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GP practices urged to take 'supermarket-style' approach to boost clinical outcomes

GP practices need to concentrate on the ‘bigger picture’ and improve the experience of patients in their surgeries as this can affect their outcomes, claims a leading thinktank.

The King’s Fund paper said patients at practices with better patient satisfaction scores – particularly for access - were more likely to attend their appointments, take their medicines and have better outcomes.

Their analysis – published this week – compared the performance of over 8,000 GP practices and they showed a correlation between practices scoring highly on delivering a good service, especially patient access, and their performance on measures of clinical quality.

The researchers also found practices which performed poorly on both patient experience and clinical outcomes are mainly based in London, were in areas of higher deprivation and also tended to have fewer GPs.

They said practices should learn lessons from supermarkets and department stores in treating patients as ‘customers’.

Researchers analysed QOF scores from 2010/11 for nine conditions, including diabetes, hypertension and stroke, and compared them with GP patient survey scores for measures such as access, cleanliness, information and involvement.

They found a significant statistical correlation with some of the patient experience scores and QOF achievement, but access scores were strongly and consistently correlated with all aspects of patient experience (with p values of less than or equal to zero).

In terms of overall satisfaction, QOF process measures for hypertension, CHD, COPD, depression and stroke had p values of zero. Process measures for asthma, dementia, smoking and heart failure were not signficantly correlated with overall patient satisfaction. QOF outcomes measures for hypertension, CHD, diabetes and stroke all had p values of less than 0.01.

The authors concluded, although they could not prove a ‘causal link’, patient experience was important for the outcomes of patients.

The report said: ‘Our analysis suggests that a patient’s ease of access to their practice and preferred GP could affect their quality of care and outcomes – for example, through its impact on attendance rates, continuity of care, communication and engagement with clinical staff, compliance and adherence with treatment, and out-of-hours access.

They added: ‘We urge staff in general practice to consider how they perform in terms of the patient experience alongside how they perform on the quality of clinical care, as it is this bigger picture that offers the greatest potential for driving further improvements in the overall quality of care.’

Study leader Dr Veena Raleigh, a senior fellow at the King’s Fund, said GP practices should compare their services with the customer service at supermarkets and department stores.

She said: ‘I think the analogy with the commercial sector is Sainsbury and John Lewis like to have happy customers.’

But Dr Osman Bhatti, a GP in Tower Hamlets, east London, and a member of Newham LMC said the study was undermined by the ‘skewed ‘ results of the patient survey.

He said: ‘Satisfaction in more deprived areas is often tended to be skewed down as most of those that reply are the ones who are going to comment negatively and often those who have no issue and feel they are well looked after, often don’t respond to such surveys.’

Dr Andrew Mimnagh, a GP in Liverpool and chair of Sefton LMC said: ‘The problem with patient outcome surveys is that a good bedside manner can hide a multitude of sins.’

Health minister, Earl Howe said the changes they were recommending for the GP contract would improve the problems identified in the report.

He said: ‘We want to tackle variation in quality of care and services by moving to a fairer system for rewarding GPs.

‘Payments should better reflect the number of patients on GPs lists and be appropriately weighted for factors such as age and deprivation.’

QOF vs. Patient satisfaction
 
 AccessInformationInvolvement
Diabetes*********
CHD********
Asthma*****NS
 
*** p<=0.000
** p<=0.01
NS = non-significant correlation

Related images

  • GP patient survey  PPL

Readers' comments (8)

  • But more 'customer' activity doesn't create greater income to invest unlike in a supermarket.

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  • Vinci Ho

    How often does a customer ask the Superstore manager , ' you are the store manager , can you make the decision of what I should buy?' That is in contrast to what the patients would ask their GPs. I am sorry , customers are customers , patients are patients . This is called common sense.....

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  • when you pay privately, you see a consultant, get a cup of tea in good china and have half an hour to 1 hour with them. the same in the nhs (limited resources, free at the point of....) last less than 10 minutes and you will see a junior doctor. Make the nhs pricate and patients pay and then it might be a possibility, until that happens there really cant be any change. practices do not have the time or money that private supperstores have to work on customer satisfaction, and if resources are directed that way, then there is less time to see patients and have continuity. you CAN NOT have both. wake up and smell the coffee. increase our pensions, pay us less, make us work longer and push more and more work our way, that last thing you are going to get is a superstore customer experience.

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  • Vinci Ho

    Good doctor-patient relationship IS NOT good doctor-customer relationship whether you are in NHS or private sector!!!

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  • "The authors concluded, although they could not prove a ‘causal link’,...... [snip speculation]"

    In my humble opinion i had to read far too much of this article to get to the point.

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  • Patients are customers, they have a choice which surgery to use!. Much of our income is based on list size.

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  • Gary Young

    While I agree with making practices very patient centric, and review what they do and how they do it to ensure they are meeting the primary care needs of their community, there are lots of reasons not to call patients 'customers', not least that customers pay directly for a service - for GPs the customer is the organisation that pays them, unless (or until..!) patients start paying over the counter for their consultations. And, as Anon 11:07 says, greater activity doesn't generate greater income - in these financially restrained times, such an approach seems self defeating?

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  • What happened to Tesco ? Surely not being held up as example.
    If you live in London you shouldn't be restricted to unethical practices of one borough if on a boundary of 3 because of catchment areas of hospitals whole country can attend . They also ignore the provision of social services for those with multi conditions NHS can't cure.

    Surgeries now need to be like mini hospitals as often the aging & disabled rationed via delay & access & blamed for condition. It appears if NHS can't cure you they ignore fact more assistance is needed.Two man teams need to collaborate into larger more specialist units with open access for over 65 & any age for those with chronic condition & disability but with heart problems don't want to refer & don't want the risk? So are we being doomed? No wonder in my area the aging & disabled have disappeared? Who sees NHS Constitution is adhered to?

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