/ Health

Are some GPs failing patients?

Cartoon of doctor running

In our undercover investigation of GP practices, we found wide differences in the quality of consultations. We also found that many GPs are not acting on patient feedback. How does your GP treat you?

We sent trained undercover fieldworkers into 30 GP practices across England to assess the consultations given to patients, and found huge variability in diagnosis.

Our expert panel – including three GPs – rated 12 of the visits poor, while 14 were good and four were satisfactory. Consultation times varied greatly, taking anywhere from three to 20 minutes for the same patients with exactly the same symptoms. There was also a significant correlation between the quality and the length of the appointment, with all 12 ‘poor’ consultations lasting eight minutes or less.

Hasty healthcare

We’d all probably agree that GPs work hard to do the best for their patients, but it’s worrying that people with the same symptoms could have such a different experience when they visit their doctor. You can see an example of this in our undercover video footage:

http://www.youtube.com/watch?v=yrwIIq6AyI0&feature=youtu.be

This is something I’ve experienced myself. Sometimes I feel like I’ve had a great consultation and other times I can see that my GP is so rushed that she just needs to move on to the next patient.

When I spent a day with a GP, it was interesting to see how just one patient, who needed emergency admission to hospital, threw the whole day out, leaving other patients with long waiting times.

Voice of the patients

In a separate survey we asked GPs how they use feedback from their patients. We found that half of GPs don’t review patient feedback from the national patient survey and a quarter don’t discuss patient feedback at staff meetings. Worryingly, two in five said they don’t change policies and procedures based on the feedback they receive.

Hopefully the changes taking place in the NHS, with new regulators and patient groups being set up, will ensure that patients’ voices are being heard and, most importantly, acted on.

Does our research fit with your own experience? Are GPs at fault, or is the system failing? Could GPs improve by simply listening more closely to their patients?

Comments
Member

trying to get to talk to the pope is easier

Member
Dr S says:
25 April 2013

Thank you Which for your article which, as a practicing GP and GP trainer, I think is a fair and balanced assessment. The answer is clearly Yes!
I agree that patients are generally good at assessing the quality of consultations. One current mechanism for driving quality is supposed to be patient choice ie theoretically as patients move from weaker practices to practices perceived as ‘good’ these will gain income and be able to grow. This market is supposed to drive poor performers out of business. What is striking however is how few practices have gone out of business despite 10 years or more of this market operation. Even though patients increasingly are exercising choice; as your work shows this market is failing but no one seems to have picked up on why.
One factor is the relative under supply of GPs which limits choice but this is hardly likely to change in the financial circumstances but there is another.
What happens is that in areas of wide variation in GP quality, high need patients in poor practices experience poor service and so switch practices. Low need patients don’t use the practice much and so don’t switch practices so often. Consequently the popular practices gain significant increases in workload but only see an average increase in income as capitation fees are based on average need. As a result popular practices experience a level of demand disproportionate to income. Poorer quality practices suffer some drop in income but a bigger drop in workload as high need patients leave and so actually become more profitable per patient! If you look at QoF data on a local geographical basis you will sometimes find very wide variations in the more demanding diagnosis types such as depression / learning disability /dementia between some neighboring practices, which is consistent with this hypothesis. There is an urgent need to calculate GP budgets on the basis of actual need rather than on the current mix of historical precedent and a formula that only works reliably for much larger populations and which take little account of demands actually faced by practices. (It may surprise people to learn that a practice will be paid exactly the same amount to care for a 30 year old fit businessman who never sees his GP as a 30 year old man who suffered meningitis with permanent brain damage at the age of 2 and is now bed bound needing 24hr nursing care in the community.. and a lot of GP attention.)
The market then might start working in favour of both patients and the sort of doctors they prefer to see.

Member

GP practices are often criticised because of difficulty in making appointments, yet these practices are still accepting new patients. Something is clearly wrong for this to be permitted.

Member

My current GP practice has a strict catchment area. Does this mean that the practice is not allowed to reject new patients provided that they live within the area concerned ? Where else would they go ?

Member

why is it when i get what they say is a emergency appointment is there only ever me there

Member

Would it better if we all had vouchers to buy appointments with the GP and Practice of choice?
The NHS will remain a conveyer-belt system especially as public spending is being capped or cut.
Where is the choice when people are lying on trollies waiting for beds?

On the other hand, when my son sprained his wrist whilst on holiday in Florida, the bill for seeing a doctor (for no more than four minutes), having a bandage and a prescription for Brufen resulted in a bill for $1800.

Wander how it is done in Germany or France! Do they have better service and more choice?

Member

I recently visited my local GP as i was suffering from severe depression. during my appointment I told him that I had recently found it hard to even get myself out of bed, and had spent the previous weekend laid in bed and thinking of ways in which I could commit suicide, I was so low!
The doctors response was that he “didn’t like to give out tablets, so just go home and try to cheer up”!
At the time, I was so low that I didn’t want to ask for a second opinion or make a complaint, and so I just left it at that. It wasn’t until a few months later that I decided to make a complaint to the Practice Manager, and had a 10 minute conversation with him on the telephone. During this conversation, he denied that I had ever had an appointment with the doctor in question, and told me that he would write to me within 10 days to let me know the next steps in the complaint procedure. That was roughly 4 months ago and was the last I heard from him!
I recently went into the surgery to pick up an official complaints form, but have not bothered to fill it in, as I have lost all faith in the surgery and its staff!

Member

I hope you are feeling improved by now and in better shape to meet the challenges of each day. If you are still very depressed, get an emergency appointment with another GP in the practice and ask to be referred to a councillor or therapist. He may suggest other treatment, but telling you to ‘go home and cheer up’ is just not acceptable treatment.

I hope you completed the complaints form as only by complaining can you register your dissatisfaction with the surgery. Also take a copy of the complaints form before you hand it in, as they may ‘lose’ it.

You can also access your surgery on NHS Choices and detail your unhappiness on your treatment by the Doctor and the Practice Manager. The Practice Manager should reply to your comment. Other patients are able to see your review and prospective patients often check this website when they are looking for a new GP.

I wish you good health and good luck.