Efficiency and Effectiveness in General Practice

Describes the exploratory use of a statistical technique called data envelopment analysis (DEA), which has been widely used in other parts of the service sector, to measure the efficiency of 52 general practices in three health districts, serving 378,500 patients (78 per cent of the resident population). DEA identified over half (60 per cent) of the 52 practices as less than 100 per cent efficient, with 25 per cent potentially capable of large increases in activity without higher resource levels. There was no significant relationship between efficiency and whether partnerships were training practices, computerized, holding regular meetings, or the total list size, or age structure of practice populations except that multi‐site practices were found to be significantly more efficient as list size increased. DEA efficiency ratings were compared with a proxy for effectiveness (the ability of practices to reach target levels set in the new GP contract). Practices which were below target levels before the new contract was introduced were far less likely to be able to reach these targets once the contract was in place if they had been classified by DEA as 100 per cent efficient (i.e. judged to be unable to achieve greater outputs without increased resources). More research effort now needs to be devoted to exploring the use of DEA in measuring efficiency in general practice, and to examining the relationship between measures of efficiency and effectiveness in primary care.