Patient and health care professional views of re-designing services in primary care

  • Nicola Mayes

Student thesis: Doctoral ThesisPhD


Background Increased pressure, rising demand and cost constraints have driven a need for radical service re-design in the NHS. To deliver re-design objectives it is necessary to understand how they are perceived by service users and providers.Aim To investigate the views of patients and health care professionals (HCP) on aspects of health policy and service re-design affecting primary care.Setting Patients and HCPs from one geographical area in England.Method Themes from phase one qualitative interviews were explored quantitatively using a questionnaire in phase two and a discrete choice experiment (DCE) in phase three. Factor analysis was used to explore HCP responses in phase two. In phase three the DCE was administered to explore patients‟ relative priorities of a range of attributes.Results HCPs had concerns that the Quality Outcomes Framework (QOF) detracted from the patient‟s agenda and did not improve health outcomes. GPs felt continuity of care was important Monday through Friday but were not keen on its provision out of hours. Neither did they feel nurses could run chronic disease management clinics without a GP present. Patients felt continuity could be provided by different HCPs for different conditionsPatients stated continuity of care and consultation duration were the most important attributes in a primary care service. However, in the DCE they prioritised both being seen on the day and by a GP over longer appointments. Patient preference to be seen by a GP may reflect the low uptake of non-medical prescribing in the area.Conclusion Continuity of care, while remarked as being important to both HCPs and patients, appears less important when weighted against other primary care service attributes. HCPs appear to want longer consultations whereas patients saw time as encompassing both the time to wait for an appointment and consultation length. For patients, the quality of the time with a HCP may be more important than its duration, additionally patients appear to want choice but not necessarily to choose.
Date of Award1 Nov 2011
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorMarjorie Weiss (Supervisor)


  • consultation duration
  • discrete choice experiment (DCE)
  • primary care
  • patient choice and preference
  • patient agenda
  • service re-design
  • quality outcomes framework (QOF)
  • non medical prescribing (NMP)
  • continuity of care

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