Partnership prophylaxis

The most common association of veterinarians in private practice is that of partnership. Some such relationships are not happy and may not endure. The concept of partnership is examined and suggestions are made which will minimise dissension.

Relationship between the number of partners in a general practice and the number of different drugs prescribed by that practice

The objective of this study was to assess whether practice size, as measured by the number of doctors, had any bearing on the range of drugs prescribed. All practices in the northern and western health boards in Northern Ireland were included in the study--a total of 132 practices (362 doctors) serving a population of 628,249. Prescribing data, obtained from the Department of Health and Social Services (Northern Ireland) information technology unit database, were analysed retrospectively for the month of January 1989. The number of different preparations prescribed in each of 22 therapeutic groups were counted. Hence a measure of the range of prescribing was assessed. A significant correlation was found between the number of different preparations prescribed and the number of general practitioners working in the practice. However, no correlation was found between the number of different drugs prescribed and the mean prescribing cost per patient or the mean list size of the doctors in each practice. The use of a practice prescribing policy was found to have no influence on the range of drugs prescribed, nor on the prescribing costs. The inference is that formal therapeutic policies may be difficult to implement within group practices. These results are of importance to general practitioners since the greater the number of different drugs prescribed the greater will be the risk of side effects and dangerous interactions.

Partner risk: the hidden threat of capitated provider networks

As provider networks align risk-sharing incentives, they must avoid partner risks that could pose a threat to the network. Partner risk results when actions taken by one or more partners in a network threaten to adversely affect other partners in the network. Such risk can arise from the way partners manage cost drivers under capitation or through passing risk to one another.

Research in primary care: extent of involvement and perceived determinants among practitioners from one English region

The lack of research evidence relevant to and generated by general practitioners (GPs) has been a concern in the context of a putative primary care-led National Health Service (NHS). However, very little has been published on the current extent or determinants of research activity among United Kingdom primary care doctors. We surveyed all (n = 2770) service GPs in the West Midlands Region in order to quantify their research involvement and to explore determinants of this. The response rate was 49% (n = 1351). A total of 84% of responders reported participating in research or audit, with 16% having initiated their own research; 9% of GPs had been published in a peer-reviewed journal; 6% had generated research funding; and 3% had held a research training fellowship. The characteristics positively associated with initiating research included an involvement in teaching, having research-active partners, the availability of protected time, and working in a larger practice. The most commonly perceived barriers to undertaking research were lack of time (92%), lack of staff to collect data (73%), and a lack of funding (71%). In all, 41% of responders reported no interest in research. Overall, the extent of research activity among responding GPs appears to be greater than is often assumed. Recent NHS research and development proposals to strengthen and develop research in primary care are, therefore, relevant in highlighting changes to address these issues.