Sociodemographic inequalities in patients' experiences of primary care: an analysis of the General Practice Patient Survey in England between 2011 and 2017

Abstract

Objective: Younger people, minority ethnic groups, sexual minorities and people of lower socioeconomic status report poorer experiences of primary care. In light of NHS ambitions to reduce unwarranted variations in care, we aimed to investigate whether inequalities in patient experience of primary care changed between 2011 and 2017, using data from the General Practice Patient Survey in England.

Methods: We considered inequalities in relation to age, sex, deprivation, ethnicity, sexual orientation and geographical region across five dimensions of patient experience: overall experience, doctor communication, nurse communication, access and continuity of care. We used linear regression to explore whether the magnitude of inequalities changed between 2011 and 2017, using mixed models to assess changes within practices and models without accounting for practice to assess national trends.

Results: We included 5,241,408 responses over 11 survey waves from 2011-2017. There was evidence that inequalities changed over time (p < 0.05 for 27/30 models), but the direction and magnitude of changes varied. Changes in gaps in experience ranged from a 1.6 percentage point increase for experience of access among sexual minorities, to a 5.6 percentage point decrease for continuity, where experience worsened for older ages. Inequalities in access in relation to socio-economic status remained reasonably stable for individuals attending the same GP practice; nationally inequalities in access increased 2.1 percentage points (p < 0.0001) between respondents living in more/less deprived areas, suggesting access is declining fastest in practices in more deprived areas.

Conclusions: There have been few substantial changes in inequalities in patient experience of primary care between 2011 and 2017.

Keywords: General Practice Patient Survey, longitudinal, patient experience.

Figure 1.

Trends in inequalities in overall patient experience. Note: The y axis on Figure 1 presents adjusted patient experience for the overall experience in primary care scaled on a 0-100 scale, with 100 being the most positive experience and 0 being the least, rescaled from the Likert response options in the original survey tool. Changes over time are presented for each group for years 2012-2017, and the overall changes (or not) in inequalities can be seen visually on this figure and correspond to the values presented in Table 3, column 1.

Figure 2.

Trends in inequalities in continuity. Note: The y axis on Figure 2 presents adjusted patient experience for continuity scaled on a 0-100 scale, with 100 being the most positive experience and 0 being the least, rescaled from the Likert response options in the original survey tool. Changes over time are presented for each group for years 2012-2017, and the overall changes (or not) in inequalities can be seen visually on this figure and correspond to the values presented in Table 3, column 5.

Figure 3.

Comparison of national and within practice trends in inequalities in access by socio-economic status. Note: The y axis on Figure 3 presents adjusted patient experience for the two access measures (telephone, top two panels and overall, bottom two panels) on a 0-100 scale, with 100 being the most positive experience and 0 being the least, rescaled from the Likert response options for each of the questions in the original survey tool. Changes over time are presented for each group for years 2012-2017. For telephone access changes in inequalities are presented in Table 3, column 4 (within practice) and Supplement Table S4, column 4 (national). Full model outputs are presented in Supplement Table S8 (telephone) and Supplement Table S9 (overall).