Influences of practice characteristics on prescribing in fundholding and non-fundholding general practices: an observational study

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Abstract
Objective: To investigate the variation in prescribing among general practices by examining the contribution to this variation of fundholding, training status, partnership status, and the level of deprivation in the practice population and to investigate the extent to which fundholding has been responsible for any changes in prescribing. Design: Analysis of prescribing data (PACT) for the years 1990-1 (before fundholding) and 1993-4 (after fundholding). Use of multiple linear regressions to investigate the variation among practices in total prescribing costs (net ingredient cost per prescribing unit), prescribing volume (items per 1000 prescribing units), and mean cost per item in each of the two years and also the change in these variables between years. Setting: Former Mersey region. Subjects: 384 practices. Results: The models developed explained the variation in cost per item (43% of variation explained for 1990-1, 38% for 1993-4) and prescribing volume (34% for 1990-1, 38% for 1993-4) better than the variation in total prescribing costs (3% for 1990-1, 7% for 1993-4). The models developed to explain the change in these variables between years did not explain more than 10% of the variation. Most of the explained variation in the change in total prescribing costs was accounted for by fundholding. Of the £3.71 saved by first wave fundholders compared with non-fundholders £3.57 was attributable to fundholding alone. Conclusion: In neither year did fundholding make a major contribution to the variation in prescribing behaviour among practices, which was better explained by deprivation, training status, and partnership status, but it did seem largely responsible for differences in the rise of total prescribing costs between fundholders and non-fundholders. Much of the variation in prescribing practice remains unexplained. Fundholding is the major contributor to the differences in the rise in prescribing costs between fundholders and non-fundholders.