Scottish Patient Experience Survey of GP and Local NHS Services 2011/12 Volume 3: Variation in the Experiences of Primary Care Patients

2 Introduction and Methods

About this report

2.1 This report explores variations in the self-reported experiences of different people using GP and out-of-hours health services. The main source of information is the Scottish Patient Experience Survey of GP and Local NHS Services 2011/12. This survey asks GP patients about their experiences of accessing and using GP and local NHS services. The analysis examined the effects of a range of patient, GP practice and regional level factors on patient experience. Patient factors included gender; age; ethnicity; religion; sexual orientation; deprivation; urban/rural classification; work status; being a carer; health status; day-to-day activity limiting health problems translation, interpreting and communication support needs; disability status; and how often people contacted their practice in the last year.

2.2 GP practice and regional level factors included: GP practice size, the percentage of patients registered at a practice living in deprived areas, as well as differences between practices, Community Health Partnerships (CHPs) and NHS Boards.

Patient Experience Survey of GP and Local NHS Services

2.3 The Patient Experience Survey of GP and Local NHS Services is a postal survey which was sent to a random sample of patients who were registered with a GP in Scotland in November 2011. The survey is the successor to the 2009/10 GP Patient Experience Survey and asks patients about their experience of accessing their GP practice, making an appointment, visiting reception, seeing either a doctor and/or nurse at the surgery, receiving medication and the overall care provided by the practice. It also asks about patients' experiences of referrals to other health professionals, out-of-hours health services and outcomes from NHS treatments. As 145,569 people responded to the survey, this allowed robust analysis to explore variations in people's experiences.

The role of this analysis

2.4 Investigating differences between groups of patients is important. The NHSScotland Quality Strategy¹ (Scottish Government 2010) states that: "NHSScotland is committed to understanding the needs of different communities, eliminating discrimination, reducing inequality, protecting human rights and building good relations by breaking down barriers that may be preventing people from accessing the care and services that they need, as well as meeting the legal duties in relation to age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. It aims to address inequalities by recognising and valuing diversity, promoting a person-centred approach and involving people in the design and delivery of healthcare".

2.5 Our findings add to the growing body of research examining variations in patients' experiences of healthcare provision. Some of the existing research focuses on patient characteristics only, while other studies take into account wider factors. Our analysis has explored the influence both patient and non-patient factors which will be useful to service providers and national improvement partners in thinking about ways to improve the experiences of patients.

Methods

2.6 For the analysis we used a statistical modelling technique to allow us to consider all of the available factors that had an effect on people's experiences. The advantage of this approach is that it doesn't look at one factor in isolation, which may potentially provide misleading results, but takes into account all other patient and non-patient characteristics which may have an effect.

2.7 We have encountered examples of misleading results caused by not considering other factors. For the Scottish Inpatient Patient Experience Survey (Scottish Government 2011)² we undertook an initial analysis of the results for patients reporting that they were gay/lesbian/bisexual without taking into account other factors such as age. We found that this group were more negative on some questions. However after taking into account other factors using multi- level modelling, we found that the finding may be largely explained by this group being younger: younger patients tended to be more negative.

2.8 For the analysis of the GP and local NHS services survey, the statistical modelling took into account the effects of patient, GP practice and other regional factors. The following personal factors were considered:

• age
• gender
• ethnicity
• religion
• sexual orientation
• deprivation
• urban/rural classification
• work status
• being a carer
• health status
• health problem or disability that limits day-to-day activities
• a variety of disabilities (deafness, blindness, physical disability, learning disability, mental health condition, chronic pain lasting at least 3 months, and another long-term condition)
• translation, interpreting and communication support needs
• how often people contacted their practice in the last year

2.9 We considered the effects of different GP practices (including the effects of practice size and the percentage of patients living in a deprived area), Community Health Partnerships (CHPs) and NHS Boards. For experiences of out-of-hours services we also considered the effects of different services (including NHS 24, out-of-hours services and A&E/casualty).

2.10 Annex A provides more information on the methodology.

Presentation and interpretation of results

2.11 The results of the analysis are presented in the main body of the report. In the Annex C, a number called the "odds ratio" is used to show whether a particular group of patients is more or less likely to give a positive response when compared with a reference group. If an odds ratio (and its lower confidence limit) are above 1, then the group has reported better experience than the reference group, whilst if the odds ratio (and its upper confidence limit) are below 1, the reported experience of the group is worse. The report only discusses differences that are statistically significant at the 5% level.

2.12 An effect is statistically significant if it is so large that an effect of that size (or greater) is unlikely to have occurred purely by chance. Conventionally, significance is tested at the 5% level, which means that an effect is considered significant if it would only have occurred once in 20 different models by chance.

2.13 It is important to note that it is difficult to explain any differences as variation in experience is a complex issue. A number of factors may play a role in influencing experience. In particular the differences reported around patient characteristics could reflect real inter-group differences in the quality of services received, or inter-group differences in subjective factors such as expectations, perceptions or the way questions are answered, or some combination of these factors.

2.14 It is also important to be aware that because of the complexity of the findings, and because a very large number of tests have been conducted, readers are advised to consider overall patterns and avoid over-interpretation of the individual odds ratios and results.

2.15 The rest of this report discusses the effects of each factor individually, firstly personal factors (e.g. age and gender) and then other factors (e.g. GP practice size).