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closeIt's not GP access which is the culprit; rather poverty
Posted by davidlewisMD on 16 Jun 2013 at 20:25 GMT
Thank you for this paper which in my opinion does not support your hypothesis at all. I have explained why here http://t.co/hf1hLieq9U
In summary, The paper does support the Government’s assertion that General Practice and GPs are not working hard enough.
It is clear to me that the research is flawed and the main conclusion is unfounded.
RE: It's not GP access which is the culprit; rather poverty
tecowling replied to davidlewisMD on 24 Sep 2013 at 12:59 GMT
First, in response to the title of the comment, we do not suggest that access to general practice services is ‘the culprit’, nor am I sure what is meant by this term in this context. We appreciate that the demand for emergency department (ED) services is influenced by a wide range of factors, including patient, health service, and societal characteristics. The article focuses on access to general practice services to reflect our pre-specified hypothesis that greater access to these services would be associated with lower rates of self-referred discharged ED visits. The results of our analysis provide evidence to support this hypothesis, having controlled for the effects of deprivation and other potential confounding variables.
Second, contrary to a suggestion made in the comment, the article does not support the assertion that general practitioners are not working hard enough. We acknowledge the increased demand for general practice consultations in England [1] and, in the article, refer to the financial pressure currently facing general practice [2].
Third, the analysis is not based on responses to the General Practice Assessment Questionnaire (GPAQ). However, the validity and reliability of questions in the GP Patient Survey (GPPS), the results of which the analysis does use, must be considered. We acknowledge that patients’ responses to certain questions of the GPPS are subject to patients’ recall. This includes the question on which the main measure of access used in our analysis was based: ‘Were you able to see a doctor on the same day or in the next 2 weekdays the GP surgery or health centre was open [on your last attempt]?’ However, the existing evidence suggests that the practice-level variable derived from this question is strongly correlated with the percentage of first appointments not available within two working days (ρ=-0.66; P<0.001) and other measures of appointment availability [3]. Further, this variable has also demonstrated high practice-level reliability previously [4]. The technical annex to the GPPS in 2010-11, the period of study, can be found at http://www.gp-patient.co.....
1. Health and Social Care Information Centre. Trends in Consultation Rates in General Practice - 1995-2009. http://www.hscic.gov.uk/s... (accessed 6th September 2013).
2. Majeed A, Rawaf S, De Maeseneer J. Primary care in England: coping with financial austerity. British Journal of General Practice 2012;62:625-26.
3. Campbell JL, Carter M, Davey A, Roberts MJ, Elliott MN, Roland M. Accessing primary care: a simulated patient study. British Journal of General Practice 2013;63:e171-76. doi: 10.3399/bjgp13X664216 (accessed 23rd June 2013).
4. Roland M, Elliott M, Lyratzopoulos G, Barbiere J, Parker RA, Smith P, et al. Reliability of patient responses in pay for performance schemes: analysis of national General Practitioner Patient Survey data in England. BMJ 2009;339:b3851. doi: 10.1136/bmj.b3851 (accessed 23rd June 2013).