Evidence and rhetoric about access to UK primary care

Cowling, Thomas E; Harris, Matthew; Majeed, Azeem

doi:10.1136/bmj.h1513

Cited by 32 publications

(38 citation statements)

References 27 publications

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“…One risk for GP services with low scores is that patients remove themselves from GP lists and register elsewhere. Poor experiences of appointment-making can also result in costly, or even dangerous, health outcomes, such as patients visiting Accident and Emergency rather than their GP [1,2]. It is for these reasons that building an understanding of how patient access works is a pressing issue in primary care.…”

Section: Introductionmentioning

confidence: 99%

Patient burden during appointment-making telephone calls to GP practices

Sikveland

Stokoe

Symonds

2016

Patient Education and Counseling

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Objective: This study addresses, for the first time, the effectiveness of receptionists handling incoming calls from patients to access General Practice services. Methods: It is a large-scale qualitative study of three services in the UK. Using conversation analysis, we identified the issue of 'patient burden', which we defined based on the trouble patients display pursuing service. We quantified instances of 'patient burden' using a coding scheme. Results: We demonstrate how 'patient burden' unfolds in two phases of the telephone calls: (i) following an initial rejection of a patient's request; and (ii) following a receptionist's initiation of call closing. Our quantitative analysis shows that the three GP services differ in the frequency of 'patient burden' and reveals a correlation between the proportion of 'patient burden' and independent national satisfaction scores for these surgeries. Conclusion: Unlike post-hoc surveys, our analysis of live calls identifies the communicative practices which may constitute patient (dis)satisfaction. Practice Implications: Through establishing what receptionists handle well or less well in encounters with patients, we propose ways of improving such encounters through training or other forms of intervention.

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Section: Introductionmentioning

confidence: 99%

Patient burden during appointment-making telephone calls to GP practices

Sikveland

Stokoe

Symonds

2016

Patient Education and Counseling

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“…16 We chose these outcome measures because they are important to patients, will be affected by organisational characteristics, have sufficient practice level reliability and are policy-relevant. 15,17,18 All outcomes relate to in-hours, rather than out-of-hours, services.…”

Section: Patient Survey Questionnairesmentioning

confidence: 99%

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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“…Access to PC is a hot, politically debated issue in some EU countries at present, particularly in those with 'Beveridgian' health care systems like the UK [15] and Italy where expectations concerning the 'gatekeeper' role of PC for hospital services are high. In addition to GP practices, PC services are provided through various LHD facilities in the INHS, making the Italian system more complex and calling for a higher level of coordination than in the UK.…”

Section: Policy Implicationsmentioning

confidence: 99%