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Patient survey ‘should scrutinise individual GP performances’

GPs should have their individual communication scores on the national GP patient survey opened up for scrutiny, primary care researchers have claimed after finding practice level data masked ‘considerable’ variation in how well each GP within the practice communicated with patients.

The team – whose study is reported in the BMJ – proposed targeting individuals in the lowest performing practices, where they found communication skills varied the most between doctors.  

GP leaders warned that such a move would lead to ‘simplistic’ interpretation of individual GPs’ performance.

It comes after policy makers and regulators indicated they are planning to publish individual GP performance on various indicators including prescribing of antibiotics and benzodiazepines.

The GP patient survey is used to measure practices’ performance on a range of measures of patient experience, results from which are then published by NHS England and used to inform development of the NHS Outcomes Framework and the CCG outcomes indicator set.

The survey includes questions around communication at the patient’s most recent GP visit, asking them how well they felt they were listened to, had things explained to them, were involved in any decisions about their care and whether they had confidence and trust in the GP.

The team of researchers, led by Professor John Campbell, professor of general practice and primary care at the University of Exeter, looked at the doctor-patient communication scores achieved by 25 practices on the GP Patient Survey between October 2011 and June 2013.

Individual GPs accounted for 3.5 times more variation than practices in patients’ reported experiences of how well they communicated in consultations – and 6.5 times more in terms of trust in the doctor.

The researchers said lower performing practices had a much wider range of performance than higher scoring practices, which tended to include only high performing doctors.

They concluded: ‘Aggregating patients’ rating of doctors’ communication skills at practice level can mask considerable variation in the performance of individual doctors, particularly in lower performing practices.

‘Practice level surveys may be better used to “screen” for concerns about performance that require an individual level survey.’

Professor Campbell said: ‘This has important implications for the ability to manage the performance of practices, as doctors with more modest interpersonal skills might be missed.

‘Doctors’ inter-personal skills need to be investigated at the level of the individual doctor, not the practice – especially in practices with scores which are

at the lower end of overall performance. Such investigation might offer potential to inform the doctor’s ongoing professional development, and training can potentially be targeted to ensure the best experience for all patients.’

However, GPC chair Dr Chaand Napgaul said GPs were already individually assessed on individual feedback and warned against ‘simplistic’ interpretation of individual GPs’ performance on the national patient survey.

Dr Nagpaul said: ‘Individual GPs already receive patient feedback as part of revalidation, which they can speak to their appraiser about in confidence. We need to be careful not draw simplistic comparisons, as the patient mix GPs see cany vary enormously between GPs even within a practice.’

Dr Nagpaul added that GPs needed more time in consultations to properly communicate with their patients.

He said: ‘Looking at the broader context,the biggest impediment to communication between GPs and patients is the fact GPs are consulting at ridiculously short intervals of 10 minutes, which doesn’t give them up enough time to spend with patients, coupled with extremely intense and complex consultations.

‘If we are to look at communication, what we must address is that GPs are working in an extremely challenging environment. This is what we should be addressing at a national level rather than getting diverted into looking at individual GPs.’  

BMJ 2014; available online 11 November