GP fundholding and the costs of prescribing: further results

Background An earlier paper published in this journal suggested that fundholding practices in Lincolnshire had managed to constrain the growth in their prescribing costs more successfully than had non-fundholders, largely on the basis of restricting the number of items prescribed per patient. At that time, insufficient data were available to explore the impact of a change in status from non-fundholding to fundholding on prescribing behaviour. Method Time-series prescribing data for the fourth-wave of Lincolnshire fundholders are analysed, and comparisons are made between this group, non-fundholders and the fundholders of the earlier waves. Results In their first year of fundholding, fourth-wave practices adopted the prescribing strategies employed previously by existing fundholders, namely, reductions in the number of items prescribed per patient and substantial increases in generic prescribing. The hypothesis that prospective fundholders inflate their prescribing budget before attaining fundholding status is not generally supported by the Lincolnshire data. Evidence is presented which suggests that the prescribing cost economies accruing to fundholding status may be short term. Conclusions With the acquisition of fundholding status, the structure of incentives facing practices changes. Our results suggest that, with respect to prescribing, practices adjust rapidly to the new incentive structure.