Performance of new alternative providers of primary care services in England: an observational study

Greaves, Felix; Pape, Utz Johann; Ramakrishnan, Anenta; Majeed, Azeem; Millett, Christopher

doi:10.1177/0141076815583303

Cited by 12 publications

(17 citation statements)

References 13 publications

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“…311 However, the circumstances in which commercial providers gain contracts for primary care services may be very different from those in other areas. The way in which the primary care workforce is configured is changing rapidly, with an increase in the proportion of salaried GPs, the development of GP federations and super-practices and an increase in the number of large-scale provider groups (owned both by commercial companies and by GPs).…”

Section: Recommendations For Researchmentioning

confidence: 99%

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Burt

Campbell

Abel

et al. 2017

Programme Grants Appl Res

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BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Recommendations For Researchmentioning

confidence: 99%

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Burt

Campbell

Abel

et al. 2017

Programme Grants Appl Res

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“…This contrasts with the previous analysis which observed the association for all Alternative Provider practices. 1 We additionally found that practices owned by large organisations (!20 practices) provided worse experiences on average than practices with a General contract which are typically small general practitioner partnerships. Therefore, our findings highlight limited companies as providing worse experiences of primary care, rather than practices with the Alternative Provider contract collectively.…”

Section: Relation To Existing Literaturementioning

confidence: 90%

“…New types of contract were introduced in 1998 and 2004 that are locally negotiated and allow commercial, voluntary sector and other new providers to offer general practice services (online supplementary material -Appendix 1). 1 Several governments have attempted to increase the role of non-traditional providers across many parts of the National Health Service over the past 17 years. [2][3][4] Limited companies -businesses with a separate legal identity to their owners -currently own less than 5% of general practices; 5 their likely share of the market in the future is unclear.…”

Section: Introductionmentioning

confidence: 99%

“…8 A national cross-sectional time series analysis of general practices in England suggested, using aggregate data, that nontraditional providers performed worse across 15 of 17 quality indicators studied from 2008 to 2013. 1 Patient experience is a key domain of performance in the English National Health Service. Measures of patient satisfaction with general practice services are monitored nationally 9 and presented to patients for each practice on an information website.…”

Section: Introductionmentioning

confidence: 99%

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Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey

et al. 2017

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Objective: To examine associations between the contract and ownership type of general practices and patient experience in England. Design: Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting: All general practices in England in 2013–2014 (n ¼ 8017). Participants: 903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures: Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results: Most practices had a centrally negotiated contract with the UK government (‘General Medical Services’ 54.6%; 4337/7949). Few practices were limited companies with locally negotiated ‘Alternative Provider Medical Services’ contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference 3.04, 95% CI 4.15 to 1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (12.78, 95% CI 15.17 to 10.39). Results were similar for practices owned by large organisations (defined as having 20 practices) which were uncommon (2.2%; 176/7949). Conclusions: Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013–2014

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“…Primary care and public health will continue to be dominated by the NHS, given these services are provided more effectively through public funding [5], though GPs may find themselves forced to charge for some services. The move of care from hospital to community will accelerate with the development of wearable devices and other telemedicine technologies [6] [7].…”

Section: Runner-up Essay -What Will British Healthcare Look Like In 2mentioning

confidence: 99%

What will British healthcare look like in 20 years' time?

Hurt¹

2017

CMJ

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Performance of new alternative providers of primary care services in England: an observational study

Cited by 12 publications

References 13 publications

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey

What will British healthcare look like in 20 years' time?

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