Letters

Medical audit advisory groups Consider the number of practices

Funding for medical audit in Kent and Manchester Family Health Services
Authorities
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                                                    Kent        Manchester
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Authority's funding for 1993-4 £   129000         128925
No of practices                                       324            104
Funding per practice £                398           1240
No of general practitioners                           832            269
Funding per general practitioner £    155            479

The management budget for Kent Family Health Services Authority is proportionately smaller than the budgets for smaller authorities, and there is therefore little scope for the authority to make up funding for Kent's medical audit advisory group to the level of that enjoyed by the Manchester group. Furthermore, there is little opportunity for economies of scale: because of our size we operate as six autonomous groups coordinated by a central committee.

Like Johnson, we have had difficulty in evaluating the cost effectiveness of our activities and so cannot claim that we are underfunded in absolute terms. If medical audit advisory groups in their current form are to continue, however, we think that this inequity in funding should be addressed urgently so that general practices have access to equally funded audit groups irrespective of the size of the family health services authority they practise in.

A J Howitt, C Varns

Kent Medical Audit Advisory Group, Harrietsham, Kent ME17 1AH

1. Johnson R. Where have all the pennies gone? The work of Manchester medical audit advisory group. BMJ 1994;309:98-102. (9 July.) [Free Full Text]

More investment means better audit yield

EDITOR, - I endorse Roger Johnson's comments about the difficulty in showing that medical audit advisory groups give value for money, particularly in the short term.¹ He correctly emphasises the groups' major role in bringing about a cultural change in general practice to introduce routine critical review; at the same time he identifies the paucity of variables available to measure this change.

I recommend caution, however, in extrapolating from the excellent work reported from Manchester to judge medical audit advisory groups throughout Britain. In terms of basic funding from the family health services authority, in 1992-93 Manchester received a sum equivalent to pounds sterling1136 per practice, well above the average allocation of pounds sterling908 per practice (though the allocation ranged from pounds sterling260 to pounds sterling 2391 per practice per group) (national survey by Birmingham Medical Audit Advisory Group). In addition, the Manchester group's organisational ability and forward thinking earned it a further pounds sterling84 000 in externally funded projects in 1992-3: this again is considerably above the average for other groups of pounds sterling 21 000 in that year (range pounds sterling 400 to pounds sterling 126 900).

I have little doubt that, at present funding levels, the greater the financial investment the better the audit yield. Pennypinching family health services authorities are likely to obtain poorer value for money from their medical audit advisory groups, which, incidentally, are well on their way to becoming multidsciplinary audit advisory groups.

G Houghton 

Birmingham Medical Audit Advisory Group, Birmingham B15 2TT.

1. Johnson R. Where have all the pennies gone? The work of Manchester Medical Audit Advisory Group. BMJ 1994;309:98-102. (9 July.)

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Related Article

Where have all the pennies gone? The work of Manchester medical audit advisory group

Roger Johnson
BMJ 1994 309: 98-102. [Full Text]