The role of performance indicators in changing the autonomy of the general practice profession in the UK

Exworthy, Mark; Wilkinson, Emma; McColl, Alastair; Moore, Michael; Roderick, Paul; Smith, Helen; Gabbay, John

doi:10.1016/s0277-9536(02)00151-x

Cited by 64 publications

(61 citation statements)

References 23 publications

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“…21,22 The flexibilities created both by the new General Medical Services Contract 23 and other forms of contracts for primary care 24,25 created opportunities for different organisational forms and skill mixes appropriate to the needs of patient populations and to the provision of out-of-hours and extended hours services. GPs, as both health-service professionals and employers, exemplify the human resource policy stream articulated first in the human resource strategy for the NHS Improvement Plan in 2002: 'more staff working differently'.…”

Section: Developments In the Uk General Practice Workforcementioning

confidence: 99%

Investigating the contribution of physician assistants to primary care in England: a mixed-methods study

Drennan

Halter

Brearley

et al. 2014

Health Serv Deliv Res

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Background: Primary health care is changing as it responds to demographic shifts, technological changes and fiscal constraints. This, and predicted pressures on medical and nursing workforces, raises questions about staffing configurations. Physician assistants (PAs) are mid-level practitioners, trained in a medical model over 2 years at postgraduate level to work under a supervising doctor. A small number of general practices in England have employed PAs. Objective: To investigate the contribution of PAs to the delivery of patient care in primary care services in England. Design: A mixed-methods study conducted at macro, meso and micro organisational levels in two phases: (1) a rapid review, a scoping survey of key national and regional informants, a policy review, and a survey of PAs and (2) comparative case studies in 12 general practices (six employing PAs). The latter incorporated clinical record reviews, a patient satisfaction survey, video observations of consultations and interviews with patients and professionals. Results: The rapid review found 49 published studies, mainly from the USA, which showed increased numbers of PAs in general practice settings but weak evidence for impact on processes and patient outcomes. The scoping survey found mainly positive or neutral views about PAs, but there was no mention of their role in workforce policy and planning documents. The survey of PAs in primary care (n = 16) found that they were mainly deployed to provide same-day appointments. The comparative case studies found that physician assistants were consulted by a wide range of patients, but these patients tended to be younger, with less medically acute or complex problems than those consulting general practitioners (GPs). Patients reported high levels of satisfaction with both PAs and GPs. The majority were willing or very willing to consult a PA again but wanted choice in which type of professional they consulted. There was no significant difference between PAs and GPs in the primary outcome of patient reconsultation for the same problem within 2 weeks, investigations/tests ordered, referrals to secondary care or prescriptions issued. GPs, blinded to the type of clinician, judged the documented activities in the initial consultation of patients who reconsulted for the same problem to be appropriate in 80% (n = 223) PA and 50% (n = 252) GP records. PAs were judged to be competent and safe from observed consultations. The average consultation with a physician assistant is significantly longer than that with a GP: 5.8 minutes for patients of average age for this sample (38 years). Costs per consultation were £34.36 for GPs and £28.14 for PAs. Costs could not be apportioned to GPs for interruptions, supervision or training of PAs.Conclusions: PAs were found to be acceptable, effective and efficient in complementing the work of GPs. PAs can provide a flexible addition to the primary care workforce. They offer another labour pool to consider in health professional workforce and education planning at local, regional ...

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Section: Developments In the Uk General Practice Workforcementioning

confidence: 99%

Investigating the contribution of physician assistants to primary care in England: a mixed-methods study

Drennan

Halter

Brearley

et al. 2014

Health Serv Deliv Res

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“…The use of performance indicators has been felt to decrease perceived autonomy even though some physicians view them as a challenge. 27 However, the perception that the level of perceived complexity of expected care was greater than it should be was a consistent correlate of dissatisfaction. Although not studied previously, Lin et al 11 found that the complexity of claims was associated with dissatisfaction among PCPs.…”

Section: Career Satisfactionmentioning

confidence: 99%

Perceived Complexity of Care, Perceived Autonomy, and Career Satisfaction Among Primary Care Physicians

Katerndahl

Parchman

Wood

2009

The Journal of the American Board of Family Medicine

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Background: The purpose of this study was to examine relationships of both perceived autonomy and perceived complexity of care with career satisfaction.Methods: This secondary analysis used 3 consecutive surveys of family physicians, internists, and pediatricians from the Community Tracking Survey. Two-way analysis of variance assessed interaction effects of perceived complexity of care and perceived autonomy on satisfaction. Logistic regression analysis identified physician characteristics, practice characteristics, practice improvement strategies, perceived complexity, and perceived autonomy that accounted for variance in career satisfaction among physicians.Results: Although 24% to 27% of physicians felt perceived complexity of care expected was greater than it should be, 83% to 86% felt free to make clinical decisions. Approximately 80% of physicians were satisfied with their careers. Differences in probability of career satisfaction were highly significant (P < .001) for both perceived complexity of care and perceived autonomy as well as their interaction. A multiphysician practice; the ability to obtain high quality ancillary services (such as physical therapy, home health care, and nutritional counseling); managed care revenue, lower levels of perceived complexity of expected care; and perceived autonomy were consistently associated with satisfaction.Conclusion: Higher perceived autonomy and lower perceived patient complexity as higher than desirable were associated with high career satisfaction among primary care physicians.

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“…Although such perspectives have been deemed exaggerated (Hafferty and Light 1995), they pointed out some of the significant changes that have transformed organisation of health care systems and the nature of medical work over the past decades. Such changes refer particularly to the administrative (Freidson 1994), financial and organisational (Exworthy et al 2003) control levied over medical practices, but also to the development of standardisation of medical practices under the influence of evidence-based medicine and epidemiology (Timmermans and Kolker 2004;Cambrosio et al 2006). In particular, the introduction of new managerialism in health care, especially in hospitals, has been described as challenging doctors' authority insofar as medical work has become subordinated to economic and policy constraints implemented through various control systems, such as performance indicators (Harrison and Ahmad 2000;Numerato et al 2012).…”

Section: Malpractice Claims As a Challenge To Professional Dominancementioning

confidence: 99%

Risk of Malpractice Claims and Changes in Professional Autonomy: A Qualitative Study of Obstetrician-Gynaecologists in Switzerland

Hammer

2017

Swiss Journal of Sociology

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Based on interviews, this article explores how obstetrician-gynaecologists in Switzerland deal with and respond to the risk of malpractice claims. It describes the factors associated with the interviewees' perceived increasing risk of litigation, as well as three attitudes towards the use of consent forms as a means of managing such a risk. This article suggests that the perceived risk of claims is closely linked to the physicians' perception of how external regulation shapes their professional autonomy.

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The role of performance indicators in changing the autonomy of the general practice profession in the UK

Cited by 64 publications

References 23 publications

Investigating the contribution of physician assistants to primary care in England: a mixed-methods study

Investigating the contribution of physician assistants to primary care in England: a mixed-methods study

Perceived Complexity of Care, Perceived Autonomy, and Career Satisfaction Among Primary Care Physicians

Risk of Malpractice Claims and Changes in Professional Autonomy: A Qualitative Study of Obstetrician-Gynaecologists in Switzerland

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