Changes in Patient Experiences of Primary Care During Health Service Reforms in England Between 2003 and 2007

Abstract

PURPOSE Major primary care reforms have been introduced in recent years in the United Kingdom, including fi nancial incentives to improve clinical quality and provide more rapid access to care. Little is known about the impact of these changes on patient experience. We examine patient reports of quality of care between 2003 and 2007, including random samples of patients on practice lists and patients with long-term conditions. METHODSWe conducted a cross-sectional design study of family practices in which questionnaires were sent to serial samples of patients in 42 representative general practices in England. Questionnaires sent to samples of patients with chronic disease (asthma, angina, and diabetes) and random samples of adult patients (excluding patients who reported any long-term condition) in 2003, 2005, and 2007 addressed issues of access, communication, continuity of care, coordination, nursing care, and overall satisfaction.RESULTS There were no signifi cant changes in quality of care reported by either group of patients between 2003 and 2007 for communication, nursing care, coordination, and overall satisfaction. Some aspects of access improved signifi cantly for patients with chronic disease, but not for the random samples of patients. Patients in both samples reported seeing their usual physician less often and gave lower satisfaction ratings for continuity of care. Most scores were signifi cantly higher for the chronic illness samples than for the random samples of patients in 2003, even after adjusting for age.CONCLUSIONS There was a modest improvement in access to care for patients with chronic illness, but all patients now fi nd it somewhat harder to obtain continuity of care. This outcome may be related to the incentives to provide rapid appointments or to the increased number of specialized clinics in primary care. The possibility of unintended effects needs to be considered when introducing pay for performance schemes.

‘Falling through gaps’: primary care patients’ accounts of breakdowns in experienced continuity of care

“…28 In many countries levels of relationship continuity are argued to be sub-optimal, 29 and in the UK relationship continuity has been in decline. 30 Our research adds weight to the growing body of evidence of the value of relationship continuity, 12,31 particularly for patients with multi-morbidity and complex needs, 1 and adds emphasis to efforts to promote and revive relationship continuity for these patients. 28 Although policy changes in England, including the introduction into the GP contract of a requirement for a named GP for patients over the age of 75, may help reverse this trend, 32 relationship continuity has not been prominent in the policy agenda for health system reform.…”

Do English patients want continuity of care, and do they receive it?

“…This is particularly important, given the evidence that continuity of care has declined in recent years. [14][15][16] There are a number of possible reasons for this, including a focus on access and rapid appointments in the 2004 GP contract, increasing part-time working among doctors, and an increase in salaried (and potentially transient) GPs. The larger medical teams now present in many general practices also make personal continuity more difficult to achieve.…”

“…[11][12][13] However, interpersonal continuity has declined in recent years in the UK and in other countries. [14][15][16] This decline may reflect increasing emphasis on technical (clinical) aspects of primary care quality, as well as a reduction in doctors' working hours, an increase in part-time working, and organisational changes in out-of-hours care.…”

Have contractual changes in primary care affected unplanned short stay childhood admissions in England? National time trends study 2001–11

“…29,30 Continuity of care, important in building a parent physician relationship and preventing the use of emergency health services also reportedly suffered with the introduction of pay for performance. [31][32][33] Evidence of the impact of pay for performance in the UK on children's access to primary care physicians is limited, but primary care consultation rates rose between 1995 and 2006 in all age groups except for children aged between 5 to 14 years. 34 We did not find a direct relationship between rising admissions for infectious illness in children, The expansion in primary care based activity as a result of reforms has meant that primary care physicians are struggling to maintain their existing workload, 37 and existing healthcare provision in England is not sufficient to contain childhood illness in the community.…”