ID-5184 Wonca Abstracts supplement L-Z 13-10-23 - Flipbook - Page 30
WONCA 2023 Supplement 2: WONCA 2023 abstracts (L–Z)
L
M
N
Impact of general practice funding on ACSC admissions:
A five-year English longitudinal study
O
Dr Veline L’esperance, Mark Ashworth
P
Q
R
S
T
U
V
W
X
Y
Z
King’s College London
Background
Hospital admissions for ambulatory care sensitive conditions (ACSC) are those that could potentially
be prevented by timely and effective disease management in general practice. The aim of this study is
to explore the impact of including general practice funding on ACSC admissions.
Methods
Using longitudinal data at the practice level, from 6974 English practices from 2013–14 to 2017–18, we
explored the relationships between the funding and quality of primary care, and hospital admissions
for ACSCs controlling for a wide range of covariates. We combined seven datasets for all English
general practices: (1) workforce and patient data; (2) payments to practices; (3) clinical achievement
indicators; (4) deprivation data; (5) neighbourhood ethnicity profiles; (6) patient experience; and (7)
distance from nearest acute hospital. We estimate Poisson models allowing for unobserved practice
effects and with robust standard errors.
Results
Mean total funding per patient at 2017 prices was £153.87 (standard deviation [SD] £41.84). ACSC
admissions (per 1000 patients) increased from 15.30 (SD 5.89) in 2013–14 to 17.02 (SD 6.31) in 2017–
18. Components of general practice funding significantly associated with lower ACSC admissions
include performance related funding for delivering enhanced services. However, capitation funding
(based on patient need) was positively associated with ACSC admissions.
Practice factors significantly associated with lower ACSC admissions include larger patient population,
increased practice list growth, higher patient satisfaction, higher clinical quality, training practice status
and a greater distance from the nearest acute hospital.
However, higher ACSC admissions were significantly associated with deprived patient populations,
higher proportion of nursing home patients, higher patient access scores and higher GP staffing.
Discussion
Components of general practice funding related to performance and operational aspects demonstrate
a direct relationship with lower ACSC admissions. This implies that additional funding directed towards
incentivising the additional work may be required to keep the patients out of hospital.
28