Primary care

Setting standards based on patients' views on access and continuity: secondary analysis of data from the general practice assessment survey

Peter Bower, senior research fellow, ^a Martin Roland, director, ^a John Campbell, professor, ^b Nicola Mead, research fellow. ^a

^a National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL, ^b Department of General Practice and Primary Care, Peninsula Medical School, Exeter EX2 5DW

Correspondence to: P Bower peter.bower{at}man.ac.uk

Objectives: To examine patients' views on access and continuity in general practice to derive quality standards.
Design: Secondary analysis of data from general practice research studies and routine quality assessment activities undertaken by practices and primary care trusts.
Setting: General practice.
Participants: General practice patients.
Results: Satisfactory standards of access were next day appointments with general practitioners and a 6-10 minute wait for consultations to begin. A satisfactory level of continuity was seeing the same general practitioner "a lot of the time." Standards varied with the analytic method used and by sociodemographic group.
Conclusions: Standards expected by patients in primary care can be derived from linked report-assessment pairs. Patients may have expectations of access that are in excess of government targets. Patients also have high expectations of continuity of care. It is unclear the degree to which such standards are reliable or valid, how conflicts between access and continuity should be resolved, or how these standards relate to other priorities of patients such as high quality interpersonal care.

What is already known on this topic Standards are increasingly being set for the provision of health services Surveys and consultation exercises before the NHS plan helped set the standard for a maximum waiting time of 48 hours for appointments to see general practitioners The optimal methods by which patients should be involved in setting standards and the utility of such standards are unclear What this study adds Satisfactory standards of access were next day appointments, a 6-10 minute wait for consultations to begin, and seeing the same general practitioner a lot of the time Patients may have expectations for access to primary care in excess of current government targets