PLEASE NOTE THIS SEMINAR HAS BEEN CANCELLED.
At this seminar, we have two talks by colleagues from the Health Organisation, Policy and Economics (HOPE) group at the Centre for Primary Care and Health Services Research.
Presentation 1: Exploring the effect of financial incentives on GP referrals to a national prevention programme
Authors: Emma McManus, Jack Elliott, Rachel Meacock, Paul Wilson, Judith Gellatly, Matthew Sutton.
Background: Prevention programmes need to enrol a sufficient number of suitable participants to be cost-effective. We consider the NHS Diabetes Prevention Programme (DPP), which aims to enrol 100,000 people at-risk of developing Type 2 Diabetes onto a lifestyle improvement programme each year. The programme is delivered by non-NHS providers, but most participants are identified and referred by GP practices. Clinical Commissioning Groups (CCGs) were given implementation funds, which they could use to offer incentives to practices for identifying and referring participants. We analyse the impact of variations in the form of these incentives on referral rates.
Aim: To evaluate the effects of the existence and structure of financial incentives on GP referrals to a prevention programme.
Data: We surveyed CCGs to establish the types of financial incentives used to encourage GP referrals. We linked this information to the Minimum Data Set collected by the DPP providers and recently published data collected from GP practices for the National Diabetes Audit. These datasets provide practice-level statistics on numbers of patients referred to and attending the DPP and numbers identified as at risk of diabetes. We also linked to national datasets containing information on practice characteristics (including contract type and other reimbursements) and population characteristics (including age and deprivation).
Methods: We classified the incentives offered to GP practices by whether they linked payment to structure, process, and/or outcomes. We used count data regression models to estimate the impact of the presence and structure of financial incentives on rates of referral to, and participation in, the DPP, conditional on practice and population characteristics.
Results: We received survey responses from 66 (60%) of the CCGs participating in Wave 1 of the DPP and 37 (77%) of the CCGs participating in Wave 2. Amongst the responding CCGs, 11 reported offering no specific financial compensation to GPs, 31 offered incentives linked to structure, 56 offered incentives linked to process and 18 offered incentives linked to outcome. Practices facing outcome incentives referred 15 more patients and had an additional 4 patients start the programme compared to those with no incentives. Practices receiving process incentives reported offering the programme to 11 more patients but made no more referrals and had 2 fewer patients starting the programme.
Conclusion: Outcome-based incentives for GP practices generated more participants compared to other forms of incentives.
Presentation 2: Community Assets – definitions and capturability in practice.Anna Wilding
There has been a recent revival of interest in “Community Approaches” to improve health and well-being, particularly in the recent NHS Long-Term Plan. Community approaches encompasses two main elements – ‘community assets’ and ‘social prescribing’. Social prescribing involves patients being referred to non-healthcare organisations and groups, including community assets. The exact definition of community assets, however, is complex. Further, the term is used somewhat inconsistently between government policy and academic literature. These inconsistencies create issues for evaluating the effectiveness of these community approaches. For example, assessing externally validity of results is often problematic due to differing definitions of community assets across different places and datasets. This presentation will discuss the current working definitions, before going on to discuss the lists of community assets within various datasets. It will conclude with an homogenous definition for future evaluations.