Reasons why people do not attend NHS Health Checks: a systematic review and qualitative synthesis

British Journal of General Practice, Br J Gen Pract 2017; DOI: https://doi.org/10.3399/bjgp17X693929 

Review of 9 qualitative studies reports people do not attend NHS Health Checks because of the lack of awareness, misunderstanding the purpose of the Health Check, aversion to preventive medicine, time constraints, and difficulties with access to general practices.

The findings particularly highlight the need for improved communication and publicity around the purpose of the NHS Health Check programme and the personal health benefits of risk factor detection.

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Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey

Journal of the Royal Society of Medicine, Article first published online: November 2, 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.

Use of an electronic consultation system in primary care: a qualitative interview study

Jon Banks, Michelle Farr, Chris Salisbury, Elly Bernard, Kate Northstone, Hannah Edwards and Jeremy Horwood, Br J Gen Pract 6 November 2017

Background The level of demand on primary care continues to increase. Electronic or e-consultations enable patients to consult their GP online and have been promoted as having potential to improve access and efficiency.

Aim To evaluate whether an e-consultation system improves the ability of practice staff to manage workload and access.

Design and setting A qualitative interview study in general practices in the West of England that piloted an e-consultation system for 15 months during 2015 and 2016.

Method Practices were purposefully sampled by location and level of e-consultation use. Clinical, administrative, and management staff were recruited at each practice. Interviews were transcribed and analysed thematically.

Results Twenty-three interviews were carried out across six general practices. Routine e-consultations offered benefits for the practice because they could be completed without direct contact between GP and patient. However, most e-consultations resulted in GPs needing to follow up with a telephone or face-to-face appointment because the e-consultation did not contain sufficient information to inform clinical decision making. This was perceived as adding to the workload and providing some patients with an alternative route into the appointment system. Although this was seen as offering some patient benefit, there appeared to be fewer benefits for the practices.

Conclusion The experiences of the practices in this study demonstrate that the technology, in its current form, fell short of providing an effective platform for clinicians to consult with patients and did not justify their financial investment in the system. The study also highlights the challenges of remote consultations, which lack the facility for real time interactions.

GP online consultations

NHS England has released a video case study in which a GP/Managing Partner at Larwood and Bawtry Primary Care Home in Nottinghamshire and South Yorkshire speaks about the impact of recently introducing online consultations in to his practice.   This case study is one of a collection of ways to improve workload and improve care through working smarter, not harder.

Effectiveness of UK provider financial incentives on quality of care: a systematic review

Rishi Mandavia, Nishchay Mehta, Anne Schilder and Elias Mossialos. Effectiveness of UK provider financial incentives on quality of care: a systematic review. Br J Gen Pract 9 October 2017; bjgp17X693149. DOI: https://doi.org/10.3399/bjgp17X693149

Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency.

Aim To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care.

Design and setting Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.

Method MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as ‘positive’, those that were ‘intermediate’ showed improvement in some measures, and those classified as ‘negative’ showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist.

Results Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points.

Conclusion The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives — if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK.

Collaboration in general practice

Collaboration in general practice: Surveys of GP practices and clinical commissioning groups | Nuffield Trust |  Royal College of General Practitioners

This report summarises the results of two surveys, sent to general practice staff and to CCG staff, aimed at finding out what had changed in the landscape of general practice since the previous surveys two years ago and to explore what GPs feel the future holds for them.

Key findings include:

  • The scaling up of general practice continues apace with 81% of general practice-based respondents reporting that they were part of a formal or informal collaboration, up from 73% in 2015.
  • However, the landscape is complex. Practices often belong to multiple collaborations that operate at different levels in the system, having been set up to fulfil different purposes.
  • The main priorities of all collaborations over the last year were: increasing access for patients, improving sustainability, and shifting services into the community. The priorities differed by size of collaboration. Both providers and commissioners reported that time and work pressures were the biggest challenge to collaborations achieving their aims.
  • When asked about developments in their local area, over half of GP staff and one-third of CCG staff surveyed felt practices and collaborations had not been at all influential in shaping the local sustainability and transformation partnership (STP). Only one-fifth of GPs thought STPs would deliver meaningful change in primary care. CCGs were more optimistic, with 61% reporting that meaningful change was probable.
  • When questioned about future models of care, around half of practice partners (53%) said they would be ‘unwilling’ or ‘very unwilling’ to give up their current GMS/PMS/APMS contract1 to join a new models contract (e.g. MCP or PACS contract2). The most common reason they gave was that they did not want to lose control of decision-making and leadership in their practice.

The report can be downloaded here