Improving patient experience in primary care

Why do patients tick the boxes they do when they score the communication skills of their GP on a questionnaire? Do doctors within each practice all have the same standard of skills for communicating with patients? Why do patients from some ethnic backgrounds report more negative experiences of GP care than patients from other ethnic backgrounds? We are currently exploring these and other questions in a series of linked studies, funded by a five-year NIHR Programme Grant (RP-PG-0608-10050). The overall ‘Improve’ programme, which was completed in September 2015, is a collaboration between Prof Martin Roland and his team here at CCHSR and Prof John Campbell at the University of Exeter: the final report is due for publication in late 2016. The programme manager is Jenni Burt, who is based at CCHSR. The three main areas of work are summarised below.

Understanding patient experience data

  • Video elicitation interviews with 52 patients from 14 GP practices to explore how patients respond to survey questions on communication with their doctor.
  • Patient, GP, and trained rater scoring of 56 video recorded consultations (from a pool of 537 consultations recorded with 45 GPs at 14 practices) to understand how GP, patient and expert raters’ assessments of communication in the same consultations are associated with each other.

 Exploring variations in patient experience

  • Simulated vignette study of 1,120 members of the public from White British (560) or Pakistani (560) backgrounds to understand why people from Pakistani backgrounds give lower scores on national patient surveys compared to White British respondents.
  • Video elicitation interviews with Pakistani respondents and focus groups with Bangladeshi, White British and Pakistani respondents to explore expectations and experiences of primary care.

 Using patient experience data for quality improvement and quality assurance

  • Patient experience survey of 7721 patients (from a sample of 15,172, response rate 50.9%) who consulted with 105 GPs in 25 practices to investigate if practice level scores mask differences between individual GPs.
  • Interviews with 40 GPs and 20 hospital consultants to explore how they respond to individual feedback from patient experience surveys.
  • 14 focus groups with GP practice staff (128 health care professionals in total) to consider how practices respond to feedback from patient experience surveys.
  • Survey of 1396 out-of-hours service users (27.6% response rate) to investigate the validity of the out-of-hours questions on the GP Patient Survey
  • Interviews with 31 staff from 11 Out-of-Hours providers to investigate how they use patient experience data to inform practice.
  • Exploratory trial in 10 GP practices using multi method approaches to consider the acceptability of real-time feedback (RTF) to capture patient experience.

Outputs to date

  • Wright, C, Davey, A, Elmore, N, Carter, M, Mounce, L, Wilson, E, Burt, J, Roland, M, Campbell, J (2017) Patients' use and views of real-time feedback technology in general practice. Health Expect 20: 419-433 PubMed Full text
  • Burt, J, Lloyd, C, Campbell, J, Roland, M, Abel, G (2016) Variations in GP-patient communication by ethnicity, age, and gender: evidence from a national primary care patient survey. Br J Gen Pract 66: e47-52 PubMed Full text
  • Maramba, ID, Davey, A, Elliott, MN, Roberts, M, Roland, M, Brown, F, Burt, J, Boiko, O, Campbell, J (2015) Web-based textual analysis of free-text patient experience comments from a survey in primary care. JMIR Med Inform 3: e20 PubMed Full text
  • Ahmed, F, Abel, GA, Lloyd, CE, Burt, J, Roland, M (2015) Does the availability of a South Asian language in practices improve reports of doctor-patient communication from South Asian patients? Cross sectional analysis of a national patient survey in English general practices. BMC Fam Pract 16: 55 PubMed Full text
  • Roberts, MJ, Campbell, JL, Abel, GA, Davey, AF, Elmore, NL, Maramba, I, Carter, M, Elliott, MN, Roland, MO, Burt, JA (2014) Understanding high and low patient experience scores in primary care: analysis of patients' survey data for general practices and individual doctors. BMJ 349: g6034 PubMed Full text
  • Boiko, O, Campbell, JL, Elmore, N, Davey, AF, Roland, M, Burt, J (2015) The role of patient experience surveys in quality assurance and improvement: a focus group study in English general practice. Health Expect 18: 1982-94 PubMed Full text
  • Ahmed, F, Burt, J, Roland, M (2014) Measuring patient experience: concepts and methods. Patient 7: 235-41 PubMed Full text
  • Burt, J, Abel, G, Elmore, N, Campbell, J, Roland, M, Benson, J, Silverman, J (2014) Assessing communication quality of consultations in primary care: initial reliability of the Global Consultation Rating Scale, based on the Calgary-Cambridge Guide to the Medical Interview. BMJ Open 4: e004339 PubMed Full text
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