GP Service.

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Which? investigation reveals poor GP practise Huge variability in diagnosis identified on visits

16 March 2013

Which? undercover investigation reveals huge variability in GP consultations.

When Which? sent specially trained undercover fieldworkers presenting with one of three conditions into 30 GP practices across England, a worrying 12 visits out of 30 were deemed poor.

Our expert panel rated 14 visits good, with four satisfactory.

GP undercover video

A panel of experts – which included three practising GPs with expertise including research and clinical commissioning – found vast differences in the quality of these visits.

Watch our GP investigation video to see the undercover footage that shows just how much difference there is between a good visit and a poor visit.

Which? also uncovered a significant correlation between the length of the visit and its quality rating. Every visit rated ‘poor’ took less than eight minutes. While only two visits rated ‘good’ (out of 14) were less than 10 minutes long.

The shortest appointment took just three minutes – it was rated poor by our experts. Ten-minute visits are the norm, although the time will vary according to patient need.

Correct GP treatment

The scenarios used by the trained undercover fieldworkers who visited as patients included:

a woman at possible risk of a stroke because of her medication;

a man wanting sleeping pills to cope with undiagnosed depression;

and a woman with symptoms that could point to an underlying heart problem.

The patient with symptoms of depression wasn’t asked about his mental health on six out of his 10 visits.

In our snapshot research, all but one of the ‘poor’ consultations fell down on history-taking – the doctor didn’t ask good enough questions to decide the right course of action for the patient.

This takes time, but the implications could be serious. As in the case of a woman leaving the surgery at needless (albeit low) risk of a stroke because no connection was made between the contraceptive pill and the symptoms of a new, severe migraine.

Patient knows best

Patients often recognise when they’re being short-changed by their doctor. Our undercover patients (who were not GPs) told us they felt fairly or very well listened to on all 14 visits rated ‘good’ by our panel. But they felt well listened to on only two of the 12 ‘poor’ visits.

Patient feedback is vital in monitoring the quality of GP practices. Judging by what our undercover fieldworkers told us, patients can often tell a good consultation from a bad.

But half of the UK’s GPs don’t actually review the feedback given by their patients on the national patient survey and nearly half don’t publicise their complaints procedure, a Which? survey has discovered.

Even when GP practices do read their feedback, they don’t always use it. A quarter of GPs don’t discuss patient feedback at staff meetings, and 40% of them don’t change policies and procedures based on the feedback they received.

Which? says

Which? executive director Richard Lloyd said:

'GPs work hard to do their best for their patients, but it’s not right that the same patient, with the same symptoms, could receive such a vastly different experience. GPs should be giving every patient the high-quality service we found offered to some in our research.

'The Government is committed to making sure that the NHS is better at listening to what patients want. But our findings show that this is far from reality across all parts of the health service. The changes taking place in the NHS from April, with a new regulator and patient groups being set up, must be an opportunity for the Government to make sure patients’ needs are being heard and acted upon.'

More on this...

Find out how to complain if you're unhappy about your GP surgery

Does our research fit with your own experience? Join the Conversation

Concerned about future health and care needs? Explore long-term care options

[elian]

If 'Which' had asked me to rate my GP's practice I would have awarded them 9 out of 10. I've never had cause to complain about the treatment I've received when visiting the surgery.

This week I attended Pontefract Hospital for a flight assessment. I went on Wednesday and was surprised when they couldn't find me on their list for that day. *senior moment* - I should have gone today !!! The guy was really pleasant with me and said as he had time to spare (!) he would fit me in there and then The upshot is that I need 1litre/minute oxygen on the flight, but that's not a problem a I have my own concentrator to take on board the aeroplane.

Yesterday I rang my GP's surgery to ask for a 'fit to fly' letter for the travel insurance company. The receptionist advised me that the doctor would ring me after surgery today. My phone rang at 10.30am and it was my GP asking how I was and what I required. After explaining to her she said I could call in at the surgery for the letter sometime next week. There was a £15 fee for the letter, but I expected that.

The National Health Service has been very good to me but I do feel sorry for those members who received a less than perfect service from their own GPs.

[Easybreather]

I have read the full article in Which and it was very interesting, but how about giving the view from the GP's side, which was also included? It is clear that they have too much to do in too little time plus mountains of paperwork; people going with a cough or cold and demanding antibiotics for same; patients with shopping lists of problems, which cannot possibly be dealt with in one visit; a child with a splinter in finger, etc. etc.

I am not on anybody's side, but am fed up with all this NHS / Doc bashing just because people do not get what they want when they want it. People research stuff and drugs on the internet (always a dangerous pasttime) and then go and demand them from their docs. When they refuse to give them, probably for a very good reason, that person starts shouting their head off.

Sorry, please do not think that this is directed at anyone on this forum - it isn't in the slightest.

Finally, to answer your questions: no I am not at all unhappy about my surgery, research does not fit with my experience and I am not concerned about future health needs at the moment as I do not know how I will be in 10 / 15 years time, so cannot comment.

[Hidden]

My experiences are the exact opposite of elian's. My COPD was apparently diagnosed 20 years ago but I was never told of it until it was severe and I was put on oxygen. The hospital said they had come across this before.

I fly every year but have never had a fit to fly assessment, I just asked for in-flight oxygen as I use it 24/7. My consultant then gave me a fit to fly letter (free) to give to the travel agents. The surgery is plain in saying GPs will not take or make telephone calls. If you need to speak to them you have to make an appointment. My GP gave me a drug it later turned out could have killed me as he did not check what other conditions I have; I was the one who realised and telephoned the surgery to just be told by a nurse to stop taking it. I have never had an apology. I have had one "review" of my medication in 7 years and that consisted of a practice nurse asking what I took and listing it.

During all this I changed my GP but the two surgeries have now amalgamated and my new GP then retired. There are no other surgeries in my (semi-rural) area. I trust my consultant but live in dread of needing the GP in an emergency.

[music in reply to Hidden]

hi auntymary may i ask when was you told about copd untill it was severe and you were put on oxegen

[Hidden in reply to music]

I was told I had COPD towards the end of 2005

[libbygood]

Our surgery did a questionaire on the practice, doctors, nurses, staff etc. The survey did well.

I've no complaints, the GPs will go over the 10 minutes if necessary and do ask many questions and read up on notes, I would also give them 9 out of 10. And 0 out of 10 for parking at the practice !

Lib x

[katieoxo60]

As a regular visitor to health services I find the lottery in health care very daunting and agree with the report that everyone should get the same quality of care, but accept that this may be a dream rather than a realistic aim,.Paperwork takes up patient care time, so does the complaints proceedure.and as any proffessionals some are more dedicated than others.I always remember the saying time is a precious commodity.Appreciate a good service when you get one as not everyone receives that sort of care, as the report points out.

[Jake54]

My own doctors are the reason I am still alive without the support and services putting me into rehab. If not perfect then more than I could have bought from a private medical service for those who remember when all dentists worked for the NHS try finding one now if gp's go with dentists we will think this was luxury treatment

[bewildered]

I have no complaints with treatment from the nurse only odd times do I see the doctor and then not always the same one. They meet my standards which is enough for me I shall not worry how they would be judged by other doctors.

[moneal]

I find my surgery really good, no complaints, I get to see the duty doctor that day if I need to, or they come to the house, they always make a return phone call when asked to do so. I guess I am very lucky; reading what others write about their experiences. We do have one doctor who asks" what do you think is wrong" which makes me want to answer "if I knew that I would not be here" but I suppose it is his way of finding out what I am thinking.

[badham]

I found that our GP was very good in the beginning over ten years ago sending my husband to the hospital for X ray and finding out that he had COPD but unfortunately over the years he has lost interest in his problems, he even said that he couldn't do anything more and we had the repeat prescriptions, and even when my husband asked if he could be seen by the lung consultant again as he hadn't seen him for nearly three years, and he felt that he was getting worse he said yes that's fine and then never bothered referring him even though we asked him again, he has since been in hospital twice in the last month, we even joined a local breath easy group, and asked if we could put a flyer up in the surgery and he replied we have more than enough self help groups and refused us to put it up. We have tried moving doctors but unfortunately we are on the borders of three counties and the doctor we wanted to move too wouldn't take him on saying that we were just out of the border for him, which is unfortunate because the lovely COPD nurse is under his surgery and she has been so helpful to my husband when he was in hospital and is the only one that has tried to even help him and understands his condition, but we are not allowed to she her and the nurse that does come out now and then doesn't know what goes on when he is in hospital and doesn't seem to care like the other nurse. So yes it is a postcode lottery when it comes to doctors, and yes there other doctors at the surgery but they all seem as bad.

[katieoxo60]

Just received a newsletter from the patients association which adds to the subject of GP services failing the patient. Apparently their current national survey reveals many shortcomings in emergency and out of hours services. Also that many patients have to wait more than 48 hours to see a Gp which explains the larger numbers of patients going to A&E or walk in centers.Thought this might be of interest to stone as it confirms some of the which findings too