Pressures on the general practitioner and decisions to prescribe.

OBJECTIVES: This study examined the extent to which four broad areas of concern associated with prescribing are perceived by general practitioners (GPs): their sense of burden in providing health care, their views on financial constraints and incentives, the use of a prescription to cope with clinical workload and their perception of demanding patients. A secondary aim was to relate these concerns to actual measures of prescribing behaviour using PACT data. METHOD: A questionnaire covering the four themes was sent to 386 GPs. Using factor analysis, new measures were constructed to reflect the GPs' perception of the four areas of concern. RESULTS: A total of 228 GPs (59%) completed the questionnaire. Results indicated a high level of concern among GPs regarding current pressures that could affect prescribing. Only the respondents' concern about the possible adverse effects of financial pressures upon medical decisions was related to prescribing: those concerned about financial pressures prescribed less generically (P < 0.0005), had higher practice costs compared with the Family Health Services Authority average (P = 0.002) and issued more prescriptions overall (P = 0.007). CONCLUSION: There is a continuing need to monitor and evaluate the effect of recent changes in primary care for their effect upon prescribing behaviour.