Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey.
Thomas E CowlingAnthony A LavertyMatthew J HarrisHilary C WattFelix GreavesAzeem MajeedPublished in: Journal of the Royal Society of Medicine (2017)
Objective To examine associations between the contract and ownership type of general practices and patient experience in England. Design Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting All general practices in England in 2013-2014 ( n = 8017). Participants 903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results Most practices had a centrally negotiated contract with the UK government ('General Medical Services' 54.6%; 4337/7949). Few practices were limited companies with locally negotiated 'Alternative Provider Medical Services' contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference -3.04, 95% CI -4.15 to -1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (-12.78, 95% CI -15.17 to -10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949). Conclusions Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013-2014.
Keyphrases
- primary care
- general practice
- healthcare
- cross sectional
- end stage renal disease
- newly diagnosed
- mental health
- emergency department
- chronic kidney disease
- case report
- type diabetes
- prognostic factors
- metabolic syndrome
- peritoneal dialysis
- adipose tissue
- weight loss
- insulin resistance
- electronic health record
- adverse drug