Poles apart? The views of general practitioners and family health services authority advisers on prescribing cost issues

BACKGROUND: In 1994, an Audit Commission report estimated that Pounds 425 million could be saved from the national drug budget if general practitioners (GPs) altered their prescribing in various ways. AIM: To assess the views of GPs and family health services authority (FHSA) advisers on issues similar to those raised in the Audit Commission report. METHOD: A questionnaire was sent to a 1 in 20 sample of GPs from 33 randomly selected FHSA areas (n = 576) and all FHSA advisers (n = 285). RESULTS: A total of 419 (72.7%) GPs and 234 (82.1%) advisers replied. There were statistically significant differences (P < 0.01) between GPs and advisers on all but one of the statements. In particular, there were marked differences on some of the statements relating to substitution with cheaper similar drugs. Differences were smaller for statements on the use of drugs of limited therapeutic value, the range of drugs prescribed, and practice prescribing policies. Differences were noted between subgroups of GPs in response to some of the statements. CONCLUSION: The majority of GPs in this survey gave responses that were supportive of many of the types of suggestion made by the Audit Commission. However, it is suggested that differences of opinion between GPs and FHSA advisers may have implications for the development of strategies to control prescribing costs.     

General practitioners' referral thresholds and choices of referral destination: an experimental study

General practitioners (GPs) exert a major impact on NHS resource use, both as providers of primary care and as referrers to secondary care. Referral rates are subject to wide variations, leading to the conjecture that certain GPs may have different 'referral thresholds' from those of others. In this paper, the authors describe an experiment designed both to test the referral threshold hypothesis and to illuminate the GP's decision process with respect to choice over referral destination. Nottinghamshire GPs were provided with hypothetical case histories and a list of possible referral destinations, specifying a range of consultants, their specialist interests, plus the expected waiting times and costs for both out-patient investigation and in-patient treatment. For each case, respondents were requested to indicate whether or not they would refer the patient, and to whom. Respondents were also asked to indicate the extent to which their choices of consultants generally were governed by the specialist interest, the waiting time and the cost information. The responses of the sample support the referral threshold conjecture, with specialist interests and waiting time appearing to be far more important than cost in influencing choice of referral destination. The possibilities of influencing GPs' referral behaviour are discussed, in the light of recent initiatives with respect to prescribing.