The Commonwealth Fund 2006 IHP Survey: Analysis of the UK data

Background

The Commonwealth Fund 2006 International Health Policy Survey of Primary Care Physicians in Seven Countries was conducted between February and August 2006. The Health Foundation funded this expansion of the UK sample, while the Australian Primary Care Research Institute and the German Institute for Quality and Efficiency in Health Care funded expansions of the Australian and German samples respectively.

Methods

Survey responses were available from 1063 GPs in the UK. The analysis of the data focussed on differences in responses to the survey questions by certain key characteristics:

• the home country in which the GP practiced (England - split into London and the rest of England, Scotland, Wales, and Northern Ireland);
  
• the demographic characteristics of the GP in terms of their age (<50, or ≥50) and gender;
• the profile of their general practice in terms of its location (city, suburban, small town or rural) and size (1 GP, >1 & ≤3 GPs, >3 & ≤ 5 GPs, and >5 GPs).

The effects of these characteristics on responses were formally tested through regression analysis, using weighting adjustments by home country and gender (as derived by Harris Interactive) to ensure that the respondent sample more closely reflected the population it was representing.

Results

UK as a whole

• While GPs expressed high levels of satisfaction with their medical practice, the great majority believed the health care system required fundamental change or a complete rebuild.

Differences by home country

• GPs from Northern Ireland expressed the least positive views regarding their health care system overall, satisfaction with aspects of medical practice and their ability to provide quality medical care compared with five years ago. GPs from London were generally less positive than GPs from the rest of England.
• The average GP worked approximately 45 hours per week, spending 80% of their time on patient care. This did not vary significantly between regions.
• The vast majority of GPs, particularly those from Wales and Northern Ireland, thought that their patients experienced long waiting times to see specialists, for diagnostic tests, and for elective surgery or hospital care.
• GPs from Wales and Northern Ireland were the most supportive of non-physician role expansion and reported that such staff were less routinely used to help provide care in their practices.
• The vast majority of GPs, particularly those in England, reported problems with coordination of care across multiple sites or providers.

Differences by GP age and gender

• Female GPs were more positive than male GPs about their ability to provide quality medical care compared with five years ago; they also rated as more effective possible initiatives to improve the quality of care, for example, better integration of information systems between doctors and hospitals.
• On average, female GPs in the UK worked 7½ fewer hours per week than their male counterparts. GPs aged fifty and over worked 3½ more hours per week than GPs aged under fifty.
• Female GPs reported that they used evidence-based treatment guidelines more often than male GPs, but that they were less likely to receive a range of available financial incentives.

Differences by practice location and size

• Single-handed practitioners were more positive about their ability to provide quality medical care compared with five years ago, although they were the least satisfied with their income. GPs practicing in rural locations were the most satisfied with their income, as well as the time they had to spend per patient.
• Larger practices (≥3 FTE GPs) were more supportive of expanding the role of non-physicians.
• Single-handed practitioners reported better coordination of care and patient safety.
• GPs practicing in inner-city locations reported that their patients had greater difficulty paying for medication and other out-of-pocket costs of care.

Discussion and Conclusions

High levels of GP satisfaction with medical practice are most likely related to the introduction of a new contract in 2004 which pays general practices for the quality of their care and frees them from responsibility for out-of-hours care. Widespread discontent with the health care system might reflect disappointment that substantial new investment in the NHS from 2000 onwards, coupled with extensive health system reform, has not yet brought about the level of improvement expected by GPs. Long waiting times for patients to access specialist care and difficulties with care coordination across multiple providers were commonly reported.

GPs from Northern Ireland were generally the least positive regarding their overall views of the health care system and their own satisfaction. Such attitudes may be related to the more limited involvement of these GPs in the governance of local primary care organisations and political turbulence surrounding devolution. GPs in England were less likely than others to report long waiting times for their patients to access specialist care which could be a reflection of the different national strategies taken to manage this issue. There was widespread support for increasing the role of non-physicians within general practice, particularly in countries where they are currently least used. The higher costs of sustaining large multi-disciplinary teams in rural areas may partly explain their lower prevalence outside England and could lead to greater future divergence in general practice structure between rural and urban areas, and hence between countries in the UK. The differences by gender on a number of issues could relate to differing age distributions, career trajectories and/or values across male and female GPs. 

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