Analysis Of National General Practitioner Patient Survey Data In England!

New research published on bmj.com today reports that the GP Patient Survey is a reliable and valid means of providing financial incentives to doctors. Moreover, there is little evidence to support concerns that it has led to unfair payments.

The GP Patient Survey is a component of the Government's commitment to make the NHS more reactive to patients' needs. In 2009, 5.5 million patients registered with over 8,000 general practices in England. They were surveyed about a series of issues, such as how easy or difficult it is for patients to make an appointment at their surgery, satisfaction with opening hours, and the quality of care received from their GP and practice nurses.

There were two questions on access to care linked directly to payments to GPs.

In July 2009, results were published. In general, patients reported favorable experiences and high levels of satisfaction with their general practices. However, numerous GPs argued that not enough patients were surveyed in some practices. In addition, the poor response rate implied that the survey results were prejudiced.

In order to find out more, a team of researchers led by Professor Martin Roland at the University of Cambridge and Professor John Campbell at Peninsula Medical School evaluated the strength of patient responses to the survey.

On the whole, the response rate was 38.2 percent (2.2 million responses). Just as with many other surveys, men, young people, and people living in underprivileged areas were less likely to respond. But the researchers found little indication that this would lead to any direct disadvantage to practices with either low or high response rates for the questions linked to payments.

The authors remark that the two questions which triggered payments to general practitioners were reliable measures of practice performance.

Overall, 97 percent of practices achieved the 90 percent limit for reliability for these two questions. There were 3 percent of practices with insufficient responses needed to meet this threshold. The authors recommend that superior numbers of patients from these practices should be sampled in future rounds of the survey.

"This study suggests that the current survey procedures result in reliable and valid survey estimates of performance at the practice level on the pay for performance items which we examined," write the authors. In addition, there is little indication to support the concern of some general practitioners that low response rates and selective non-response bias have led to systematic unfairness in payments attached to questionnaire scores.

In addition, the study provides a teaching for the UK and for other countries who are considering the use of patient experience as part of pay for performance schemes.

They write in conclusion: "Patient reported measures of quality are an important aspect of care, and the GP Patient Survey represents a major opportunity to improve care on a national scale. None the less, additional refinements of the measurement or compensation process and ongoing dialogue with practising doctors will be essential if the survey is to play an important role in improving in patient experience in the UK."

"Reliability of patient responses in pay for performance schemes: analysis of national General Practitioner Patient Survey data in England"
Martin Roland, professor of health services research, Marc Elliott, senior statistician, Georgios Lyratzopoulos, clinical senior research associate, Josephine Barbiere, research assistant, Richard A Parker, research assistant, Patten Smith, director of research methods, Peter Bower, reader in health services research, John Campbell, professor of general practice and primary care
BMJ 2009; 339:b3851
doi:10.1136/bmj.b3851
bmj.com