Better access to general practice is linked to improved quality of care, finds analysis

BMJ 2012; 345 doi: (Published 07 November 2012) Cite this as: BMJ 2012;345:e7502
  1. Zosia Kmietowicz
  1. 1London

General practices could improve the quality of their care by taking heed of patient satisfaction surveys and clinical effectiveness outcomes together and comparing themselves with the best performers, a health services think tank has said.

An analysis by the King’s Fund looked at the association between the clinical quality of services provided in general practice and the experience of patients using those services by analysing data from the Quality and Outcomes Framework (QOF) and surveys of patients for 2010-11 in all 8042 practices in England.1

It found that practices whose patients reported a better experience of services generally also performed better on clinical quality in terms of measures of processes and outcomes.

When the researchers looked in more detail they found that the link between a practice’s QOF scores and patients’ experiences was stronger in relation to access, cleanliness, and information than for other areas of patients’ experience, such as dignity and respect, involvement, confidence and trust, and overall satisfaction.

In particular, patients’ feedback on ease of access to their general practice consistently showed a strong link with the process and outcome indicators for all clinical conditions. Information received by patients also consistently showed a clear positive link with all process and outcome measures of the quality of clinical care.

The analysis also found that practices in London and in deprived areas were more likely to perform poorly on both clinical quality and on patient experience. Smaller practices with fewer GPs also tended to perform less well.

The current changes to the NHS and the shift to GP led clinical commissioning offer important opportunities for tackling some of the underlying issues that resulted in poorer outcomes, said the report.

“Although our analysis cannot demonstrate a causal link, it is fair to assume that patients’ experience of using their GP services—especially ease of access—can affect their uptake of services and their interaction with services. And this, in turn, can affect their quality of care,” it said.

It added, “Analysing both dimensions of quality together can reveal systemic problems such as poor access, or gaps in coordination and communication, that can have a major impact on both quality and efficiency. We urge staff in general practice to consider how they perform in terms of the patient experience alongside how they perform on the quality of clinical care, as it is this bigger picture that offers the greatest potential for driving further improvements in the overall quality of care.”


Cite this as: BMJ 2012;345:e7502