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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.