General Practice Choice Pilot Evaluation

Between April 2012 and March 2013, in four Primary Care Trust (PCT) areas in England – Westminster, Manchester, Salford and Nottingham – patients were able to access a General Practitioner (GP) practice away from the area in which they lived, either in place of, or in addition to, their ‘home’ practice.

The evaluation examined:

• the level of demand for GP choice;

• the experiences of care received by patients; and

• the impact on pilot practices and commissioners of GP services.

The evaluation comprised: 

• Interviews with patients in the pilot 

• Interviews with practice staff and PCT staff involved in the pilot 

• A postal survey of all patients involved in the pilot (modelled on the GP patient survey which is undertaken twice a year by NHS England so the results could be compared) 

• A web survey of staff from all pilot practices 

• Analysis of administrative data 

• A discrete choice experiment to explore which attributes patients valued when choosing a GP practice. 

There were 1108 out of area (OoA) registered patients and 250 day patients at the 43 volunteer practices that participated in the pilot. 
 
There were four types of OoA registered patients: 

1. Patients who had moved house, but did not want to change their practice (26%) 
2. Patients who had chosen their practice for convenience (33%) 
3. Patients who were new to the area and had registered with a pilot practice, 
   but lived outside the practice’s catchment area (24%) 
4. Patients who were dissatisfied with their previous practice or chose their new practice for specific services or to see a particular GP (14%). 

Most OoA registered patients were positive about the scheme. Convenience and continuity of care after moving house appeared to be the main benefits perceived.

The scheme also suited patients with long commutes. 

There were three types of day patients: 

1. Patients motivated by convenience related to their lifestyle or place of work (69%) 
2. Patients who could have been registered as Temporary Residents (19%) 
3. Patients who wanted to see a particular GP or obtain care that their registered practice did not provide, or who were not satisfied with the quality of care at their registered practice (8%). 

Most day patients expressed positive views of the scheme for its convenience to their work or lifestyle and ease of making an appointment. The scheme suited patients wishing to remain registered with a practice near their homes. 
 
PCT managers had some concerns related to the risk that, with out-of-area registration, practice populations could become more socio-economically segregated. Another concern for the future, if more patients found themselves living outside the area where their general practice was located, relates to making and managing referrals and their costs. Practice staff were broadly (though not uniformly) positive about extending the out of area registration aspect of the scheme. 
 
The discrete choice experiment showed that a minority of the population would be willing to register with a practice outside their neighbourhood provided that there was such a practice available that was more convenient for them. However, there was considerable heterogeneity in preferences. Some sub-groups, either because they are less mobile (e.g. older people and those with caring responsibilities), or because they are satisfied with their local services, were far less interested in registering at a practice outside their neighbourhood. In choosing a practice, people feel most strongly about obtaining an appointment with a GP as quickly as possible. Most people did not regard weekend opening (Saturday and Sunday) as important in determining their choice of practice. Some people, in particular those who worked and older people, felt strongly about having responsive services that had extended opening hours, whether it meant that they had to register with a practice locally or not. These findings are consistent with the results from the surveys of patients using the pilot.