Determinants of primary medical care quality measured under the new UK contract: cross sectional study.
OBJECTIVE
To identify factors associated with the quality of primary medical care incentivised under the new UK general medical services contract.


METHODS
Cross sectional study.


METHODS
NHS Ayrshire and Arran area, Scotland.


METHODS
60 general practices.


METHODS
Quality scores reflecting the total points achieved on the 10 clinical domains and holistic care. Univariate and multivariate regression analyses were used to relate quality scores to measures of population characteristics, urban-rural location, general practitioner characteristics, clinical team size and composition, practice characteristics, and income from other sources.


RESULTS
Deprivation was associated with higher scores. Quality scores increased with the size of the clinical team. Practices with higher income from other sources had lower quality scores. Practices that were accredited, had training status, or contained younger general practitioners had higher quality scores, but these effects were explained by other associated factors. 53% of the variation in quality scores was explained by a multivariate model, which included measures of deprivation, clinical team size and composition, and financial incentives.


CONCLUSIONS
Population characteristics showed little association with the quality of primary medical care incentivised under the UK general medical services contract. Larger clinical teams delivered higher quality clinical care, but the nurse-doctor composition of the clinical team did not influence quality. Practices that were more likely to respond to financial incentives because of previous behaviour or lower income from other sources recorded higher quality. If generalisable, the results suggest that initiatives to improve primary medical care quality should focus on the structure and resourcing of providers.
Sutton
Matt
M
Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD. m.sutton@abdn.ac.uk
McLean
Gary
G
D003430:Cross-Sectional Studies; D005194:Family Practice / Q000191:economics / Q000592:standards*; D006276:Health Facility Size; D006801:Humans; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012044:Regression Analysis; D012051:Reimbursement Mechanisms; D019035:Rural Health Services / Q000592:standards; D012606:Scotland; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000592:standards; D016526:Workload