Improving patient experience in primary care

AIMS1 To understand how general practices respond to low patient survey scores, testing a range of approaches that could be used to improve patients’ experience of care.2 To estimate the extent to which aggregation of scores to practice level in the national study masks differences between individual doctors3 To investigate how patients’ ratings on questions in the GP Patient Survey relate to actual behaviour by GPs in consultations. 4 To understand better patients’ responses to questions on communication and seeing a doctor of their choice.5 To understand the reasons why ethnic minority groups, especially South Asians, give lower scores on patient surveys compared to the white British population. 6 To carry out an exploratory randomised controlled trial of an intervention to improve patient experience, using tools developed in earlier parts of the programme.7 To investigate how the results of the GP Patient Survey can be used to improve patients’ experience of out of hours care.BACKGROUNDImproving patient experience is identified as a high policy priority in the Darzi review, and the NHS has embarked on a systematic programme to assess patient experience of primary care. From 2009, 5.6 million patients are being surveyed annually to describe patient experience for all 8500 general practices in England, and detailed results will be published on the internet. This research programme will identify ways in which the results of this survey (the largest undertaken in the NHS) can be used to improve care. In addition to being an important outcome in its own right, patient experience is linked to good treatment adherence, to patient safety, and to enhancing patients’ ability to manage their own care, each of which are NHS priorities.The GP Patient Survey asks questions about five main aspects of GP care. We have chosen to focus on three: communication in the consultation, ability of patients to choose the doctor they see (linked to continuity of care), and out of hours care. This is because of concerns about recent changes to quality of care in these areas.RESEARCH PLANSThe research consists of seven linked projects, each contributing to one of the aims listed above. A range of methods are used including group and one to one interviews with health professionals (aims 1 and 7), interviews with patients (aims 4, 5 and 7), further surveys (aims 2 and 7), analysis of taped consultations (aim 3), assessing the response of different population groups to simulated consultations (aim 5), and design and testing an intervention to improve care (aim 6).RESEARCH TEAMThe applicants have more experience than any other UK group in the development and validation of patient surveys in primary care. They have developed questionnaires for the 2004 GP contract, for out of hours care and for the new GP patient survey (GPPS). They have a substantial track record of publication relating to these questionnaires and more generally to health services research in primary care. Their grants total over £40m in the last ten years, and publications include five recent papers in the New England Journal of Medicine.PROGRAMME MANAGEMENTThe programme will be jointly managed by Roland (lead applicant) and Campbell (co-PI) who have an eight year track record of collaborative working and joint publication. Although all seven projects are linked, none is critically dependent on completion of a previous project in the case that unforeseen delays were to occur. RESEARCH ENVIRONMENTThe research will be based in three of the leading centres for primary care research in the UK, Cambridge and Manchester (both members of the NIHR School for Primary Care Research) and Peninsula Medical School which has the strongest research record of the new Medical Schools. The involvement of RAND in Santa Monica brings in one of the world’s leading centres of research into patient experience.ANTICIPATED OUTPUTSEach element of this research aims to produce change and improve patient exper