GPs are generally the gatekeepers to health care for most of us, and more than 90 per cent of health care contacts in the UK take place in general practice. It's therefore important that, as well as delivering good quality clinical care, practices can also ensure that people have a positive experience of using their services.
By ‘experience’ we mean the non-clinical dimensions of care for patients – such as how easy it is to book an appointment and get to the surgery, being able to see their preferred doctor, having tests and treatments explained, having trust and confidence in the staff, being treated with care and concern, being involved in decisions their own care – things that really matter to patients.
From April 2013, patient experience measures will take their place alongside measures of clinical care in the NHS Outcomes Framework that will be used by ministers to hold the NHS Commissioning Board to account. The Board will have responsibility for commissioning primary care in England, so the performance of primary care on patient experience and clinical quality nationally will be of increasing importance in future. Moreover, the new GP-led clinical commissioning groups (CCGs) will have a duty to improve the quality of primary care locally. This means not just offering patients better quality clinical care, but also improving the ways in which that care is accessed by and delivered to patients.
In our new report on Improving GP services in England, we compared data on measures of clinical quality and of patient experiences for all practices in England. Generally speaking, we found that practices whose patients report high satisfaction with their experience of care also perform well on measures of clinical quality. The reverse was also true – practices whose patients are more negative about access to the practice and using its services generally perform less well on clinical quality.
We also found that practices that perform poorly on both clinical outcome measures and patient experience are more likely to be located in London and in more deprived areas. This is not surprising – these practices face special challenges, both in terms of having populations with greater and more complex health care needs, and because they often have to deliver services from less well developed premises, compared with practices in more affluent areas. However, there is evidence of variation in performance even between practices in these areas and examples of high-performing innovators who have found ways of overcoming such obstacles – for example, by tailoring services to the particular needs of their local populations.
The non-clinical dimensions of care matter to patients and can have an effect – positive or negative – on how they can best avail themselves of that care. Patients’ experience of using their GP services – ease of access in particular – can affect their interaction with staff, compliance with treatment and ability to self-care, and this can in turn affect their quality of care and outcomes. So it is important for practice staff to routinely review information about how they are performing on both clinical quality measures and patient feedback, to get a more rounded view of practice performance. This will offer them additional insights into where the potential for improvement lies, enabling them to learn from the high achievers and develop locally tailored solutions.
General practice in the UK is acclaimed internationally for providing a free and universally accessible health care service in the community. By improving performance to the level of the best, and ensuring that all patients have a positive experience of using services, general practice can do even better.
- Read the paper: Improving GP services in England
- See our previous Inquiry into the quality of general practice in England