GP Patient Survey Research Articles

Weekend opening in primary care: analysis of the General Practice Patient Survey.

Seven-day opening in primary care is a key policy for the UK government. However, it is unclear if weekend opening will meet patients' needs or lead to additional demand. To identify patient groups most likely to use weekend opening in primary care. The General Practice Patient Survey 2014, which sampled from all general practices in England, was used. Logistic regression was used to measure the associations between perceived benefit from seeing or speaking to someone at the weekend and age, sex, deprivation, health conditions, functioning, work status, rurality, and quality of life. Out of 881 183 participants who responded to the questionnaire, 712 776 (80.9%) did not report any problems with opening times. Of the 168 407 responders (19.1%) who reported inconvenient opening times, 73.9% stated that Saturday opening, and 35.8% Sunday opening, would make it easier for them to see or speak to someone. Only 2.2% of responders reported that Sunday, but not Saturday, opening would make it easier for them. Younger people, those who work full time, and those who could not get time off work were more likely to report that weekend opening would help. People with Alzheimer's disease, learning difficulties, or problems with walking, washing, or dressing were less likely to report that weekend opening would help. Most people do not think they need weekend opening, but it may benefit certain patient groups, such as younger people in full-time work. Sunday opening, in addition to Saturday, is unlikely to improve access.

Variations in GP-patient communication by ethnicity, age, and gender: evidence from a national primary care patient survey.

BackgroundDoctor–patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor–patient communication. However, it is currently unknown whether these ethnic differences are concentrated in one gender or in particular age groups.AimTo determine how reported GP–patient communication varies between patients from different ethnic groups, stratified by age and gender.Design and settingAnalysis of data from the English GP Patient Survey from 2012–2013 and 2013–2014, including 1 599 801 responders.MethodA composite score was created for doctor–patient communication from five survey items concerned with interpersonal aspects of care. Mixed-effect linear regression models were used to estimate age- and gender-specific differences between white British patients and patients of the same age and gender from each other ethnic group.ResultsThere was strong evidence (P<0.001 for age by gender by ethnicity three-way interaction term) that the effect of ethnicity on reported GP–patient communication varied by both age and gender. The difference in scores between white British and other responders on doctor–patient communication items was largest for older, female Pakistani and Bangladeshi responders, and for younger responders who described their ethnicity as ‘Any other white’.ConclusionThe identification of groups with particularly marked differences in experience of GP–patient communication — older, female, Asian patients and younger ‘Any other white’ patients — underlines the need for a renewed focus on quality of care for these groups.

Variation in patient experience between general practice contract types: multilevel analysis of a national cross-sectional survey

BackgroundRecent health-care reforms in England have opened up the provision of general practice to new models of care, and primary care can now be provided under various contractual mechanisms. Previous research has highlighted population-level variation in quality indicators across practices under different contract types. We present differences in patient-reported experience of general practice services across three contract types in England. MethodsData come from the national General Practice Patient Survey 2013–14 (903 357 responders from 7949 general practices in England; 34% response rate, range 29–44). The primary outcome was overall patient experience of a general practice (on a five-point scale, rescaled to 0–100 for all measures). Sociodemographic data included patient age, sex, ethnicity, deprivation, and self-reported health, and the profile of each practice's registered population. We used mixed-effects linear regression, using a random intercept for each general practice to estimate case-mix-adjusted associations between contract type and patient experience. FindingsThe mean score for overall experience across all practices was 83·3 (SD 20·3), indicating a fairly good experience nationally. Practices run as limited companies were uncommon (n=118, 1·5%) but overall their levels of patient experience were lower. Relative to general medical services (GMS) practices (mean 83·7), the adjusted means for overall experience for limited company-owned alternative provider of medical services (APMS) and personal medical services (PMS) practices were 3·0 (p<0·0001) and 3·6 (p=0·0176) lower. Results were similar for the other indicators: ability to see a preferred doctor (GMS mean 70·3; mean difference limited company APMS −12·8 [p<0·0001], mean difference limited company PMS −11·6 [p=0·0003]), appointment convenience (78·5; −3·0 [p<0·0001], −2·8 [p=0·1330]), doctor communication (84·1; −2·9 [p<0·0001], −3·5 [p=0·0052]), and ease of telephone contact (69·6; −0·2 [p=0·5527], −6·2 [p=0·0465]). InterpretationGeneral practices run as limited companies had worse scores for overall patient experience. Strengths of this study include the large, nationally representative sample. Limitations include the possibility for residual confounding, and the cross-sectional nature of available data. The results support continued monitoring of quality of care across different forms of general practice service provision. FundingThis research was supported by the National Institute for Health Research (NIHR) (Doctoral Research Fellowship for TEC, DRF-2013-06-142).

Emergency attendance

The strength of relationship between all types of emergency department (ED) attendance, the characteristics of the populations concerned and primary care were examined in this study. A multivariate linear regression analysis was undertaken on a dataset constructed from the General Practice Patient Survey (GPPS) in England, the Quality and Outcome Framework data and A&E attendance, and population characteristics data from the Health and Social Care Information Centre.

Establishing the validity of English GP Patient Survey items evaluating out-of-hours care

BackgroundA 2014 national audit used the English General Practice Patient Survey (GPPS) to compare service users’ experience of out-of-hours general practitioner (GP) services, yet there is no published evidence on...

The use of patient experience survey data by out-of-hours primary care services: a qualitative interview study

BackgroundEnglish National Quality Requirements mandate out-of-hours primary care services to routinely audit patient experience, but do not state how it should be done.ObjectivesWe explored how providers collect patient feedback data...

Informal carers' health-related quality of life and patient experience in primary care: evidence from 195,364 carers in England responding to a national survey.

BackgroundWe aim to describe the health-related quality of life of informal carers and their experiences of primary care.MethodsResponses from the 2011-12 English General Practice Patient Survey, including 195,364 informal carers, were analysed using mixed effect logistic regressions controlling for age, gender, ethnicity and social deprivation to describe carer health-related quality of life (mobility, self-care, usual activities, pain, and anxiety/depression, measured using EQ-5D) and primary care experience (access, continuity and communication).ResultsInformal carers reported poorer health-related quality of life than non-carers of similar age, gender, ethnicity and social deprivation. Increasing caring commitment was associated with worse EQ-5D scores, with carers of 50+ hours a week scoring 0.05 points lower than non-carers (95 % CI 0.05 to 0.04), equivalent to 18 fewer days of full health annually. Considering each domain of EQ-5D separately, carers of 50+ hours/week were more likely to report pain OR = 1.53 (1.50-1.57), p < 0.0001, and anxiety/depression OR = 1.69 (1.66-1.73), p < 0.0001, than non-carers. Younger carers scored lower on EQ-5D than non-carer peers but the converse was true among over-85s. In the most deprived areas carers reported the equivalent of 37 fewer days of full health annually than carers in the most affluent areas. On average, carers reported poorer patient experiences in all areas of primary care than non-carers (odds ratios 0.84-0.97), with this difference being most marked in the domain of access.ConclusionsInformal carers experience a double disadvantage of poorer health-related quality of life and poorer patient experience in primary care. We find no evidence for health benefits of caregiving. We recommend physicians identify and treat carer health problems, including pain and anxiety/depression, particularly among young, deprived and high time-commitment carers. Improving patient experience for carers, including access to primary care, should be a priority.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0277-y) contains supplementary material, which is available to authorized users.

Does the availability of a South Asian language in practices improve reports of doctor-patient communication from South Asian patients? Cross sectional analysis of a national patient survey in English general practices.

BackgroundEthnic minorities report poorer evaluations of primary health care compared to White British patients. Emerging evidence suggests that when a doctor and patient share ethnicity and/or language this is associated with more positive reports of patient experience. Whether this is true for adults in English general practices remains to be explored.MethodsWe analysed data from the 2010/2011 English General Practice Patient Survey, which were linked to data from the NHS Choices website to identify languages which were available at the practice. Our analysis was restricted to single-handed practices and included 190,582 patients across 1,068 practices. Including only single-handed practices enabled us to attribute, more accurately, reported patient experience to the languages that were listed as being available. We also carried out sensitivity analyses in multi-doctor practices.We created a composite score on a 0-100 scale from seven survey items assessing doctor-patient communication. Mixed-effect linear regression models were used to examine how differences in reported experience of doctor communication between patients of different self-reported ethnicities varied according to whether a South Asian language concordant with their ethnicity was available in their practice. Models were adjusted for patient characteristics and a random effect for practice.ResultsAvailability of a concordant language had the largest effect on communication ratings for Bangladeshis and the least for Indian respondents (p < 0.01). Bangladeshi, Pakistani and Indian respondents on average reported poorer communication than White British respondents [-2.9 (95%CI -4.2, -1.6), -1.9 (95%CI -2.6, -1.2) and -1.9 (95%CI -2.5, -1.4), respectively]. However, in practices where a concordant language was offered, the experience reported by Pakistani patients was not substantially worse than that reported by White British patients (-0.2, 95%CI -1.5,+1.0), and in the case of Bangladeshi patients was potentially much better (+4.5, 95%CI -1.0,+10.1). This contrasts with a worse experience reported among Bangladeshi (-3.3, 95%CI -4.6, -2.0) and Pakistani (-2.7, 95%CI -3.6, -1.9) respondents when a concordant language was not offered.ConclusionsSubstantial differences in reported patient experience exist between ethnic groups. Our results suggest that patient experience among Bangladeshis and Pakistanis is improved where the practice offers a language that is concordant with the patient’s ethnicity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0270-5) contains supplementary material, which is available to authorized users.

Characteristics of service users and provider organisations associated with experience of out of hours general practitioner care in England: population based cross sectional postal questionnaire survey

Objective To investigate the experience of users of out of hours general practitioner services in England, UK.Design Population based cross sectional postal questionnaire survey.Setting General Practice Patient Survey 2012-13.Main outcome...

Why do patients with multimorbidity in England report worse experiences in primary care? Evidence from the General Practice Patient Survey

ObjectivesTo describe and explain the primary care experiences of people with multiple long-term conditions in England.Design and methodsUsing questionnaire data from 906 578 responders to the English 2012 General Practice...

Responding to the challenges of primary diabetes care through the national diabetes education program.

In this issue of Diabetes Care , the article by Paddison et al. (1) provides valuable information that furthers our understanding of the primary care patient experience for people with diabetes. Using the English General Practice Patient Survey (GPPS), the authors compare the primary care experience of 85,760 survey responders with self-reported diabetes with 820,818 responders without diabetes across three domains of care delivery: access, continuity, and communication. Individuals with diabetes reported primary care experiences that were as good as or better than people without diabetes across most domains of care. The authors point out that the concept of family practice in England is not dissimilar to that of the patient-centered medical home (PCMH) articulated in the U.S. Primary care practices in both countries identify patient populations and both share some degree of financial risk for keeping their patients healthy. Despite the similarities, several findings do not broadly generalize to the U.S. health care system. Patient satisfaction surveys reflect perceptions as well as the capabilities of a health care delivery system, but the realities faced by U.S. and U.K. patients are different. In the 2014 National Committee for Quality Assurance annual summary of assessments from U.S. health plans, 94.5% of patients reported that their doctors usually or always explained things, listened carefully, showed respect, and spent enough time, and 86.7% of patients reported that access to care was good, comparing favorably with the GPPS results (2). However, only 67.6% of these …

Patients’ experiences of the choice of GP practice pilot, 2012/2013: a mixed methods evaluation

ObjectivesTo investigate patients’ experiences of the choice of general practitioner (GP) practice pilot.DesignMixed-method, cross-sectional study.SettingPatients in the UK National Health Service (NHS) register with a general practice responsible for their...

Primary care competition and the effect of new providers on quality of care in England

BackgroundHealth system reforms in England have welcomed competition by opening broad areas of clinical practice to new providers of care. As part of these reforms new entrants, including private companies, have been allowed into the primary care market since 2004 under contracting mechanisms known as alternative provider of medical services. The characteristics and performance of general practices working under new alternative provider contracts are not well described. MethodsBetween 2008–09 and 2012–13, we compared performance on 17 established quality indicators that included clinical effectiveness, efficiency, access, and patient experience in all general practices in England by contract type. Data were obtained from the Quality and Outcomes Framework and General Practice Patient Survey. We used linear regression in cross-sectional and time series analyses, adjusting for practice and population characteristics and underlying trends, to compare quality in practices using alternative provider contracts to traditional practices. We created a regression model using practice fixed effects to estimate the effect on performance of practices changing to the new contract type. Findings347 (4·1%) of 8300 general practices in England were run by alternative contract providers. These practices tended to be smaller, and serve younger, more diverse, and more deprived populations than traditional providers. Practices run by alternative providers performed worse than traditional providers on 15 of 17 indicators after adjustment for practice and population characteristics (p<0·001 for all 15), including diabetes and hypertension control, admissions for ambulatory care sensitive conditions, and overall satisfaction with care. Alternative providers had a higher percentage of patients reporting satisfaction with opening hours and higher prescribing of generic medications than did general practices not run by alternative providers. Switching to a new alternative provider contract did not result in improved performance in our fixed-effect models. InterpretationThe introduction of contracts for new alternative providers to deliver primary care services in England has not led to improvements in quality and might have resulted in worse care. Strengths of our study include use of a 5-year national data sample. Limitations include risk of lack of adjustment for unmeasured confounding factors. Regulators should ensure that new entrants to clinical-provider markets are performing to adequate standards and at least as well as traditional providers. FundingThere was no specific funding for this work. FG is funded by London Deanery and the Commonwealth Fund. CM is funded by the Northwest London National Institute for Health Reasearch Collaboration for Leadership in Applied Health Research & Care and the Higher Education Funding Council for England.

Common patterns of morbidity and multi-morbidity and their impact on health-related quality of life: evidence from a national survey.

BackgroundThere is limited evidence about the impact of specific patterns of multi-morbidity on health-related quality of life (HRQoL) from large samples of adult subjects.MethodsWe used data from the English General Practice Patient Survey 2011–2012. We defined multi-morbidity as the presence of two or more of 12 self-reported conditions or another (unspecified) long-term health problem. We investigated differences in HRQoL (EQ-5D scores) associated with combinations of these conditions after adjusting for age, gender, ethnicity, socio-economic deprivation and the presence of a recent illness or injury. Analyses were based on 831,537 responses from patients aged 18 years or older in 8,254 primary care practices in England.ResultsOf respondents, 23 % reported two or more chronic conditions (ranging from 7 % of those under 45 years of age to 51 % of those 65 years or older). Multi-morbidity was more common among women, White individuals and respondents from socio-economically deprived areas. Neurological problems, mental health problems, arthritis and long-term back problem were associated with the greatest HRQoL deficits. The presence of three or more conditions was commonly associated with greater reduction in quality of life than that implied by the sum of the differences associated with the individual conditions. The decline in quality of life associated with an additional condition in people with two and three physical conditions was less for older people than for younger people. Multi-morbidity was associated with a substantially worse HRQoL in diabetes than in other long-term conditions. With the exception of neurological conditions, the presence of a comorbid mental health problem had a more adverse effect on HRQoL than any single comorbid physical condition.ConclusionPatients with multi-morbid diabetes, arthritis, neurological, or long-term mental health problems have significantly lower quality of life than other people. People with long-term health conditions require integrated mental and physical healthcare services.Electronic supplementary materialThe online version of this article (doi:10.1007/s11136-014-0820-7) contains supplementary material, which is available to authorized users.

How do people with diabetes describe their experiences in primary care? Evidence from 85,760 patients with self-reported diabetes from the English General Practice Patient Survey.

Developing primary care is an important current health policy goal in the U.S. and England. Information on patients' experience can help to improve the care of people with diabetes. We describe the experiences of people with diabetes in primary care and examine how these experiences vary with increasing comorbidity. Using data from 906,578 responders to the 2012 General Practice Patient Survey (England), including 85,760 with self-reported diabetes, we used logistic regressions controlling for age, sex, ethnicity, and socioeconomic status to analyze patient experience using seven items covering three domains of primary care: access, continuity, and communication. People with diabetes were significantly more likely to report better experience on six out of seven primary care items than people without diabetes after adjusting for age, sex, ethnicity, and socioeconomic status (adjusted differences 0.88-3.20%; odds ratios [ORs] 1.07-1.18; P < 0.001). Those with diabetes and additional comorbid long-term conditions were more likely to report worse experiences, particularly for access to primary care appointments (patients with diabetes alone compared with patients without diabetes: OR 1.22 [95% CI 1.17-1.28] and patients with diabetes plus three or more conditions compared with patients without diabetes: OR 0.87 [95% CI 0.83-0.91]). People with diabetes in England report primary care experiences that are at least as good as those without diabetes for most domains of care. However, improvements in primary care are needed for diabetes patients with comorbid long-term conditions, including better access to appointments and improved communication.

How do adults with physical disability experience primary care? A nationwide cross-sectional survey of access among patients in England

ObjectivesAlmost a quarter of adults in England report a longstanding condition limiting physical activities. However, recent overseas evidence suggests poorer access to healthcare for disabled people. This study aimed to...

Access to general practice and visits to accident and emergency departments in England: cross-sectional analysis of a national patient survey.

BackgroundThe annual number of unplanned attendances at accident and emergency (A&E) departments in England increased by 11% (2.2 million attendances) between 2008–2009 and 2012–2013. A national review of urgent and emergency care has emphasised the role of access to primary care services in preventing A&E attendances.AimTo estimate the number of A&E attendances in England in 2012–2013 that were preceded by the attending patient being unable to obtain an appointment or a convenient appointment at their general practice.Design and settingCross-sectional analysis of a national survey of adults registered with a GP in England.MethodThe number of general practice consultations in England in 2012–2013 was estimated by extrapolating the linear trend of published data for 2000–2001 to 2008–2009. This parameter was multiplied by the ratio of attempts to obtain a general practice appointment that resulted in an A&E attendance to attempts that resulted in a general practice consultation estimated using the GP Patient Survey 2012–2013. A sensitivity analysis varied the number of consultations by ±12% and the ratio by ±25%.ResultsAn estimated 5.77 million (99.9% confidence interval = 5.49 to 6.05 million) A&E attendances were preceded by the attending patient being unable to obtain a general practice appointment or a convenient appointment, comprising 26.5% of unplanned A&E attendances in England in 2012–2013. The sensitivity analysis produced values between 17.5% and 37.2% of unplanned A&E attendances.ConclusionA large number of A&E attendances are likely to be preceded by unsuccessful attempts to obtain convenient general practice appointments in England each year.

Do difficulties in accessing in-hours primary care predict higher use of out-of-hours GP services? Evidence from an English National Patient Survey

IntroductionIt is believed that some patients are more likely to use out-of-hours primary care services because of difficulties in accessing in-hours care, but substantial evidence about any such association is...

Smoking prevalence and the changing risk profiles in the UK ethnic and migrant minority populations: implications for stop smoking services

ObjectivesSmoking is the leading risk factor for disability-adjusted life-years, yet evidence with which to establish the smoking rates of people with different ethnic backgrounds and how they are changing in relation to recent migration is lacking. The objective is to provide current information on the changing risk profiles of the UK population. Study designObservational study using cross-sectional surveys. MethodsData from the Integrated Household Survey (pooled for the years 2009/10–2011/12), obtained under Special Licence, and the GP Patient Survey (2012) have been used to establish smoking prevalence in a wider range of ethnic groups in England and Wales, including the ‘mixed’ groups and amongst East European migrants, and how such prevalence differs across socio-economic classes. ResultsSmoking prevalence is substantially higher amongst migrants from East European countries (that for males exceeding 50% from three such countries and for females over 33% from four countries) and from Turkey and Greece, compared with most other non-UK born groups, and amongst ethnic groups is elevated in the ‘mixed’ groups. Rates are highest in the Gypsy or Irish Traveller group, 49% (of 162) and 46% (of 155) for males and females respectively. Across ethnic groups, rates are almost always higher in the UK born than non-UK born population with the notable exception of the ‘White Other’ group, with Prevalence Ratios (PRs) indicating a larger migrant-non-migrant differential amongst females (e.g. Indians 2.95 (2.33–3.73); Black Caribbeans 3.28 (2.73–3.94). Age-adjusted rates show the persistence of these differentials in females across age groups, though young males (18–29) in seven minority ethnic groups show lower rates in the UK-born groups. The ‘White’ and ‘Chinese’ groups show a strong socio-economic gradient in smoking which is absent in the South Asian groups and diminished in the ‘mixed’ and black groups. ConclusionsGiven the evidence that smoking behaviour is significantly different in some of the new groups, notably East European migrants, stop smoking services are failing to optimize the acceptability and, consequently, favourable outcomes for these programmes. These services need to be adapted to the particular patterns of smoking behaviour and language skills within different communities of descent.

Patient experience and the role of postgraduate GP training: a cross-sectional analysis of national Patient Survey data in England.

Quality indicators for primary care focus predominantly on the public health model and organisational measures. Patient experience is an important dimension of quality. Accreditation for GP training practices requires demonstration of a series of attributes including patient-centred care. The national GP Patient Survey (GPPS) was used to determine the characteristics of general practices scoring highly in responses relating to the professional skills and characteristics of doctors. Specifically, to determine whether active participation in postgraduate GP training was associated with more positive experiences of care. Retrospective cross-sectional study in general practices in England. Data were obtained from the national QOF dataset for England, 2011/12 (8164 general practices); the GPPS in 2012 (2.7 million questionnaires in England; response rate 36%); general practice and demographic characteristics. Sensitivity analyses included local data validated by practice inspections. multilevel regression models adjusted for clustering. GP training practice status (29% of practices) was a significant predictor of positive GPPS responses to all questions in the 'doctor care' (n = 6) and 'overall satisfaction' (n = 2) domains but not to any of the 'nurse care' or 'out-of-hours' domain questions. The findings were supported by the sensitivity analyses. Other positive determinants were: smaller practice and individual GP list sizes, more older patients, lower social deprivation and fewer ethnic minority patients. Based on GPPS responses, doctors in GP training practices appeared to offer more patient-centred care with patients reporting more positively on attributes of doctors such as 'listening' or 'care and concern'.