Patient experience and the role of postgraduate GP training: a cross-sectional analysis of national Patient Survey data in England

Mark Ashworth; Peter Schofield; Stevo Durbaba; Sanjiv Ahluwalia

doi:10.3399/bjgp14X677545

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Re: Patient experience and GP trainees
Hamish D Greig

Published on: 04 March 2014
Patient experience and GP trainees
Hajira Dambha

Published on: 03 March 2014

Published on: (4 March 2014)
Page navigation anchor for Re: Patient experience and GP trainees
Re: Patient experience and GP trainees
Hamish D Greig, GP
This article taxes one of the oldest issues within general practice which is whether the 'quality' of the training practice relates to the smaller list size absolute and often the lower list size per FTE which may or may not include the 'trainees'. We need to know whether there are differences between practices in their patient experience when these issues are controlled. It is not clear how well these issues were controlle...
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This article taxes one of the oldest issues within general practice which is whether the 'quality' of the training practice relates to the smaller list size absolute and often the lower list size per FTE which may or may not include the 'trainees'. We need to know whether there are differences between practices in their patient experience when these issues are controlled. It is not clear how well these issues were controlled in this study. I think that in my experience patient satisfaction is less about the training status of the practice and more about the attitude of the practitioner and issues about the demands of time and workload.
The government made a conscious move to increase the element of income related to patient list sizes in the 1990 contract when at the time the practices certainly in my area were trying to reduce the list size per GP in order to improve patient satisfaction and the quality of a doctors' work-life balance. In areas where the practice was, prior to 2004, unable to form a cooperative and provided its own out-of-hours (OOH) services the practices, in my opinion, struck a balance between the number of GPs in the practice and thus the rota OOH and practice income. Since 2004 these tensions have changed and some practices have reduced FTE numbers either by reducing the number of GPs but also through the reduction of sessions per GP. Increasing numbers of salaried GPs in practices may be another factor which needs to be explored with their income less tied to patient satisfaction and thus list size. Life in complicated.
As someone who has been out of practice for some while but still oversees registrars from time to time, I have been impressed with the reaction of the registrars when presented with what some might consider an old-fashioned view of general practice, from a holistic point of view, including the use of community beds with the possibility of diagnostic ultrasound. The possibility of providing holistic care appears to appeal to the aspirations with which they started their journey into medicine and possibly became obscured by their experience in medicine so far. I admit that this is personal experience, anecdotal, and not evidence, however the positive reinforcement of a sequence of registrars leads me to think it is a reasonable insight. The recent proposals to increase the proportion of training for all doctors in the community can only help to foster these aspects. It would appear that increasing the number of practices that have trainees will, of itself, improve patient satisfaction which is an interesting thought.
Conflict of Interest:
Semi-retired so now more of a patient than doctor? Previously worked in a training practice where rurality and distance from the University centre affected recruitment of trainees and the leaving of training status. However we continued the attachment of students to the practice.
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Competing Interests: None declared.
Published on: (3 March 2014)
Page navigation anchor for Patient experience and GP trainees
Patient experience and GP trainees
Hajira Dambha, Academic Clinical Fellow in Primary Care,
The contribution of GP trainees to individual practices, and to national data on patient experience is often not emphasised, or perhaps undervalued. I would be interested in clarifying what proportion of consultations within these training practices, were conducted by its trainees. How much, if at all, does the patient experience at training practices, reflect interactions with its GP trainees?
Indeed we have...
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The contribution of GP trainees to individual practices, and to national data on patient experience is often not emphasised, or perhaps undervalued. I would be interested in clarifying what proportion of consultations within these training practices, were conducted by its trainees. How much, if at all, does the patient experience at training practices, reflect interactions with its GP trainees?
Indeed we have longer consultations, and financial or administrative targets are a lower priority. When I commenced GP training, most of us had a wonderful 15-20 minutes for each appointment. If my trainer sat in with me for joint surgeries, there was even more flexibility in the consultation. During these extended consultations, we had the time and opportunity to really understand our patients, explore their worries and experiences of the disease rather than simply treating biochemical markers of a disease.(1-3) The patient was my only priority. As I come to the end of GP training and experience the reduced 10-minute appointments, increases in tick-box targets and administration, my consultations are changing and inevitable the patient experience will do so to.(4)
References
1. Freeman GK. Evolving general practice consultation in Britain: issues of length and context. BMJ 2002; 324: 880-882.
2. Cape J. Consultation length, patient-estimated consultation length, and satisfaction with the consultation. Br J Gen Pract 2002; 52: 1004-1006.
3. Dugdale DC, Epstein R, Pantilat SZ. Time and the patient-physician relationship. J Gen Intern Med 1999; 14 Suppl 1: S34-S40.
4. Chew-Graham CA, Hunter C, Langer S, et al. How QOF is shaping primary care review consultations: a longitudinal qualitative study. BMC Fam Pract 2013; 14: 103.
Conflict of Interest:
None declared
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Competing Interests: None declared.