Title: Improving patient experience in primary care
Funder: Department of Health (England)

Abstract: AIMS 1 To understand how general practices respond to low patient survey scores, testing a range of approaches that could be used to improve patients’ experience of care. 2 To estimate the extent to which aggregation of scores to practice level in the national study masks differences between individual doctors 3 To investigate how patients’ ratings on questions in the GP Patient Survey relate to actual behaviour by GPs in consultations. 4 To understand better patients’ responses to questions on communication and seeing a doctor of their choice. 5 To understand the reasons why ethnic minority groups, especially South Asians, give lower scores on patient surveys compared to the white British population. 6 To carry out an exploratory randomised controlled trial of an intervention to improve patient experience, using tools developed in earlier parts of the programme. 7 To investigate how the results of the GP Patient Survey can be used to improve patients’ experience of out of hours care. BACKGROUND Improving patient experience is identified as a high policy priority in the Darzi review, and the NHS has embarked on a systematic programme to assess patient experience of primary care. From 2009, 5.6 million patients are being surveyed annually to describe patient experience for all 8500 general practices in England, and detailed results will be published on the internet. This research programme will identify ways in which the results of this survey (the largest undertaken in the NHS) can be used to improve care. In addition to being an important outcome in its own right, patient experience is linked to good treatment adherence, to patient safety, and to enhancing patients’ ability to manage their own care, each of which are NHS priorities. The GP Patient Survey asks questions about five main aspects of GP care. We have chosen to focus on three: communication in the consultation, ability of patients to choose the doctor they see (linked to continuity of care), and out of hours care. This is because of concerns about recent changes to quality of care in these areas. RESEARCH PLANS The research consists of seven linked projects, each contributing to one of the aims listed above. A range of methods are used including group and one to one interviews with health professionals (aims 1 and 7), interviews with patients (aims 4, 5 and 7), further surveys (aims 2 and 7), analysis of taped consultations (aim 3), assessing the response of different population groups to simulated consultations (aim 5), and design and testing an intervention to improve care (aim 6). RESEARCH TEAM The applicants have more experience than any other UK group in the development and validation of patient surveys in primary care. They have developed questionnaires for the 2004 GP contract, for out of hours care and for the new GP patient survey (GPPS). They have a substantial track record of publication relating to these questionnaires and more generally to health services research in primary care. Their grants total over £40m in the last ten years, and publications include five recent papers in the New England Journal of Medicine. PROGRAMME MANAGEMENT The programme will be jointly managed by Roland (lead applicant) and Campbell (co-PI) who have an eight year track record of collaborative working and joint publication. Although all seven projects are linked, none is critically dependent on completion of a previous project in the case that unforeseen delays were to occur. RESEARCH ENVIRONMENT The research will be based in three of the leading centres for primary care research in the UK, Cambridge and Manchester (both members of the NIHR School for Primary Care Research) and Peninsula Medical School which has the strongest research record of the new Medical Schools. The involvement of RAND in Santa Monica brings in one of the world’s leading centres of research into patient experience. ANTICIPATED OUTPUTS Each element of this research aims to produce change and improve patient experience in the NHS. At stages through the programme, we will provide practices and PCTs with evidence based guidance on ways to improve care, based on our existing expertise complemented by what we learn from the programme. This will give these two key stakeholders tools which they can use to work together to improve patient care. In addition we will engage at high level with the Department of Health (steering group already established for out of hours care) so that the results of the research can inform national policy. PATIENT AND PUBLIC INVOLVEMENT Patient representatives have been involved in the development of both outline and full applications, and have agreed to form a Steering Group to give advice throughout the programme. JUSTIFICATION OF RESOURCES REQUESTED The applicants bring a wide range of expertise and representation of the key disciplines required to supervise mid-grade and junior research staff employed in the programme.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE