title: Spending by primary care practices - does it show what we expect?
abstract: BACKGROUND
  Over recent years, a number of policies and financial incentives in primary care have been proposed to tackle issues such as deprivation and health outcomes. This article investigates the association between healthcare spending, deprivation and outcomes. It argues that individual practice data are analysed before blanket application and acceptance that one size fits all in a local area.
  
  
  METHODS
  Financial data were analysed alongside key outcome data, including quality and outcomes framework (QOF) indicators for a large urban primary care trust (PCT) in the UK. The PCT had a large population and number of practices, including single-handed practices and an average list size in excess of 5000. The PCT will remain anonymous.
  
  
  RESULTS
  There was no relationship between primary care investment and the practices' deprivation score. There was a strong statistically significant negative correlation between QOF payments and deprivation, (correlation = -0.46, p < 0.001). There were only weak links between primary care investment and health outcomes. There was no relationship between high emergency spending and health outcome.
  
  
  CONCLUSIONS
  The data presented suggest that one size does not necessarily fit all - in terms of providing the appropriate incentives in primary care, nor do national incentives and policies always have the desired effect.
authors.forename: Marilyn
authors.initials: M
authors.lastname: James
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stokes
mesh_terms: D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D002391:Catchment Area, Health; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D006302:Health Services Research; D006801:Humans; D011320:Primary Health Care / Q000191:economics*; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000191:economics*; D013222:State Medicine / Q000191:economics*; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D006113:United Kingdom / Q000453:epidemiology; D014505:Urban Population