Four in five UK GPs report problems for patients caused by poor coordination of care

Patients in the UK are likely to be suffering as a result of poor coordination of care between different parts of the health and care system, according to a new report Under pressure published today (17 February) by the Health Foundation.

The report presents the health charity’s analysis of findings from the Commonwealth Fund’s 2015 International Health Policy Survey of Primary Care Doctors. It reveals that 79% of UK GPs report one of their patients has experienced a problem in the previous month because care wasn’t well coordinated across multiple sites or care providers. This compares to an average of 48% across the other countries featured in the survey.

Of the 11 countries taking part in the survey, GPs in the UK report far greater challenges when coordinating care with social services or other community providers, with 70% of GPs finding it somewhat or very difficult – the highest of any country. The UK also has the highest rate of GPs reporting the need to repeat tests or procedures because test results ‘were unavailable’, at 48%.

These findings have led the health charity to conclude that the quality of patient care is likely to be suffering as a result of poor communication and coordination between different parts of the health and care system.

However, the picture is mixed and communication (an element of care coordination) between GPs and hospitals is relatively strong in the UK, the survey found. The UK performs better than all other countries, except France, for GPs receiving information about changes made to a patient’s medication or care plan. It also performs relatively well on GPs being notified when their patient has attended A&E, or been admitted to hospital.

The survey shows that the challenges of coordinating and communicating between different parts of fragmented health and care systems are common to all the countries featured. In 10 out of 11 countries, less than 40% of GPs report always receiving information about changes made to a patient’s medication or care plan (the UK was second highest at 36%). There is also an association between GPs reporting difficulty coordinating care and the amount of time they spend doing administrative tasks across all the countries in the survey.  

The report – which also looked at GP satisfaction and use of electronic medical records (EMRs) – shows a varied picture for general practice in the UK:

• The UK is a leader in the use of electronic medical records with 98% of GPs in the UK routinely using an EMR in their daily practice. However, the UK lags behind a lot of other countries when it comes to practices offering patients the option to email a medical question or concern, at just under four in ten (38%).
• Since 2012 there has been a collapse in the number of GPs who think that the system of general practice doesn’t require change: in 2012, 46% of UK GPs surveyed felt the system worked well and only minor changes were needed, by 2015 this had fallen to 22% – the biggest decline of any of the countries surveyed.
• 67% of GPs in the UK report they are either ‘very satisfied’ or ‘satisfied’ with practising medicine, compared to an average of 79% of primary care doctors in the other 10 countries featured in the survey.
• Only 26% of UK GPs are ‘satisfied’ or ‘very satisfied’ with the amount of time they spend with patients, compared to an average of 59% across the other countries featured in the survey.    
• Nearly 30% of UK respondents plan to leave general practice within five years. The survey results indicate a clear correlation between stress and a desire to leave general practice.

Commenting on the findings, Edward Davies, Policy Fellow at the Health Foundation, said:

'Action needs to be taken to ensure patients consistently receive high quality care and don’t become entangled in the complicated web connecting different parts of the health and care system in the UK. GPs are reporting challenges coordinating care for their patients with different parts of the system, especially social services and community providers. UK GPs report the highest number of patients experiencing problems as a result of poor coordination of care. This complex array of relationships between different parts of the health and care system and how they are coordinated needs to be better understood to safeguard the quality of patient care.'

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