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.
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? 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.'
- Find out how to complain if you're unhappy about your GP surgery
- Does our research fit with your own experience? Join the Conversation
- Concerned about future health and care needs? Explore long-term care options