1. ¹University of Algarve, Campus de Gambelas, Faro, Portugal
2. ²University of Warwick, Coventry, UK

Correspondence: CAF Amado, Centre of Advanced Studies in Economics and Econometrics, Faculty of Economics, University of Algarve Campus de Gambelas, Faro 8005 139, Portugal. E-mail: camado@ualg.pt

Received July 2006; Accepted November 2008; Published online 4 February 2009.

Abstract

Primary care is currently at the heart of the UK National Health Service policy. Primary care trusts have the crucial role of improving the efficiency and equity in primary care delivery. However, few studies have focused on performance assessment in primary care provision. In this paper, we examine the role of data envelopment analysis (DEA) in helping decision makers to understand and improve the performance of primary care practices. We discuss the results from a study of 14 practices in England in terms of their delivery of diabetes services. In order to take into account the multiple values that underlie public services provision, we have considered several different perspectives for evaluation. These were: technical, allocative and cost efficiency, clinical and patient-focused effectiveness, and equity. The approach adopted involved a deep engagement with the practices. The purpose was to understand the structures and processes supporting effective practice using DEA in a formative role rather than the more usual summative role with a large data set. This approach is in the tradition of the developmental engagement approach of operational research.