Limited impact on patient experience of access of a pay for performance scheme in England in the first year

Abstract

Background: Improvement of access to general practice is a priority in England. In 2006/07 an annual national survey of patient experience of access was introduced, with financial incentives to practices based on the findings of the survey among their own patients. Objectives: To describe changes in patient experience of access over the first two years of the survey and incentive scheme, and identify respondent and practice characteristics associated with patient experience of access. Design and methods: The study included 222 general practices in the east of England, which had completed the access survey in 2006/07 and 2007/08. We compared proportions of patients reporting satisfaction with different aspects of access in each year. In explanatory regression models, we investigated the associations between improvement of reported access and respondent and practice characteristics. Results: There were some small improvements in reported access between the two surveys, although satisfaction with opening hours declined marginally. The explanatory analysis showed that larger practices, a higher proportion of respondents from ethnic minority groups, and higher deprivation were associated with patient reports of worse access. These variables and practice response rates did not explain the amount of change between the two years.

Conclusions: The launch of the incentive scheme was not followed by convincing improvements in patient experience of access. Practices with deprived populations or with a high proportion of ethnic minority survey respondents are perceived as offering worse access, were not more likely to achieve improvements, and additional support should be considered to help these practices.

Key words::

• Family practice
• patient satisfaction
• health care quality
• access and evaluation

Acknowledgements

The authors thank Professor Mayur Lakhani for advice on access and ethnic minority groups. Dr Bankart and Professor Baker are supported by the NIHR CLAHRC for LNR. The views expressed in this paper are not necessarily those of the NIHR.

Declaration of interest: Professor Baker was lead of a national expert group on patient experience indicators for the QOF. There are no other competing interests.