Quality in access and continuity – the patient view

The problem

Year after year GPs are voted Britain’s most trusted profession, which speaks of the high quality of GP consultations in clinical terms.  While efforts are made to measure such quality, and it is of course crucial to the service, complaints are relatively rare as a proportion of interactions.  However, there is a continual stream of complaints about poor access, and not being able to see a choice of doctor.  Though this concerns operational performance of GPs, it must impinge on clinical quality – you can’t provide a sound opinion on a patient you don’t see. Measuring what happens in reception has revealed in 80 diverse practices that 1 in 8 patients asking to see a GP is turned away, ie asked to call on another day.  Operational measures of quality in access and continuity are therefore fundamental to primary care.

The new model

We help practices adopt a new model of access through our Launch Programme.   The acid test is, does this work for patients? Our survey, which starts immediately after launch, aims to find out and we now have n=2945 responses from randomly selected patients who have actually used the service, telephoned by a member of practice staff.  An earlier paper, “What matters to patients in General Practice” showed that speed of response and choice of usual doctor (where a preference is given) were the drivers of satisfaction.

Chart of response time by GP to patient call

Response time in minutes improves from 55 to 32 minutes (click the chart to see full size)

This finding led to more effort with practices around those twin goals, fast response and continuity.  Only with a thorough understanding of demand and a whole system design can they be pursued together.  Now by continuing with the same patient survey, we can see the results by looking at changes over 3 month periods, working with multiple practices.

Results

The first chart shows the patient reported average time in minutes between calling the surgery and a GP speaking to the patient.  It has almost halved from around 55 to 32 minutes.  To those reading of ever longer waits to see a GP, often a week and sometimes three or more weeks, this may seem incredible, but these practices had exactly the same problem pre-launch.  Now they measure the wait in minutes.

Chance of speaking to a usual doctor plotted by quarter

Chance of speaking to or seeing a usual doctor rises from 60% to 80%

The second chart shows the proportion of patients who were spoken to by their usual doctor, if they expressed a preference (40% who did not are excluded).  Many have stated that rapid access is the enemy of continuity.  In a poorly designed system, prioritising speed over continuity that may be so. These practices have shown that both can improve together.

 

The final chart shows the proportion of these patients answering the question “Is the new system better, the same or worse?” Bearing out the prediction from the earlier paper, as response time has fallen and continuity risen, the already high proportion of patients saying the new system is better has risen from 55% to 71%. Perhaps more importantly, those saying it is worse have dropped from 20% to just 7%.

 

Conclusion

Quality can be improved in both access and continuity at the same time.  Acting on survey results can produce improvements to patient service.  Views on the merits of the new system are less about personal preferences, and more about how the system performs. Practices in diverse situations can make significant improvements with predictable outcomes.

 

Harry Longman

Note:  see live charts of all time results from the patient survey here.

 

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