Domhnall MacAuley: Good news on UK primary care

Domhnall MacauleyOverwhelmed by the relentless tide of bad news stories about UK primary care? Well, this is a good news story. A webinar organised by The Commonwealth Fund (a US philanthropic organisation originally created by the Harkness Family to identify policies and practice that could improve the US health system) discussed findings from the latest International Health Policy Survey of Primary Care Physicians conducted in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, Sweden, the United Kingdom, and the United States. What did they find? The UK performed very well. While the UK spends 9.6% of its GDP on healthcare, less than its European neighbours, and less compared to 17.6% in the US, the findings were consistently positive in all areas.

Access is a priority for patients and government. Remarkably, the UK scores top on out of hours care. Also, 55% of doctors said that most of their patients (>80%) could get a same day or next day appointment—although France was way ahead on 86%. The UK does very well on opportunities to arrange an appointment online (40%) or request a repeat prescription online (56%),  bettered only by Norway and Sweden, and the Netherlands in the case of repeat prescriptions. Overall 97% of UK doctors use electronic medical records- similar to other northern European countries—but only 69% of US doctors do and, surprisingly, only 41% of Swiss doctors. In addition, the UK has the highest multifunctional IT capacity.

The UK comes top in using nurses in managing serious medical conditions, and UK GPs receive most information on their performance against targets and comparative performance with other practices. Looking at perceptions of patient barriers to specialist healthcare, I was surprised, in spite of relentless media stories, that UK patients have relatively good access to specialist care, but unsurprised at relatively poor communication from specialist colleagues.

What does this mean? UK GPs can take heart from these international comparisons. It was also very helpful, as part of the webinar, to hear Martin Roland’s UK perspective. He commented on the findings reflecting that, while UK access to healthcare seems relatively good, it may be more difficult to gain access to one’s own doctor and to book ahead—an unintended consequence of incentivisation.  He also questioned if increased nursing management of chronic conditions had reduced unplanned admissions and that it may, in some cases, have led to an increase. And, while the UK may be number one for clinical outcomes and patient satisfaction, he did not necessarily feel that incentives were a magic bullet.

UK general practice is doing well. It is rewarding to have the endorsement of this research from the Commonwealth Fund. And, we know that achievements through QOF are also widely recognised. While its great to have this international recognition, it would be nice to have some at home.

The full article is published in Health Affairs.

Domhnall MacAuley is primary care editor, BMJ.