Reported clinical quality plays an important role in determining which family doctor practice people in England choose. That is the central finding of research by Rita Santos, Hugh Gravelle and Carol Propper, published in the March 2017 issue of the Economic Journal.
Their study, which analyses the choices of family doctor made by around 3.5 million people living in the East Midlands, finds that people prefer practices that have higher clinical quality, that are closer to home, that have more female doctors and that have more doctors trained in the UK.
The researchers note that many of the reforms of UK public services over the last 20 years have sought to give the users of these services a choice of provider with the intention that this will drive up the quality of care. But such reforms will work only if quality affects choice of provider. This study, undertaken at the Universities of York and Bristol and Imperial College London, set out to test this crucial pre-requisite.
Family doctor practices provide primary care and control access to non-emergency hospital care, the quality of their clinical care is measured and published, and this care is free. In this setting, clinical quality should affect choice.
But there is a widespread belief that clinical quality is either less important to patients than other aspects of the service – for example, opening hours or the range of services provided – or that while patients do care about quality, the measures of quality that are available don''t enable them to distinguish between good and bad quality – or that there is no choice because doctors don''t allow new patients to join their lists.
In fact, this study finds, clinical quality is important in determining which family practice people choose. A higher rating on the government''s measure of practice performance (known as the QoF) increases the number of patients who choose the practice.
Other aspects of care are also important. Unsurprisingly, these include the distance between where people live and the practice, the age of the doctors, the gender of the doctors and where the doctors trained. People prefer practices that have higher clinical quality, that are closer to home, that have more female doctors and that have more doctors trained in the UK.
The researchers also find that these results are not affected by whether practices temporarily close their lists to new patients because they are over-subscribed. Put another way, people still care about quality even if their first choice is denied to them.
Most people have similar ratings of quality relative to other aspects of care. But the researchers find that younger men care more about the distance to their practice and less about quality than other people. Younger men on average use GP services less than other groups, so it may well be that quality is less important to them than accessibility.
The researchers comment:
''Our results suggest that individuals do value the clinical quality of care and make their choices based, in part, on this. This implies that the public policy aim of increasing choice of family doctor may help to drive up standards.''
''Our findings also suggest that practices with poor published clinical quality will, over time, lose patients relative to those that are similar in terms of location and their staffing, but have higher published clinical quality.''
''Publishing greater information on clinical quality will help patients make choices.''
''Does Quality Affect Patients'' Choice of Doctor? Evidence from England'' by Rita Santos, Hugh Gravelle and Carol Propper is published in the March 2017 issue of the Economic Journal. Rita Santos and Hugh Gravelle are at the University of York. Carol Propper is at Imperial College London and was formerly at the University of Bristol''s Centre for Market and Public Organisation (CMPO), where this research was first published.
