Do GP practices that offer high-quality clinical care also offer a good experience for their patients?

Clinically effective care and good patient experience are universally recognised as key elements of health care quality. But does one always go hand in hand with the other?

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.


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#11606 Rick Harris
Managing Director
Customer Faithful

Whilst I applaud the objective of trying to track GP services to outcomes, I'm concerned by the mindset driving how this research is framed.
By defining patient ‘experience’ as "the non-clinical dimensions of care for patients", this illustrates how healthcare organisations continue to structure and silo patient experience in their own narrow terms.
My research into patient experience consistently finds patients frustrated by the lack of holistic and joined up thinking in how lived experience of healthcare is understood by HCPs. By restricting patients to respond within this framework, the report risks excluding valuable insights into how patients themselves perceive and experience clinical outcomes, defined in their own terms. Why should such perceptions be seen as not worthy of inclusion?

#11664 Nick Pahl
British Acupuncture Council

Id like to see research as to how innovative GP practices have added in other services, such as acupuncture, so people have a positive experience of using their services, as well as improved health outcomes.

I agree that you defintion of ‘experience’ should include being treated with care and concern – it or course is something that really matter to patients.

Small scale research carried out by our members have found that patients who recieve acupuncture have greater ability to self-care, which has we know can in turn affect their quality of care and outcomes.

So it is important for research to take into account what other services GP practices have on their premises. By adding ins services such as acupuncture, we can improve performance to the level of the best, and ensure that all patients have a positive experience of using services.

#11717 Harry Longman
Chief Executive
Patient Access

The finding which made me sit up was that the strongest link between experience and clinical outcomes was from access. Being able to see the doctor is great for your health!

Questions: you show the association between experience and outcomes, but to what extent do these confound each other? Are they really independent? Let me illustrate: as a rail commuter some years ago with an unreliable service, I found myself complaining about dirty trains (as well as lateness). If they had run on time I would have been happy with the dirt.

Secondly, you talk about satisfaction being generally high at 85% or so. I guess this includes "satisfied" or "very satisfied". When I worked on the data, I found this a poor discriminator. Most people tick the second box without thinking about it. But the first box "very satisfied" can be a good discriminator, as people are reflecting a positive experience. Could you please correlate this with the outcomes and see what happens?

#11742 Peter Durrant
Retired community/social worker

Very much agree with the 'holistic' views above and we are currently, and hopefully with difficulty, working with local authorities in Cambridge to promote the Bromley-by-Bow.healthclinic approaches in East London through the Locality Acts. It does seem to us as a marginallyy funded small group, and we are also into trying to develop a community pub on, brokerage, informal referrals through a social work student unit etc on that there are dozens of community development work options which extends the concept of preventative health if we all thought about it more radically. Peter Durrant.

#13329 Mark Rickenbach
Professor of Healthcare Education and Quality

Of course, as GPs and patients, we all want Clinical quality and patient experience to be of the very highest standard possible. We need to consider which is the prime driver. There is a risk that early access to healthcare for minor self limiting illness in the young well person reduces access for the older person with complex and serious illness. It is all about getting a balance within a system that is financially restricted. Some aspects of patient experience need prioritising. From both the clinical quality perspective and the patient experience perpsective in people with serious illness these should be integration of healthcare and continuity of healthcare

#26410 Dr Malcolm Rigler
NHS GP North SOmerset
Various GP Surgeries as Locum GP

The main way in which the Patient Experiance can be improved is by providing time, space and "an environment for learning" within spaces and places allied to the GP surgery but not in it. There is no GP surgery in the NHS that can as yet can provide the "guided websurfing" available at MAGGIES Cancer Care CEntres, There are very few if any GPs in practice who have studied the importance of "the environment for learning" and to the best of my knowledge there are no Practice Managers who have pushed for the development of "patient education/learning centres" in Primary Care. As GPs and Practice Managers we need to learn from professionals within Adult and COmmunity Education about such things and ensure that we use ICT services to offer patients and carers "information that they can understand" ( The GMC requires this of each one of us GPs ) even in GP practices where 10 or more languages other than English are spoken. Only the "Libraries and Health" partnership programmes will be able to offer such services leading to truly "informed consent" . We all need to adopt the strap line of the Patients Assn. "no decison about me without me". seem to be on the right lines but no doubt they struggle for funding and recognition.

#41853 Dr Sri
Retired GP

NHS has given more importance to "Patient satisfaction" and so compromised on the quality of care. I started my work in 2003 to help reduce demand by reducing wasted consultations, ease access to doctors and prevent wrong doings, I have only seen the quality of care in NHS decline. Unless we are open and criticise doctors, managers and people in power, I think this profession is doomed to disappear. Knowing antibiotic resistance will soon make members of medical profession go on their knee and beg for mercy. I am not pessimist but a doctor who has seen how advances in our knowledge and treatment has been abused by members of our profession and corporations to help increase return on their investment.
I hope institutions will critically evaluate quality of care offered by doctors and not depend on patient satisfaction as the yardstick.

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