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Quality over quantity?

Rachel CopeIt didn’t escape my attention today that Ed Milliband visited my local NHS hospital in Cheshire and made some bold statements about what Labour would do to reduce GP waiting times so that no patient need wait more than 48 hours for an appointment.  I’m not going to tread the complex path that is political policy making, but I would like to look at how research evidence should be used to inform such decisions.

Despite a move from measuring patient satisfaction to understanding the patient experience, most research surveys which seek to gather feedback from NHS service users are still weak at trying to understand patient priorities.  The Labour leader used research findings to support his proposed policy.  Patient feedback suggested that waiting times are too long yet, while this may be true, very few surveys – including the national GP patient survey and patient surveys commissioned by the CQC – actually ask patients what is important to them.  Most measure the experience of attending an appointment and visiting a GP or nurse, and quantify the experience (e.g. waiting time for an appointment or to see a GP) but assume these aspects of the experience are of equal importance.

Research in the US suggests that the GP’s knowledge and experience is the most important criterion contributing to a positive experience with a healthcare provider followed by the GP’s access to the patient’s medical history.  Meanwhile recent qualitative research by academics in Sweden among cancer patients suggests that psychosocial aspects of healthcare were the most important aspects of the patient experience.  This included the patient feeling like they were being treated as an individual and building good relationships with healthcare staff, other patients and family members.  Granted, this isn’t UK-based evidence, but it does suggest there’s far more to the quality of GP service provision than how long the patient waits for an appointment.

So while it is put to us that a 5% increase in patients seeing their GP could indeed cut emergency admissions by up to 159,000 in a year; and save the NHS more than £300 million, what will the impact be on the quality of service provided by GPs?  I struggle to see how investing in measures to reduce waiting times by increasing the number of appointments will also increase the knowledge and experience of our doctors or improve the quality of the experience (i.e. affect the measures that really matter to patients).


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