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Investment in primary care leads to secondary care savings

Study shows it also reduces emergency admissions

Jo Carlowe

Tuesday, 26 September 2017

Stronger investment in primary care would lead to significant savings for secondary care, according to new research.* 

The findings from King’s College London, published this week in the British Journal of General Practice, reveal that higher levels of capitation supplement were associated with reduced A&E attendances, reduced emergency admissions, and reduced ambulatory care sensitive conditions (ACSCs) admissions. 

The retrospective cross-sectional study was conducted using practice-level data for the 2014-15 financial year. The authors calculated the 2014–2015 capitation payment for each practice as £ per registered patient. The researchers defined three different types of practice in England according to the method of allocating capitation payments: practices with a national contract (General Medical Services [GMS] practices) that receive capitation payments weighted according to a needs-based formula, GMS practices with a national contract that, in addition to their weighted capitation payment, receive a capitation supplement based on higher historical budget allocations (mean practice income guarantee [MPIG] payments), and practices with a locally negotiated contract (Personal Medical Services [PMS] practices). 

Of the three models, only practices in receipt of capitation supplements (MPIG payments) demonstrated a clear association between higher levels of funding and reduced secondary care utilisation. In these practices, it was additional capitation supplements rather than additional capitation payments that were associated with reduced secondary care use. 

No association was found between additional capitation-based funding and QOF performance, probably because QOF as an incentive scheme is separately funded. Although not part of the financial modelling, the authors found some evidence linking additional funding in GMS practices with higher patient-reported satisfaction. 

The authors concluded: “This study provides new evidence that primary care investment could translate into reductions in secondary care costs, although longitudinal evaluation would offer stronger evidence of a causal relationship. The findings suggest that capitation payments are broadly aligned to patient need, at least in terms of secondary care usage. However, supplements to the current capitation formula may produce a reduction in secondary care costs. If these findings are borne out by further studies, proposed reductions in capitation supplements may be counterproductive.”

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, welcomed the study: “These findings back up what the College has been saying for years – that investing more in general practice makes sound economic sense, and can alleviate pressures right across the health service. This should translate into reducing demand on secondary care colleagues, and more care and services being delivered in the community, where it is more cost effective, and where our patients want it most.”

She added: “GPs and our teams make the vast majority of NHS patient contacts – today alone we will see more than 1 million patients across the country. Our service is the lifeblood of the NHS and without it, other services would simply crumble. Yet, whilst workload in general practice has soared – 16% over the last seven years according to recent research – funding for our service has declined, and our workforce has not risen in pace with demand.

“NHS England’s GP Forward View has pledged £2.4 billion extra a year for general practice, 5,000 more GPs and 5,000 more members of the wider practice team by 2020 – today’s study is further evidence that this must be delivered in full and as a matter of urgency.”

* L’Esperance V, Sutton M, Schofield P, et al. Impact of primary care funding on secondary care utilisation and patient outcomes: a retrospective cross-sectional study of English general practice. Br J Gen Pract, 25 September 2017. DOI: 10.3399/bjgp17X693101

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