Abstract
BackgroundLocal and national financial incentives were introduced in England between 2008 and 2015 to encourage screening and brief alcohol intervention delivery in primary care. We used routine Read Code data and interviews with General Practitioners (GPs) to assess their impact.MethodsA sequential explanatory mixed-methods study was conducted in 16 general practices representing 106,700 patients and 99 GPs across two areas in Northern England. Data were extracted on screening and brief alcohol intervention delivery for 2010-11 and rates were calculated by practice incentive status. Semi-structured interviews with 14 GPs explored which factors influence intervention delivery and recording in routine consultations.ResultsScreening and brief alcohol intervention rates were higher in financially incentivised compared to non-incentivised practices. However absolute rates were low across all practices. Rates of short screening test administration ranged from 0.05% (95% CI: 0.03-0.08) in non-incentivised practices to 3.92% (95% CI: 3.70-4.14) in nationally incentivised practices. For the full AUDIT, rates were also highest in nationally incentivised practices (3.68%, 95% CI: 3.47-3.90) and lowest in non-incentivised practices (0.17%, 95% CI: 0.13-0.22). Delivery of alcohol interventions was highest in practices signed up to the national incentive scheme (9.23%, 95% CI: 8.91-9.57) and lowest in non-incentivised practices (4.73%, 95% CI: 4.50-4.96). GP Interviews highlighted a range of influences on alcohol intervention delivery and subsequent recording including: the hierarchy of different financial incentive schemes; mixed belief in the efficacy of alcohol interventions; the difficulty of codifying complex conditions; and GPs’ beliefs about patient-centred practice.ConclusionsFinancial incentives have had some success in encouraging screening and brief alcohol interventions in England, but levels of recorded activity remain low. To improve performance, future policies must prioritise alcohol prevention work within the quality and outcomes framework, and address the values, attitudes and beliefs that shape how GPs’ provide care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0561-5) contains supplementary material, which is available to authorized users.
Highlights
Local and national financial incentives were introduced in England between 2008 and 2015 to encourage screening and brief alcohol intervention delivery in primary care
Quantitative results Data were collected in 16 practices, representing 106,700 patients and 99 General Practitioners (GPs) in Northern England
Our findings suggest that some incentive schemes are more impactful than others, with Quality and Outcomes Framework (QOF) unarguably most influential as far as English primary care is concerned
Summary
Local and national financial incentives were introduced in England between 2008 and 2015 to encourage screening and brief alcohol intervention delivery in primary care. In one area of Northern England, practices received £8.00 for each registered patient aged 16+ (excluding newly registered patients covered via the DES) who screened positive for risky drinking and received brief advice. Both national and local schemes were voluntary, and separate to the Quality and Outcomes Framework (QOF), the principal UK incentive scheme, which links up to 25% [10] of GPs’ income to performance against a series of clinical and organisational priority areas [11]. The QOF does not include specific payments for alcohol interventions, GPs are expected to record alcohol consumption in some disease management areas such as hypertension, coronary heart disease and mental health
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