Which? investigation reveals poor GP practiseHuge variability in diagnosis identified on visits

16 March 2013




Which? undercover investigation reveals huge variability in GP consultations.

When Which? sent specially trained undercover fieldworkers presenting with one of three conditions into 30 GP practices across England, a worrying 12 visits out of 30 were deemed poor.

Our expert panel rated 14 visits good, with four satisfactory.

GP undercover video

A panel of experts – which included three practising GPs with expertise including research and clinical commissioning – found vast differences in the quality of these visits. 

Watch our GP investigation video to see the undercover footage that shows just how much difference there is between a good visit and a poor visit.


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Video transcript

Are some GPs failing patients? We have found huge variation in the quality of GP visits. Of the 30 GPs in England we visited in our undercover investigation. Twelve of our visits were rated poor or very poor by an expert panel that included 3 GPs. Perhaps, unsurprising, was the significant correlation between the length of the visit and its quality rating.

Some GP's were ending consultations with our undercover field workers, after as little as three minutes. 

Five minutes into the consult
and the patient has told the GP that he needs sleeping tablets. We know that suicide risk increases in middle-aged men yet the GP hasn't asked a single question about why her patient isn't sleeping, or found out that he is very depressed and asked him about his mental health. 

The GP turns away
as she gives him a week's supply tablets, ignoring what he is saying about how he is feeling, with no followup visits suggested. 

"I'm tired and
I've gotten worked up, can't relax and I can't sleep again I'm just feeling really uptight at the moment." 

Every one of our poor
visits was 8 minutes long or less. Our shortest was just 3 minutes. 

Look at the contrast with this G
P, his thorough questions and caring manner. 

"Because from what you're
screaming to me right now, is that it's a man that I'm concerned about because, you know you just look down in the dumps. And just, to me, looking at you, you just look like a person who's just crying out for help.

"You did the right thing coming here today, because you 're a young chap. You're only 44. You've got a whole lot of life ahead of you, whole lot of life ahead of you.

Patient: "Yeah, I just can't see it at the moment"

GP: " Yeah Ineed to help you to see that, because you've got loads. So, it's good that you've come today, and that you realize that you need help. I want to see you again, just to see how you're doing. Can I see you on Thursday? Because you're only close by aren't you?

"Can I see you Thursday? Then you can tell me anything else that you want to, twenty past 9. Is that ok?"

What is
causing this variation in practice? 

"GPs really strive to provide
high quality care for their patients. But the pressures on their job have grown tremendously. We know that not every patient gets the same quality of experience and that there is a variation in the time and quality of GP consultations.

"Many GP's report wanting to spend more time with their patients, but few use data on patient experiences to reflect on performance with their peers or to seek to improve quality as a result. This needs to change." 

Half of GPs don't review
the data given by patients of their practice on the National Patient Survey.

Nearly half don't even publicise their complaints procedure. 

58 percent of people
who experienced a problem related to a GP over the last 12 months told us that they did not complain. 

Twenty-seven percent didn't complain because
they thought complaining could lead to worse service or treatment. 

Fifty-one percent didn't complain because
that nothing would be done.

We want the patients to be at the heart of every consultation with GPs using the feedback they routinely get to improve care. 

Let us know what you think.
Are some GPs patients? Does your GP ask for feedback? Join the Which conversation. 

Which? also uncovered a significant correlation between the length of the visit and its quality rating. Every visit rated ‘poor’ took less than eight minutes. While only two visits rated ‘good’ (out of 14) were less than 10 minutes long. 

The shortest appointment took just three minutes – it was rated poor by our experts. Ten-minute visits are the norm, although the time will vary according to patient need.

Correct GP treatment

The scenarios used by the trained undercover fieldworkers who visited as patients included: 

  • a woman at possible risk of a stroke because of her medication; 
  • a man wanting sleeping pills to cope with undiagnosed depression; 
  • and a woman with symptoms that could point to an underlying heart problem. 

The patient with symptoms of depression wasn’t asked about his mental health on six out of his 10 visits.

In our snapshot research, all but one of the ‘poor’ consultations fell down on history-taking – the doctor didn’t ask good enough questions to decide the right course of action for the patient.

This takes time, but the implications could be serious. As in the case of a woman leaving the surgery at needless (albeit low) risk of a stroke because no connection was made between the contraceptive pill and the symptoms of a new, severe migraine.

Patient knows best

Patients often recognise when they’re being short-changed by their doctor. Our undercover patients (who were not GPs) told us they felt fairly or very well listened to on all 14 visits rated ‘good’ by our panel. But they felt well listened to on only two of the 12 ‘poor’ visits.

Patient feedback is vital in monitoring the quality of GP practices. Judging by what our undercover fieldworkers told us, patients can often tell a good consultation from a bad. 

But half of the UK’s GPs don’t actually review the feedback given by their patients on the national patient survey and nearly half don’t publicise their complaints procedure, a Which? survey has discovered.

Even when GP practices do read their feedback, they don’t always use it. A quarter of GPs don’t discuss patient feedback at staff meetings, and 40% of them don’t change policies and procedures based on the feedback they received.

Which? says

Which? executive director Richard Lloyd said:

'GPs work hard to do their best for their patients, but it’s not right that the same patient, with the same symptoms, could receive such a vastly different experience. GPs should be giving every patient the high-quality service we found offered to some in our research.

'The Government is committed to making sure that the NHS is better at listening to what patients want. But our findings show that this is far from reality across all parts of the health service. The changes taking place in the NHS from April, with a new regulator and patient groups being set up, must be an opportunity for the Government to make sure patients’ needs are being heard and acted upon.'

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