Article Text
Abstract
Objectives To examine patient consultation preferences for seeing or speaking to a general practitioner (GP) or nurse; to estimate associations between patient-reported experiences and the type of consultation patients actually received (phone or face-to-face, GP or nurse).
Design Secondary analysis of data from the 2013 to 2014 General Practice Patient Survey.
Setting and participants 870 085 patients from 8005 English general practices.
Outcomes Patient ratings of communication and ‘trust and confidence’ with the clinician they saw.
Results 77.7% of patients reported wanting to see or speak to a GP, while 14.5% reported asking to see or speak to a nurse the last time they tried to make an appointment (weighted percentages). Being unable to see or speak to the practitioner type of the patients’ choice was associated with lower ratings of trust and confidence and patient-rated communication. Smaller differences were found if patients wanted a face-to-face consultation and received a phone consultation instead. The greatest difference was for patients who asked to see a GP and instead spoke to a nurse for whom the adjusted mean difference in confidence and trust compared with those who wanted to see a nurse and did see a nurse was −15.8 points (95% CI −17.6 to −14.0) for confidence and trust in the practitioner and −10.5 points (95% CI −11.7 to −9.3) for net communication score, both on a 0–100 scale.
Conclusions Patients’ evaluation of their care is worse if they do not receive the type of consultation they expect, especially if they prefer a doctor but are unable to see one. New models of care should consider the potential unintended consequences for patient experience of the widespread introduction of multidisciplinary teams in general practice.
- health services research
- primary care
- patient experience
- quality In health care
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Footnotes
Contributors All authors (CAMP, GAA, JB, JLC, MNE, VAL and MR) jointly conceived of the research questions, reviewed/edited the manuscript and contributed to discussion and interpretation of the data. CAMP and GAA led on writing the manuscript and GAA completed the statistical analysis. All authors (CAMP, GAA, JB, JLC, MNE, VAL and MR) had full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. CAMP is the guarantor of the paper.
Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0608-10050). The study was sponsored by the University of Cambridge.
Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The researchers confirm their independence from the study funders, the National Institute for Health Research.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.