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Improving GP services in England

Exploring the association between quality of care and the experience of patients


Two key elements of the quality of health care provided by GPs are the Quality and Outcomes Framework (QOF), which rewards GP practices for achievement against a range of indicators of clinical quality, and the GP Patient Survey, which asks patients about their experience of using GP services.

Using data for more than 8,000 general practices in England, this paper examines the association between patients’ perceptions about the non-clinical aspects of care and practice performance on measures of clinical quality.

Key findings

  • Both clinical effectiveness and patient experience are key domains of health care quality. By considering the relationship between them, general practices can better understand the quality of care they are providing and identify areas for improvement.

  • Generally speaking, practices that deliver a good experience for their patients have higher QOF outcomes scores. The reverse is also true – practices whose patients are more negative about access to the practice and using its services generally perform less well on clinical quality.

  • With some exceptions, 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. These practices face special challenges.

  • Patients’ experience of using their GP services – especially ease of access – can affect their use of and interaction with those services, which could in turn affect the quality of their care.

Policy implications

Patients’ experience of using health care services is recognised internationally as a key measure of health care quality. The coalition government’s NHS Outcomes Framework for England recognises patient experience as one of five domains that will be used to assess the performance of the newly formed NHS Commissioning Board from 2013 onwards. The Board will have responsibility for commissioning primary care, so national primary care performance on patient experience and clinical quality will be of increasing importance in future. The new GP-led clinical commissioning groups will have a duty to improve the quality of primary care locally.