Operational failures in general practice: a consensus-building study on the priorities for improvement

Abstract

Background: System problems, known as operational failures, can greatly affect the work of GPs, with negative consequences for patient and professional experience, efficiency, and effectiveness. Many operational failures are tractable to improvement, but which ones should be prioritised is less clear.

Aim: To build consensus among GPs and patients on the operational failures that should be prioritised to improve NHS general practice.

Design and setting: Two modified Delphi exercises were conducted online among NHS GPs and patients in several regions across England.

Method: Between February and October 2021, two modified Delphi exercises were conducted online: one with NHS GPs, and a subsequent exercise with patients. Over two rounds, GPs rated the importance of a list of operational failures (n = 45) that had been compiled using existing evidence. The resulting shortlist was presented to patients for rating over two rounds. Data were analysed using median scores and interquartile ranges. Consensus was defined as 80% of responses falling within one value below and above the median.

Results: Sixty-two GPs responded to the first Delphi exercise, and 53.2% (n = 33) were retained through to round two. This exercise yielded consensus on 14 failures as a priority for improvement, which were presented to patients. Thirty-seven patients responded to the first patient Delphi exercise, and 89.2% (n = 33) were retained through to round two. Patients identified 13 failures as priorities. The highest scoring failures included inaccuracies in patients' medical notes, missing test results, and difficulties referring patients to other providers because of problems with referral forms.

Conclusion: This study identified the highest-priority operational failures in general practice according to GPs and patients, and indicates where improvement efforts relating to operational failures in general practice should be focused.

Keywords: Delphi technique; general practice; operational failures; organisational efficiency; primary health care; quality improvement.

Figure 1.

Overview of the data collection steps throughout the study.

Figure 2.

Number of patient participants recruited and retained (n/n) by each local Healthwatch group. ^aOne responder did not indicate which Healthwatch group they were part of.