie
B
Sibbald
Jackie
J
Williams
Roland
R
Petchey
Brenda
B
Leese
D002204:Capitation Fee; D003284:Contract Services / Q000145:classification* / Q000191:economics; D004526:Efficiency; D004739:England; D005194:Family Practice / Q000191:economics / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans; D006302:Health Services Research; D006801:Humans; D010548:Personal Health Services / Q000191:economics*; D010821:Physicians, Family / Q000191:economics* / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012052:Reimbursement, Incentive; D012456:Salaries and Fringe Benefits; D013222:State Medicine / Q000458:organization & administration; D017748:Time Management; D016526:Workload