Characteristics of service users and provider organisations associated with experience of out of hours general practitioner care in England: population based cross sectional postal questionnaire survey
BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2040 (Published 29 April 2015) Cite this as: BMJ 2015;350:h2040
- Fiona C Warren, lecturer1,
- Gary Abel, senior research associate2,
- Georgios Lyratzopoulos, clinical reader in cancer epidemiology23,
- Marc N Elliott, senior principal researcher4,
- Suzanne Richards, senior lecturer1,
- Heather E Barry, associate research fellow1,
- Martin Roland, professor2,
- John L Campbell, professor1
- 1Department of Primary Care, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
- 2Cambridge Centre for Health Services Research, University of Cambridge, Institute of Public Health, Cambridge, UK
- 3Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
- 4RAND, Santa Monica, California, USA
- Correspondence to: F Warren f.c.warren{at}exeter.ac.uk
- Accepted 30 March 2015
Abstract
Objective To investigate the experience of users of out of hours general practitioner services in England, UK.
Design Population based cross sectional postal questionnaire survey.
Setting General Practice Patient Survey 2012-13.
Main outcome measures Potential associations between sociodemographic factors (including ethnicity and ability to take time away from work during working hours to attend a healthcare consultation) and provider organisation type (not for profit, NHS, or commercial) and service users’ experience of out of hours care (timeliness, confidence and trust in the out of hours clinician, and overall experience of the service), rated on a scale of 0-100. Which sociodemographic/provider characteristics were associated with service users’ experience, the extent to which any observed differences could be because of clustering of service users of a particular sociodemographic group within poorer scoring providers, and the extent to which observed differences in experience varied across types of provider.
Results The overall response rate was 35%; 971 232/2 750 000 patients returned surveys. Data from 902 170 individual service users were mapped through their registered practice to one of 86 providers of out of hours GP care with known organisation type. Commercial providers of out of hours GP care were associated with poorer reports of overall experience of care, with a mean difference of −3.13 (95% confidence interval −4.96 to −1.30) compared with not for profit providers. Asian service users reported lower scores for all three experience outcomes than white service users (mean difference for overall experience of care −3.62, −4.36 to −2.89), as did service users who were unable to take time away from work compared with service users who did not work (mean difference for overall experience of care −4.73, −5.29 to −4.17).
Conclusions Commercial providers of out of hours GP care were associated with poorer experience of care. Targeted interventions aimed at improving experience for patients from ethnic minorities and patients who are unable to take time away from work might be warranted.
Footnotes
We thank the service users who completed the GPPS 2012-2013. We are grateful to Ipsos MORI for their assistance in providing the GPPS data and Jonathan Jackson of NHS England for providing the data to map out of hours GP providers to associated practices. We also thank Chris Wright of Devon Doctors Ltd, and John Horrocks and Hazel Harrison of Urgent Health UK, for their assistance with determining type of provider organisation.
Contributors: FW performed the analyses with input and advice from GL, GA and ME and, with JC, drafted the first version of the manuscript. SR and HB assisted with mapping of practices to out of hours providers and determining provider organisation type. JC and MR were involved in the implementation of the General Practice Patient Survey and design of the questionnaire. All authors contributed to the development of the manuscript and approved the final draft. FW and JC are guarantors.
Funding: This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (Grant Reference RP-PG-0608-10050). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. The UK National Institute for Health Research had no direct involvement in the design and conduct of the study, the collection, management, analysis and interpretation of the data, or in the preparation, review or approval of the manuscript. GL was supported by a postdoctoral fellowship by the National Institute for Health Research (PDF-2011-04-047) 2012-2014 and by a Cancer Research UK clinician scientist fellowship award (A18180) from March 2015.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare MR and JC act as academic advisers to Ipsos MORI for the General Practice Patient Survey; the other authors have no competing interests to declare.
Ethical approval: Not required.
Transparency declaration: FW and JC affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Data sharing: No additional data available.
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