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1.  The relationship between social deprivation and the quality of primary care: a national survey using indicators from the UK Quality and Outcomes Framework 
Background
The existence of health inequalities between least and most socially deprived areas is now well established.
Aim
To use Quality and Outcomes Framework (QOF) indicators to explore the characteristics of primary care in deprived communities.
Design of study
Two-year study.
Setting
Primary care in England.
Method
QOF data were obtained for each practice in England in 2004–2005 and 2005–2006 and linked with census derived social deprivation data (Index of Multiple Deprivation scores 2004), national urbanicity scores and a database of practice characteristics. Data were available for 8480 practices in 2004–2005 and 8264 practices in 2005–2006. Comparisons were made between practices in the least and most deprived quintiles.
Results
The difference in mean total QOF score between practices in least and most deprived quintiles was 64.5 points in 2004–2005 (mean score, all practices, 959.9) and 30.4 in 2005–2006 (mean, 1012.6). In 2005–2006, the QOF indicators displaying the largest differences between least and most deprived quintiles were: recall of patients not attending appointments for injectable neuroleptics (79 versus 58%, respectively), practices opening ≥45 hours/week (90 versus 74%), practices conducting ≥12 significant event audits in previous 3 years (93 versus 81 %), proportion of epileptics who were seizure free ≥12 months (77 versus 65%) and proportion of patients taking lithium with serum lithium within therapeutic range (90 versus 78%). Geographical differences were less in group and training practices.
Conclusions
Overall differences between primary care quality indicators in deprived and prosperous communities were small. However, shortfalls in specific indicators, both clinical and non-clinical, suggest that focused interventions could be applied to improve the quality of primary care in deprived areas.
PMCID: PMC2078188  PMID: 17550668
primary care; quality indicators; social deprivation
3.  Eliciting patients' concerns: a randomised controlled trial of different approaches by the doctor 
Background: Although a ‘patient-centred’ approach to general practice consultation is widely advocated, there is mixed evidence of its benefits.
Aim: To measure the costs and benefits of using a prompt to elicit patients' concerns when they consult for minor illness.
Design of study: An open randomised controlled trial.
Setting: Four training semi-rural general practices in the south-east of the United Kingdom.
Method: Patients identified during the first part of the consultation as having a self-limiting illness were randomised to a second part of the consultation that was conducted ‘as usual’ or involved a written prompt to elicit the patient's concerns. After each consultation the doctor noted the diagnosis and the consultation length and the patient self-completed a questionnaire containing measures of satisfaction, enablement and anxiety.
Results: One hundred and ten patients were studied. Patients in the elicitation group reported a small but significant increase in the ‘professional care’ score of the consultation satisfaction questionnaire (88.2 versus 80.9, mean difference = 7.3, 95% confidence interval = 2.0 to 12.6) but no other benefits were detected. Consultations in the elicitation group, however, were longer by about a minute.
Conclusion: Given the pressures on consultation time in general practice there must be questions about the practical value of eliciting patients' concerns if the benefit of doing so is small and the cost large.
PMCID: PMC1326066  PMID: 15353051
consultation; general practice; patient concern; patient satisfaction; self-limiting illness; time
4.  What constructs do GPs use when diagnosing psychological problems? 
Background: The mismatch between general practice and psychiatric diagnosis of psychological problems has been frequently reported.
Aims: To identify which items from the 28-item general health questionnaire (GHQ-28) best predicted general practitioners' (GPs') own assessments of morbidity and the proportion of time spent in consultations on psychological problems.
Design of study: Cross-sectional survey.
Setting: General practice in southeast London.
Method: Eight hundred and five consultations were carried out by 47 GPs, during which patients completed the 28-item GHQ, and doctors independently assessed the degree of psychological disturbance and the proportion of the consultation spent on psychological problems. Data from the consultations were entered into a stepwise multiple regression to determine the best GHQ item predictors of GP judgements.
Results: GPs' assessments of the degree of psychological disturbance were best predicted using only seven GHQ items, and their perceptions of the proportion of time spent on psychological problems were predicted by only four items. Items were drawn predominantly from the ‘anxiety and insomnia’ and ‘severe depression’ sub-scales, ignoring the ‘somatic’ and ‘social dysfunction’ dimensions.
Conclusion: In diagnosing psychological disturbance GPs ignore major symptom areas that psychiatrists judge important.
PMCID: PMC1324836  PMID: 15296555
consultation; mental disorders; psychiatric diagnosis; questionnaire
5.  Partnership effects in general practice: identification of clustering using intra-class correlation coefficients. 
Although most United Kingdom general practitioners (GPs) work together in a shared professional arrangement termed 'partnership', little is known about the nature of such partnerships. We report the results of a survey of 61 general practice partners in 15 group practices and their attitudes to prescribing and managerial issues related to participation in a commissioning group. Intra-class correlation coefficients (ICCs) were used to explore how these individually held attitudes clustered within groups. The low ICCs found for attitudes relating to prescribing issues suggested that GPs acted individually in this respect, while, in contrast, responses to managerial questions clustered strongly in partnerships, implying that managerial attitudes were more likely to be shared within partnerships. The ICC statistic is a useful tool for exploring homogeneity and heterogeneity within general practice partnerships.
PMCID: PMC1314729  PMID: 14702906

Results 1-5 (5)