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

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
Sarina Rana and Jaclyn Yizhen Tan

Published on: 16 November 2020

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

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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.

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Competing Interests: None declared.