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'Worse service' by private GP care

Private providers of out-of-hours GP care in England are giving patients a poorer service than NHS surgeries or those that are not-for-profit, a large-scale study has suggested.

Out-of-hours GP care in England - operated between 6.30pm and 8am on weekdays and throughout weekends and public holidays - is delivered by a combination of NHS, not-for-profit, and commercial providers.

Research led by the University of Exeter Medical School saw more than 900,000 patients answer a questionnaire on their experiences of GP care outside the working week.

The team analysed answers to three questions: the timeliness of receiving care; the level of confidence and trust in the out-of-hours clinician ; and their overall experience of the out-of-hours GP service.

They found that while there were no differences between NHS and not-for-profit organisations with regard to any of the outcomes, commercial providers scored lower than not-for-profit organisations in all three individual outcomes. But the best commercial providers scored higher than many of the NHS and not-for-profit providers.

They also found that patients of mixed ethnicity and Asian ethnicity reported poorer care for all three questions than white respondents.

They suggested this could be because of differences in cultural attitudes regarding an acceptable waiting time.

Researchers also found that those who were unable to take time away from work to attend their practice gave lower scores for all three questions than those for whom this was not an issue.

"Commercial providers of out-of-hours GP care were associated with poorer experience of care," the study concluded. "Targeted interventions aimed at improving experience for patients from ethnic minorities and patients who are unable to take time away from work might be warranted."

But the team also said that although the lower scores of private providers could be because they offer genuinely poorer care, alternatively it could be down to the willingness of commercial providers to provide care in areas deemed less attractive to the NHS or not-for-profit organisations.

Professor John Campbell, who led the study, said: "This is a large scale and robust study, and yields interesting results that warrant further investigation and understanding.

"It is important to exercise caution in interpreting the results.

"Although commercial providers scored lower overall, the best commercial providers scored higher than many of the NHS and not-for-profit providers.

"There are variations and examples of good practice among all providers, but the overall trend is that patients report less positive experiences with commercial providers, and we now need to understand why that is the case."

An accompanying editorial from academics at the Department of Health Sciences at the University of Leicester said t he reasons why commercial providers are associated with poorer experience of care are unclear.

"It is possible that commercial providers are located in areas with more complex population needs, but it is also possible that patient experience is genuinely poorer," they wrote.

They added that the practicality of proposals to introduce seven day access to general practices is " open to question, as GPs are already struggling to cope with current demand".

British Medical Association (BMA) GP committee deputy chair, Dr Richard Vautrey, said politicians needed to learn lessons from such research and move away from increasing private sector involvement in the NHS.

"There is evidence of a division in quality between OOH services that are developed from GP-led co-ops and those run by the private sector," he said.

"The BMJ study chimes with the results of a recent BMA survey of over 15,500 GPs that found that only 5% of GPs felt that contracts run by commercial providers were value for money and just 8% believed they delivered good quality care.

"The BMA's survey found that seven out of 10 GPs working in OOH care felt that their level of workload was negatively impacting on patient care."


From Belfast Telegraph