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The waiting game

Patients are more satisfied with practices owned by GP partners, finds study

GP practices owned by limited companies experience lower levels of patient satisfaction than those under GMS contracts, a study has found.

Practices operating under locally negotiated Alternative Provider Medical Services (APMS) contracts performed more poorly than practices under GMS contracts on several measures of patient satisfaction.

The study, carried out by researchers at Imperial College London, compared the results of just over 903,000 patient satisfaction surveys from 7,949 practices.

It found:

  • The average overall patient experience scores in APMS practices were around three points lower than in GMS practices.
  • APMS practices scored worse than GMS practices on frequency of being able to consult a preferred doctor, with an average 12 point difference in scores.
  • They also scored worse for appointment convenience and doctor communication skills, with around a three-point difference on average for both measures of satisfaction. 

APMS contracts are always issued for a limited-time period, typically around five years, after which they are subject to review, whereas GMS and PMS contracts are life-long contracts.

Based on latest data from NHS Digital, 69.1% of England's GP practices have a GMS contract, 27.4% a PMS contract and only 2.2% an APMS contract. However, the study comes as Pulse recently revealed that NHS England and CCGs have virtually stopped issuing non-APMS contracts.

The researchers said in the paper: ‘Limited company ownership of general practices remains uncommon in England. Although our results suggest that limited companies provide worse patient experiences on average, some practices owned by these companies provide a good experience; others provide the opposite.

‘It is the responsibility of commissioners, regulators, clinicians and owners to guarantee that individual practices meet expected standards while ensuring that care quality is not systematically associated with the ownership.

'Commissioners also need to ensure that contracts offer good value for money, more so at a time when the NHS is very financially challenged.’

Professor Azeem Majeed, professor of primary care at Imperial College London and one of the authors, said: ‘One message from the paper is that NHS commissioners need to support the more traditional general practices.

‘Some commissioners seem to believe that commercial providers, operating at scale, will perform better than the more typical general practice. Our research shows that, with the exception of some high performing companies, this is not the case.’

In 2014, GP leaders took legal advice to challenge a reading by NHS managers that all new GP practices must be thrown open to competition due to the Health and Social Care Act reforms.

Since then, NHS England's advice has been that it is up to regional teams to decide which model is best on a case-by-case basis.

J. R. Soc. Med. 2017; available online 3rd November

The death of the lifelong GP contract?

Pulse reported in July that not a single new GMS contract has been issued in five years in England, leading to concern over continuity of care and insecurity for staff. Some 242 APMS contracts were issued between 2013 and 2017, and just one PMS contract.

Bucking the trend, NHS Bradford City CCG made the decision in September to disperse patients to practices with long-term contracts rather than renew three APMS contracts when they run out early next year. The CCG said its decision was based on a patient consultation showing that patients preferred the GP services of long-term providers, which offer better continuinity of care.

The issue had brought to the fore in April when ministers revealed that 50 APMS contracts had been awarded in London since 2013, with no GMS or PMS contracts awarded.

This was followed by a warning from the GPC to practices to avoid handing back their contracts to NHS England as this would lead to them being reprocured under APMS, and potentially privatisation.


Readers' comments (10)

  • Azeem Majeed

    The study can be viewed on the JRSM website.

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  • Bornjovial

    Very true and also patient satisfaction drops off after about 15-16 k patients. #
    Smaller practices have better overall satisfaction, less admissions and less referrals but have more variability between the group more due to sample size being smaller than in cohort of larger practices.
    It would be interesting to study other outcomes such as OPD referrals, inpatient admissions, Overall cost per patient in relationship to partnerships vs APMS, limited companies and also size!

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  • It is human nature that if it is not your practice you will care less, especially if the staff are ill treated by the big companies.

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  • 'performed more poorly'

    What a horrible phrase!

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  • If these large practices that have 30,000 patients were so marvellous they would have evolved naturally over the last 50 years. They are only forming now due to external pressures. In the natural scheme of cyclical things (? a Corbyn government for a start) these pressures will melt away and GPs will find themselves ensnared in too large organisations with the consequent loss of autonomy which is the one thing that makes this job bearable. There is a massive land grab going on in my area largely due to a fear of missing out. Practices should resist these mega mergers at all costs.Working at scale is the the thing but it is SMALL scale.

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  • Nhsfatcat

    So what. Does anyone think HMG care? Mr Hunt cannot grasp statistics so will ignore this too.
    All monies coming to primary care will be linked to working at scale.

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  • National Hopeless Service

    So we now have several studies confirming what has been known for years that small GP partnerships with good continuation of care are the most effective. So why the f#ck are the 'powers' pushing the likes of Modality and Hurley?

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  • What a reassuring statistic for those of us in GMS practices who care about patient care.

    Sadly I do not think the results will effect any deviation in Tory policy for primary care, not because Mr Hunt "cannot grasp statistics", but because the Tory priority is not patient care.

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  • This study is an example of one that confirms what everybody (including every patient) knows.

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  • Large practices may well have barcodes on patients to process them and off they go to accident or dr Google , destroying the trust and dare we GPs can give.

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