The relationship between general practice funding and patient experience in England: a longitudinal analysis, 2013 – 2016.

Problem

It has been demonstrated across a wide range of international settings that greater investment in primary healthcare is associated with improved population health outcomes. However, less is known about the influence of funding on patient experience and overall satisfaction in primary care. The aim of this study is to understand the relationship between general practice funding and patient experience.

Approach

We used panel data multivariable regression to relate general practice funding to patient experience in the domains of access, continuity of care, professionalism and overall satisfaction. Descriptive data for all general practices in England over the 4-year period 2013-2016 (2013, n= 7931; 2014, n= 7768; 2015, n = 7612; 2016, n= 7342) were obtained from the General and Personal Medical Services database. Patient experience data was obtained from the General Practice Patient Survey for the same period sent to a representative sample of just over 1 million registered patients per year. Practice funding was defined as pounds (£)/1000 patients/year, based on capitation payments. Fixed effects multivariable linear regression was employed to examine the effect of general practice funding on measures of patient experience in each domain. The Hausman test was used for model selection; the P value <0.001 confirmed appropriate use of the fixed-effects model. The model was adjusted for confounding by practice and demographic characteristics and for year effects.

Findings

Mean patient experience scores were calculated using the top two positive responses (good and very good) for questions relating to the domains of access (mean: 80%), continuity (mean: 48%), professionalism of GP (mean: 84%) and overall experience (mean: 81%). Analysis of data for all practices demonstrated a significant positive association between funding and reported patient experience of access (B coefficient 0.88; 95%CI : 0.64, 1.10), continuity of care (B 3.48; 95%CI : 2.19, 4.77), professionalism of the GP (B 1.02: 95%CI : 0.73, 1.31), and overall satisfaction (B 1.24: 95%CI : 0.90, 1.59). Based on the regression model, an additional capitation payment of £10/patient/year to the mean overall capitation funding (£83.36) would translate into an increase of 1.2% (95%CI: 1.15 - 1.3) in the overall patient experience score. Corresponding increases for individual domains were 0.9% (95%CI: 0.8, 0.9) for access; 3.5% (95%CI: 3.1, 3.8) for continuity; 1.0% (95%CI: 0.9, 1.1) for GP professionalism.

Consequences

Patient experience is a key component of the quality of clinical care. This is the first national study to explore the relationship between funding allocated to GP practices and self-reported measures of patient experience. We found evidence that increased funding is associated with higher levels of patient experience, both for overall satisfaction and for all included domains, especially continuity of care.