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Patients value GP quality over extended access, shows major study

Patient experience of general practice is most influenced by the attention and communication they receive from their GP, according to a study of over two million patients in England.

Researchers analysed the opinion of patients from over 8,000 practices, and found that GPs giving patients enough time, listening, explaining tests and treatments, involving patients in decision making, and treating them with care, were most strongly associated with a patient’s overall experience.

In comparison, the association with opening hours and the appointment-making process was noticeably less associated with their overall experience.

Study authors concluded that rather than focusing on extending GP opening hours, the Government should improve the quality of services patient receive during normal hours by addressing the GP shortage and lack of investment in GP services.

The research team, from Imperial College London and the London School of Hygiene and Tropical Medicine, set out to examine factors influencing the overall experience of general practice.

They analysed data from general practice patient surveys conducted between 2011 and 2014, covering over two million patients across 8,289 GP practices in England.

The paper, published in BJGP, reported that patient experience of making appointments and satisfaction with opening hours were only 'modestly associated' with overall experience, while the 'strongest association' was with interpersonal quality of care provided by GPs.

When measured on 0-100 scales, researchers saw that a 20 point increase in GP interpersonal quality of care predicted an increase of seven points in overall experience.

This association was 40% greater than that between experience of making appointments and overall experience, and 125% greater than the association between satisfaction with opening hours and overall experience.

GP interpersonal quality of care was calculated from five questions that related to GPs. These included giving patients enough time, listening, explaining tests and treatments, involving patients in decision making, and treating patients with care.

The researchers wrote: ‘Policymakers could reflect on this finding and consider the contexts of GPs’ work that affect interactions with patients; for example, a large workload could affect whether GPs can give each patient enough time at consultation.

'Policymakers in England should not assume that recent policies to improve access will result in large improvements in patients’ overall experience of general practice.'

They also highlighted that interventions being promoted to improve access, such as telephone and video consultations, could substantially alter the relationship between GPs and their patients, and could unintentionally reduce the interpersonal quality of care.

Professor Azeem Majeed, head of primary care and public health at Imperial College London and a GP in south London, said: ‘There has been a lot of focus from the Government on extended hours schemes. However, our research suggests patients’ satisfaction with GP services is more influenced by the quality of care and attention they receive from GPs.

‘Extending GP opening hours is also not cost-effective. We should aim to improve access to primary care and the quality of services patient receive during normal opening hours by addressing problems with shortages of GPs and a lack of investment in GP services, rather than investing in extended opening hours schemes.’

BMA GP Committee chair Richard Vautrey said: ‘This echoes what we have been repeatedly saying, including in our Saving General Practice plan, and underlines why we would be far better investing in core hours to address GP workload pressures and give practices the resources to expand their workforce.

‘The practice embedded in the community, with continuity of care at its heart, is the foundation on which the rest of the NHS has been built for the last 70 years and why for the future it’s so important to strengthen this foundation with the additional investment promised by the government.’

The latest NHS Digital data showed that the number of GP practices offering extended hours appointments has increased, with 40% of patients being able to make routine GP appointments in evenings and at weekends in March of this year.

But simultaneously GP workforce numbers in England have continued to decline, as official statistics from last month reveal that the number of FTE GPs has decreased by more than 1,000 since September 2015.

Readers' comments (8)

  • Puh, evidence! As if that is relevant with NHSE.

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  • Since when did NHS E or Politicians ever follow something that's clearly evidenced?

    Much better to follow hair brained vote catching b******t.

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  • Vinci Ho

    You see
    The way we have been trained as GPs in this country is always about interpersonal and community skills . Pendleton’s seven tasks of consultation cannot be succeeded by rushing through 10 minutes facing the computer and anticipating another 30 patients later in the morning
    This is something economists can never understand because interpersonal success and continuity of care are not hard core parameters that are measurable.
    Increasing access (hence , quantity of appointments) does not improve quality , especially there is always a climate of under-resources (which once again , I must stress the simultaneous presence of money , manpower , expertise and time ).
    Productivity has a different meaning in medicine and general practice to the one measured by economists.
    I accept the fact that if tax is to be raised for NHS AND new money is really coming into general practice, the public will have different expectations in GPs and we will have to re-adjust ourself. But these new ‘expectations ‘ cannot be fulfilled by us if there are no new and adequate resources (my definition) coming to our way .
    Nothing pains me more than what these seven day GP opening protagonists are pushing , purely based on their egoistic ideology ignoring the simple truth that every job can only be delivered by the right amount of tools .......

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  • So patients value GP quality do they? What do they know because clearly the politicians value us about as much as they value dog poop on the pavement!

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  • So far what we have seen is the lack of determination to invest in general Practice whatever patients value or not value. It is at best a mediocre service demonstrating rationalised healthcare where both professionals and patients choices are limited by regulation and funding. I am not holding my breath with tax rises. The system is unsustainable as unlimited free access will always be abused and does not square with unlimited funding. Past experiences of moving money around equivalent to shuffling deck chairs on the titanic and NHSE saying once you have done something for some time it is taken as acceptance as part of your usual work and is part of the Global sum-no additional payment for the activity. Just like medicines management and choose and book. To make sure you do not do any better for more work the tax and pension penalty system will make sure of that just in case you get more money for the extra work.

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  • Yay no more evening clinics

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  • there seems to be a steady stream of evidence coming out that backs up what GPs have been saying for some time.

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  • AlanAlmond

    Yet more evidence in support of 24/7 access and ‘phenomenal’ Skype consultations then? Sure to effect government policy. I use the word ‘government’ in the loosest possible way obviously, purely referring to the politicians who form the country’s ‘administrative’ body (the word ‘administrate’ used in the loosest possible way naturally). The word ‘government’ actually implies some degree of rational planning and sensible coordination - which is totally and utterly lacking...and why this research will be completely ignored by those who ‘govern’

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