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The European Journal of Health Economics

Open Access 07-12-2024 | Antibiotic | Original Paper

The effect of workload on primary care doctors on referral rates and prescription patterns: evidence from English NHS

Authors: Hanifa Pilvar, Toby Watt

Published in: The European Journal of Health Economics

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Abstract

This paper investigates the impact of workload pressure on primary care outcomes using a unique dataset from English general practices. Leveraging the absence of General Practitioner (GP) colleagues as an instrumental variable, we find that increased workload leads to an increase in prescription rates of antibiotics as well as in the share of assessment referrals. On the other hand, the quantity and frequency of psychotropics decreases. When there is an absence, workload is intensified mostly on GP partners, and the mode of consultation shifts toward remote interactions as a response to higher workload pressure. The effects are more pronounced for patients above 65 years-old and those in Short-staffed practices. Our study sheds light on the intricate relationship between workload pressure and patient care decisions in primary care settings.
Appendix
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Footnotes
1
80% of NHS budget coming from general taxation, 18.5% from National Insurance contributions, and 1.5% from patient charges such as dental fees [16].
 
2
The Index of Multiple Deprivation is a comprehensive relative measure of deprivation that combines seven domains, including income, employment, education, health, crime, housing, and living environment deprivation. In our context, a practice or patient is considered more deprived if it is in decile 1 or 2 of IMD deciles.
 
3
We identified the most frequently prescribed drugs in English general practices using the Open-Prescribing project. The ten most prescribed drugs are as follows (BNF chapters in parentheses): Lipid regulating drugs (2.12), Renin-Angiotensin system drugs (2.5.5), Proton Pump inhibitors (1.3.5), Antidiabetic drugs (6.1.2), Selective Serotonin Re-Uptake inhibitors (4.3.3), Beta- Adrenoceptor Blocking drugs (2.4), Non-Opioid Analgesics and Compound Preparations (4.7.1), Antiplatelet drugs (2.9).
 
4
BNF chapter: 4.7.2.
 
5
BNF chapters: 4.1, 4.2, 4.3, 4.4, 4.10.
 
6
BNF chapters: 11.3.1, 13.10.1, 5.1.
 
7
QOF incentivized drug BNF chapters include: 2.4, 2.5.5, 2.8, 2.9, 2.12.0.
 
8
We only have de-identified GP id in the data. We cannot observe any characteristic of the doctor other than their role.
(e.g., GP partner, salaried GP etc.) in the practice. In terms of the practice, we have only de-identified practice id and can only observe the IMD score of the practice.
 
9
Repeating the regression of Eq. 1 but limiting the observations to appointments with a referral.
 
10
They tend to have significantly lower referral rates in remote consultations. On average, telephone consultations exhibit a referral rate of 1%, whereas face-to-face consultations have a referral rate of 2.1%.
 
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Metadata
Title
The effect of workload on primary care doctors on referral rates and prescription patterns: evidence from English NHS
Authors
Hanifa Pilvar
Toby Watt
Publication date
07-12-2024
Publisher
Springer Berlin Heidelberg
Keyword
Antibiotic
Published in
The European Journal of Health Economics
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-024-01742-7