Intended for healthcare professionals

Rapid response to:

General Practice

Explaining variation in hospital admission rates between general practices: cross sectional study

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7202.98 (Published 10 July 1999) Cite this as: BMJ 1999;319:98

Rapid Response:

Hospital Admission Rates and Resources Allocation

Fiona Reid et al’s observation that variation in hospital admission
rates between general practices is related to patients’ socio-economic
factors rather than practice characteristics comes as little surprise
since the study was conducted across an entire health authority with
considerable social diversity.

Likewise the lack of correlation between proxies of quality in
practices – cervical screening uptake rates etc – and hospital admissions
is easily explicable in that the former directly enhanced the doctors
earnings while referral and admission rates reflect in part the burden of
clinical load primary care doctors are willing to accept.

With the advent of Primary Care Groups evidence is emerging that
individual practices within a locality may vary greatly in both the
baseline budget they enjoy for practice staff and the support they receive
from community based staff. Such variation probably reflects the historic
enterprise of individual practices in maximising opportunities to improve
patient care both through General Medical Services monies and fund-holding
budgets.

It follows, therefore, that to evaluate performance indicators it
might prove more productive to study populations with uniform socio-
economic circumstances and the practices that serve them. Once the
population is standardised then it should prove possible to examine
suitably selected practice characteristics, eg baseline staff budgets and
community staff, in relation to referral rates and admission rates. For
the purposes of resource allocation within individual PCGs this work needs
to be urgently undertaken.

Competing interests: No competing interests

28 July 1999
D L Child
Principal
Cape Hill Medical Centre