Changes in Patient Experiences of Primary Care During Health Service Reforms in England Between 2003 and 2007

Campbell and colleagues conduct a rigorous assessment of changes in primary care patients’ experiences stemming from recent National Health Service reforms (1). Their results highlight an important tension between improving access to primary care and achieving continuity of primary care. The implementation of changes to the delivery of chronic illness care resulted in improved access to care scores for patients’ with chronic illness (3 points out of a 100-point scale). At the same time, continuity reports and ratings declined by approximately 7 and 5 points, respectively, for patients with chronic illness and a by a similar amount for general primary care patients.

Previous research has underscored the challenges and tradeoffs associated with employing interdisciplinary primary care team approaches (2). For example, a previous study indicates that patient-reported experiences of primary care were lower for patients who had less visit continuity with their primary care physician irrespective of whether or not the visits with other clinicians were with primary care team members (3). The Campbell study results underscore the importance of making interdisciplinary primary care teams “real” and “visible” to patients. Shared care arrangements need to be organized and presented to patients in ways that support the physician-patient relationship rather than distract from it.

It would be very interesting to explore the extent to which there is clinic-level variation in the access and continuity changes over time. For example, a practice that was more successful with implementing interdisciplinary primary care team approaches might be able to achieve access improvement without compromising continuity ratings. The teamlet model of primary care (4), for example, attempts to maximize the clinician and staff scope of practice using a relationship-centered approach that includes pre- and post-visit self-management support. Multidisciplinary primary care teams are a core feature of the patient-centered medical (PCMH) model (5) and more attention should be devoted to understanding the factors that enable their effectiveness.

References

1. Campbell SM, Kontopantelis E, Reeves D, et al. Changes in patient experiences of primary care during health service reforms in England between 2003 and 2007. Annals of Family Medicine 2010;8:499-506

2. Safran DG. Defining the future of primary care: what can we learn from patients? Annals of Internal Medicine 2003;138:248-255

3. Rodriguez HP, Rogers WH, Marshall RE, et al. Multidisciplinary primary care teams: effects on the quality of clinician-patient interactions and organizational features of care. Medical Care 2007;45:19- 27

4. Bodenheimer T, Laing BY. The teamlet model of primary care. Annals of Family Medicine 2007;5:457-461

5. Nutting PA, Miller WL, Crabtree BF, et al. Initial lessons from the first national demonstration project on practice transformation to a patient-centered medical home. Annals of Family Medicine 2009;7:254-260

Competing interests:   None declared