Patient experience – how much of a role do CCGs play?

Problem

Patient experience is routinely measured in UK general practice and is increasingly seen as being as important as clinical quality of care. Findings from the national GP Patient Survey are used make assessments of the quality of general practices, and form the basis of a number of key metrics used at local and national level including monitoring by the Quality Care Commission. However, it is unknown what influence CCGs have in determining the quality of patient experience in general practice when compared with the role of practices in determining such quality.

Approach

National data was used for the 2015/16 GP patient survey. Hierarchical linear regression models were used to model seven measures of patient experience including access, continuity of care, receptionists, GP communication, out of hours care and overall satisfaction. In models, patients were nested within practices which were nested within CCGs. Adjustment was made for patient age, gender, ethnicity and deprivation. A further set of models also adjusted for geographic region, rurality, and an interaction between these two variables to establish to what extent differences between CCGs could be explained by macro-scale factors.

Findings

We restrict our interpretation to the variance components attributable to practices and CCGs (ignoring the residual variance). For the two out-of-hours questions, the organisational variation was mostly attributed to the CCG (57% of organisational variance in both cases). For the questions addressing in-hours care only a minority of variance was attributable to CCGs. This varied from 5% of organisational variance in the case of continuity of care to 17% in the case of GP communication. Between 35% and 63% of the between-CCG variance could be explained by macro-scale factors.

Consequences

For aspects of care not under the control of individual practices (such as out-of-hours care) there was greater variability in patient experience scores between CCGs than practices. For aspects of care directly under the control of general practices, there was still variability between CCGs, which, although small, is non-ignorable. In part this was explained by macro-scale factors and so may reflect the challenges of working in rural areas or the general attractiveness of certain regions as a place to work and thus aiding recruitment. However we would suggest that while CCGs are not driving patient experiences, they may have some impact, possibly, for example, through attracting high quality staff.