The cornerstone of good general practice has long been recognised as lying in the quality of the relationship between doctor and patient. This focus on the interaction between GP and patient has been further reinforced in recent years by increasing attention on the patient’s experience of healthcare encounters. Measures of this aspect of general practice activity have been elicited through patient surveys that invite patients to report on the care they have experienced from their local practice. This process has been formalised since 2007 in the annual General Practice Patient Survey (GPPS), which invites a representative sample of around 2.7 million adults registered with GPs in England to comment on the quality of their care.1 Not only does this survey provide feedback from patients to their GPs, but it has also been a component of the pay-for-performance Quality and Outcomes Framework and is currently monitored by commissioners and inspectors of primary care. GPs are incentivised to make the experience of care a good one.
However, pleasing the patient is not always consistent with providing good-quality care. GPs are well aware that patients may demand an antibiotic when it is not judged clinically appropriate. Sometimes it is the GP’s perception of that demand that seems important.2 In a survey of GPs by the organisers of the Longitude Prize (a national science prize in which the public voted for the most pressing issue facing humanity), 55% reported pressure to prescribe antibiotics, 45% had prescribed antibiotics for a viral infection knowing that they would be ineffective, and 44% admitted that they had prescribed antibiotics in order to get a patient to leave the consulting room.3 Spending more time with patients has been reported to result in fewer antibiotic prescriptions.4
There may be a trade-off between the wish to nurture the doctor–patient relationship and antibiotic stewardship.4 This trade-off may be an important obstacle to the appropriate limitation of antibiotic prescribing, especially in the context of growing concerns about antibiotic resistance. Therefore, this study aimed to use the findings of the GPPS to determine whether there was an association between antibiotic prescribing and patient satisfaction in primary care. In particular, it aimed to determine whether patients registered at practices that prescribed fewer antibiotics reported lower levels of overall patient satisfaction.
How this fits in
This is the first study linking national patient experience survey data with prescribing patterns in primary care. The findings demonstrate that patients report lower levels of satisfaction if they are registered at practices that prescribe fewer antibiotics. Although observational studies cannot prove a causal relationship, these findings are consistent with other studies and suggest that frugal antibiotic prescribing is associated with modest reductions in patient satisfaction. GPs who wish to play their part in addressing issues of antibiotic resistance will need to consider alternatives to an antibiotic prescription that do not compromise patient satisfaction.