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Research

Changes in patient experience associated with growth and collaboration in general practice: observational study using data from the UK GP Patient Survey

Lindsay JL Forbes, Hannah Forbes, Matt Sutton, Katherine Checkland and Stephen Peckham
British Journal of General Practice 2020; 70 (701): e906-e915. DOI: https://doi.org/10.3399/bjgp20X713429
Lindsay JL Forbes
Centre for Health Services Studies, University of Kent, Canterbury.
Roles: Clinical professor of public health
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Hannah Forbes
Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester.
Roles: Research assistant
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Matt Sutton
Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester.
Roles: Chair in health economics
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Katherine Checkland
Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester.
Roles: Professor of health policy and primary care
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Stephen Peckham
Centre for Health Services Studies, University of Kent, Canterbury.
Roles: Director
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  • Changes in patient experience associated with growth and collaboration in general practice
    Robert Varnam
    Published on: 28 November 2020
  • Changes in patient experience associated with growth and collaboration in general practice: observational study using data from the UK GP Patient Survey
    Sarina Rana and Jaclyn Yizhen Tan
    Published on: 16 November 2020
  • Published on: (28 November 2020)
    Changes in patient experience associated with growth and collaboration in general practice
    • Robert Varnam, GP and Director of Primary Care Improvement, NHS England and NHS Improvement

    These insights into the impact of practice size and/or collaboration on continuity of care are timely and concerning. Efforts to strengthen collaboration between practices have continued in the UK since the end of the study period, so the trend the authors report up until 2018 may well have progressed.

    For at least some patients (notably the most vulnerable and complex), continuity of care has repeatedly been shown to be a key factor in the quality of primary care and the satisfaction of patients and clinicians. Evidence of the continued fall reduction in continuity as reported by patients is therefore a cause of concern, but it seems likely to be amenable to practical action in every practice.

    In the early days of the NHS, the single-handed nature of general practices ensured a strongly personal (and wholly medical) model of care. With the exception of holiday periods, continuity could be 100%. Although this was valued by GPs and patients, general practice was providing continuity by default rather than by design. As we began adopting group practice and multidisciplinary approaches, surveys have pointed to a reduction in continuity. However, this can be seen not as an inherent consequence of size but simply as a failure to design continuity into our model of access.

    The opportunity to improve continuity of care lies largely in the hands of practices ourselves. Ensuring that those patients who most need continuity are more consistently signposted to...

    Show More

    These insights into the impact of practice size and/or collaboration on continuity of care are timely and concerning. Efforts to strengthen collaboration between practices have continued in the UK since the end of the study period, so the trend the authors report up until 2018 may well have progressed.

    For at least some patients (notably the most vulnerable and complex), continuity of care has repeatedly been shown to be a key factor in the quality of primary care and the satisfaction of patients and clinicians. Evidence of the continued fall reduction in continuity as reported by patients is therefore a cause of concern, but it seems likely to be amenable to practical action in every practice.

    In the early days of the NHS, the single-handed nature of general practices ensured a strongly personal (and wholly medical) model of care. With the exception of holiday periods, continuity could be 100%. Although this was valued by GPs and patients, general practice was providing continuity by default rather than by design. As we began adopting group practice and multidisciplinary approaches, surveys have pointed to a reduction in continuity. However, this can be seen not as an inherent consequence of size but simply as a failure to design continuity into our model of access.

    The opportunity to improve continuity of care lies largely in the hands of practices ourselves. Ensuring that those patients who most need continuity are more consistently signposted to the right person usually involves relatively simple adjustments to a practice’s access system, supported by training for reception staff. While we are unlikely ever to return to the days where one GP shouldered 100% of responsibility for their patients’ needs, improving continuity is within our grasp, as long as practices design it in.

    Show Less
    Competing Interests: None declared.
  • Published on: (16 November 2020)
    Changes in patient experience associated with growth and collaboration in general practice: observational study using data from the UK GP Patient Survey
    • Sarina Rana, Medical Student, University College London (UCL)
    • Other Contributors:
      • Jaclyn Yizhen Tan, Medical Student, University College London (UCL)
    We read with great interest the paper written by Forbes et al.,1 which attempted to assess a patient's perspective on the growth of GP practices across the UK. We acknowledge the importance of evaluating the efficacy of growth and collaboration in general practice and would like to highlight the shortfalls of this study in attaining this goal.
     
    The measures used to analyse the significance of increased practice size were arbitrary and determined solely by the authors' considerations - this inevitably introduces bias. In addition, the simplistic analysis fails to recognise the accompanying increase in staff to cope with the changes, or the possibility that ‘newly registered’ patients only sought specific medical attention from specialist services which could not be provided by their primary GP. This means that their primary GP still retains responsibility for most of their health concerns.
     
    Additionally, several limitations such as the change in patient demographics and increase in non-responders’ rates with increased cohort size were unaccounted for. Also, it takes time to find a system that optimises both service efficiency and standard of care and for it to be reflected in clinical practice. Data collection during this time period would lead to poorer results that may not truly reflect the long-term impact of such reforms.2
     
    ...
    Show More
    We read with great interest the paper written by Forbes et al.,1 which attempted to assess a patient's perspective on the growth of GP practices across the UK. We acknowledge the importance of evaluating the efficacy of growth and collaboration in general practice and would like to highlight the shortfalls of this study in attaining this goal.
     
    The measures used to analyse the significance of increased practice size were arbitrary and determined solely by the authors' considerations - this inevitably introduces bias. In addition, the simplistic analysis fails to recognise the accompanying increase in staff to cope with the changes, or the possibility that ‘newly registered’ patients only sought specific medical attention from specialist services which could not be provided by their primary GP. This means that their primary GP still retains responsibility for most of their health concerns.
     
    Additionally, several limitations such as the change in patient demographics and increase in non-responders’ rates with increased cohort size were unaccounted for. Also, it takes time to find a system that optimises both service efficiency and standard of care and for it to be reflected in clinical practice. Data collection during this time period would lead to poorer results that may not truly reflect the long-term impact of such reforms.2
     
    Moreover, although this paper acknowledges logistical and practical challenges that new governmental policies can cause, the current study design does not allow for adequate analysis of the implications to patient experience. The dataset currently used is subjective with no clear parameters. A more reliable reflection of changes in continuity or standards of care would be to monitor the responses of patients with chronic conditions that require regular follow-up rather than the general population with sporadic consultations until present day to account for the transition phase.
     
    More robust studies, with statistical significance, need to be carried out to critically evaluate the efficacy of changes made to GP population sizes. This will be vital to guide timely policy changes within the NHS, in order to improve service provision for the nation.
     
    References
    1. Forbes, L., Forbes, H., Sutton, M., Checkland, K, Peckham, S. Changes in patient experience associated with growth and collaboration in general practice: observational study using data from the UK GP Patient Survey. Br J Gen Pract 2020, Nov 2: bjgp20X713429. doi: 10.3399/bjgp20X713429.
    2. Tammes, P., Payne, R., Salisbury, C., Chalder, M., Purdy, S, Morris, R. The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016. BMJ Open 2019, 9(9): p.e029103.  doi: 10.1136/bmjopen-2019-029103.
     
    Show Less
    Competing Interests: None declared.
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British Journal of General Practice: 70 (701)
British Journal of General Practice
Vol. 70, Issue 701
December 2020
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Changes in patient experience associated with growth and collaboration in general practice: observational study using data from the UK GP Patient Survey
Lindsay JL Forbes, Hannah Forbes, Matt Sutton, Katherine Checkland, Stephen Peckham
British Journal of General Practice 2020; 70 (701): e906-e915. DOI: 10.3399/bjgp20X713429

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Changes in patient experience associated with growth and collaboration in general practice: observational study using data from the UK GP Patient Survey
Lindsay JL Forbes, Hannah Forbes, Matt Sutton, Katherine Checkland, Stephen Peckham
British Journal of General Practice 2020; 70 (701): e906-e915. DOI: 10.3399/bjgp20X713429
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Keywords

  • family practice
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More in this TOC Section

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