OBJECTIVES

In England, general practice funding has several components, the largest of which is capitation-based payment (54% of funding), weighted according to factors affecting GP workload. Additional funding can be obtained through providing performance related activity (16%) including the Quality and Outcome Framework and by delivering Enhanced Services. QOF is an annual incentive programme based on the achievement of quality indicators for long-term conditions (LTCs). Enhanced services include extended opening hours. This study investigates the relationship between general practice funding and clinical achievement.

METHODS

: We combined five datasets for all general practices in England (n=7310): (i) General and Personal Medical Services database (2013-2016), providing workforce and patient data, (ii) NHS payments to General Practice, (2013-2016) which records payments to practices, (iii) Quality and Outcomes Framework (2013-2016) describing performance on clinical achievement indicators in LTCs, (iv) deprivation data for each practice, and (v) neighbourhood ethnicity for each practice. We used random effects practice level panel models to examine the relationship between general practice funding and clinical achievement of blood pressure control in common LTCs and glycaemic control in diabetes.

RESULTS

The mean total funding per patient was £125. Practices which received less total funding per patient were less successful at achieving clinical targets. Following adjustment for confounders, higher funding was significantly associated with greater achievement of blood pressure control in patients with peripheral vascular disease, hypertension, stroke, and diabetes and with greater clinical achievement in glycaemic control in diabetic patients. Factors influencing higher clinical achievement include higher proportion of older patients, group practices, practices which provide postgraduate training and lower patient list size growth.

CONCLUSIONS

: This study suggests that the measured dimensions of clinical achievement are related to the underlying funding allocated to each general practice. This study supports the argument that improvement in the clinical management of LTCs may be achieved through additional investment.