Changes in patient experience associated with growth and collaboration in general practice: observational study using data from the UK GP Patient Survey (original) (raw)
Related papers
2020
Background For the last few years, English general practices, which are traditionally small, have been encouraged to work together to serve larger populations of registered patients, by merging or collaborating with each other. Meanwhile, patient surveys suggest worsening continuity of care and access to care. Aim To explore whether increasing size of practice population and working collaboratively are linked to changes in continuity of care or access to care. Design and setting Observational study in English general practice using data on patient experience, practice size and collaborative working Methods The main outcome measures were General Practice Patient Survey practice-level proportions of patients reporting positive experiences of access and relationship continuity of care. We compared change in proportions 2013-2018 among practices that had grown and those that had stayed about the same size. We also compared patients’ experiences by whether practices were working in close...
London journal of primary care, 2016
With rising patient demand and expectations, many practices are struggling to respond to the demand for appointments. To investigate different approaches to improving access to general practice and assess the impact on (i) patient experience, (ii) practice staff experience and (iii) activity in A&E and walk-in centres. Greenwich CCG piloted three approaches in 12 volunteer practices. The schemes were:(1) Systematic GP telephone triage of all appointment requests.(2) Analysis and comparison of practice data including demand and capacity to identify opportunities for improvement.(3) Online consultations. Qualitative and quantitative evaluation was undertaken. Overall results were inconclusive and no one pilot scheme was overwhelmingly successful in improving patient experience of access or reducing practice workload. Scheme 1 telephone triage: In some cases, overall demand on clinician time through the day reduced as face-to-face consultations were replaced with shorter telephone cons...
Continuity of care in general practice: effect on patient satisfaction
BMJ, 1992
Objective-To evaluate the influence of continuity of care on patient satisfaction with consultations. Design-Direct and episodic specific evaluation of patient satisfaction with recent consultation. Setting and subjects-A representative sample of 3918 Norwegian primary care patients were asked to evaluate their consultations by filling in a questionnaire. The response rate was 78%. Main outcome measures-The patient's overali satisfaction with the consultation was rated on a six point scale. Continuity of care was recorded as the duration and intensity of the present patient-doctor relationship and as patients' perception ofthe present doctor being their personal doctor or not. Results-The multivariate analysis indicated that an overali personal patient-doctor relationship increased the odds of the patient being satisfied with the consultation sevenfold (95% confidence interval 4 9 to 9.9) as compared with consultations where no such relationships existed. The duration of the patient-doctor relationship had a weak but significant association with patient satisfaction, while the intensity of contacts showed no-such association. Conclusion-Personal, continuous care is linked with patient satisfaction. If patient satisfaction is accepted as an integral part of quality health care, reinforcing personal care may be one way of increasing this quality.
The Annals of Family Medicine, 2013
PURPOSE Clinical quality and patient experience are both widely used to evaluate the quality of health care, but the relationship between these 2 domains remains uncertain. The aim of this study was to examine this relationship using data from 2 established measures of quality in primary care in England. METHODS Practice-level analyses (N = 7,759 practices in England) were conducted on measures of patient experience from the national General Practice Patient Survey (GPPS), and measures of clinical quality from the national pay-forperformance scheme (Quality and Outcomes Framework). Spearman's rank correlation and multiple linear regression were used on practice-level estimates. RESULTS Although all the correlations between clinical quality summary scores and patient survey scores are positive, and most are statistically significant, the strength of the associations was weak, with the highest correlation coefficient reaching 0.18, and more than one-half were 0.11 or less. Correlations with clinical quality were highest for patient-reported access scores (telephone access 0.16, availability of urgent appointments 0.15, ability to book ahead 0.18, ability to see preferred doctor 0.17) and overall satisfaction (0.15). CONCLUSION Although there are associations between clinical quality and measures of patient experience, the 2 domains of care quality remain predominantly distinct. The strongest correlations are observed between practice clinical quality and practice access, with very low correlations between clinical quality and interpersonal aspects of care. The quality of clinical care and the quality of interpersonal care should be considered separately to give an overall assessment of medical care.
Understanding collaboration in general practice: a qualitative study
Family Practice, 2017
Background. An increased incidence of chronic and complex conditions in the community is placing pressure on human resources in general practice. Improving collaboration between GPs and registered nurses may help alleviate workforce stressors and enhance health outcomes. Objective. To explore the facilitators and challenges of collaboration between GPs and registered nurses in Australian general practice. Methods. Eight GPs and 14 registered nurses from general practices in New South Wales, Australia, participated in semi-structured face-to-face interviews. Recordings were transcribed verbatim and underwent thematic analysis. Results. The overarching theme 'Understanding collaboration in general practice' comprises four sub-themes, namely (i) interpreting collaboration in general practice, (ii) modes of communication, (iii) facilitators of collaboration and (iv) collaboration in practice. Conclusion. Our findings suggest that regular, formal avenues of communication, professional development and non-hierarchical environments facilitated collaboration between nurses and GPs. Implementing strategies to promote these features has the potential to improve inter-professional collaboration and quality of care within primary care.
Large-scale general practice in England: what can we learn from the literature?
2016
Traditional general practice is changing. Three-quarters of practices are now working collaboratively in larger-scale organisations – albeit with varying degrees of ambition and organisational integration. Policy-makers and practitioners have high hopes for these organisations and their potential to transform services both within primary care and beyond. But can we be confident that they can live up to these expectations? This report presents findings of an extensive literature review on the subject of large-scale general practice, and contributes to a stream of work by the Nuffield Trust in this area, details of which can be found at: www.nuffieldtrust.org.uk/large-scale-general-practice .
Continuity of GP care is related to reduced specialist healthcare use: a cross-sectional survey
British Journal of General Practice, 2013
Background Continuity of GP care is associated with reduced hospitalisations, but solid documentation of its relationship to use of outpatient specialist services is lacking. Aim To test the association between continuity of GP care and use of inpatient and outpatient specialist services. Design and setting A cross-sectional population-based study with questionnaire data from the sixth Tromsø Study (2007-2008). Method Descriptive statistics and two sample t-test were used to estimate specialist healthcare use according to duration of the GP-patient relationship. Logistic regression analysis was used to assess associations between duration and intensity of the GP-patient relationship and use of specialist care. Analyses were adjusted for sex, age, marital status, income, education, and self-rated health, and also stratified by self-rated health and age. Results Of 10 624 eligible GP users, 85% had seen the same GP for >2 years. The probability of visiting outpatient specialist services was significantly lower among these participants compared to those with a shorter GP relationship (odds ratio [OR] = 0.81, 95% confidence interval [95% CI] = 0.71 to 0.92). Similar findings were found for hospitalisations (OR = 0.76, 95% CI = 0.64 to 0.90). Stratified analyses revealed that these associations were not dependent on self-rated health or age. The probability of specialist use increased for the frequent GP users. Conclusion Continuity of GP care is associated with reduced use of outpatient specialist services and hospitalisations. Healthcare providers and policymakers who wish to limit use of specialist health care may do well to perform and organise health services in ways that support continuity in general practice.
BMJ (Clinical research ed.), 2014
To determine the extent to which practice level scores mask variation in individual performance between doctors within a practice. Analysis of postal survey of patients' experience of face-to-face consultations with individual general practitioners in a stratified quota sample of primary care practices. Twenty five English general practices, selected to include a range of practice scores on doctor-patient communication items in the English national GP Patient Survey. 7721 of 15,172 patients (response rate 50.9%) who consulted with 105 general practitioners in 25 practices between October 2011 and June 2013. Score on doctor-patient communication items from post-consultation surveys of patients for each participating general practitioner. The amount of variance in each of six outcomes that was attributable to the practices, to the doctors, and to the patients and other residual sources of variation was calculated using hierarchical linear models. After control for differences in p...
Patient Choice in General Practice: The Implications of Patient Satisfaction Surveys
Journal of Health Services Research & Policy, 2008
Objectives To identify factors that explain patient satisfaction with general practice physicians and hence that may drive patients’ choice of practice. Methods Logistic regression analysis of English National Health Service national patient survey data is used to identify the aspects of general practice care that are associated with high levels of overall satisfaction among patients. Results Confidence and trust in the doctor is the most important factor in explaining the variation in overall patient satisfaction (predicting 82% of satisfaction levels accurately). The seven variables relating to the relationship between patient and doctor have stronger explanatory power than other aspects of the general practitioner (GP) experience. The variables with the lowest overall predictive power are whether the patient was told how long they would have to wait in the surgery (72%), the length of time they had to wait after their appointment time (74%) and ability to get through to the surge...