Polyclinics and super-surgeries 'likely to undermine trust and cooperation between patients and their GPs'
Research highlights the value of continuity in GP-patient relationships
Issued 23 September 2008
Research carried out at the University of Leicester by Carolyn Tarrant and Tim Stokes, of the Department of Health Sciences, and Andrew Colman, of the School of Psychology, suggests that polyclinics and super-surgeries are likely to undermine trust and cooperation between patients and their GPs.
The research, which is scheduled to be published later this year in the British Journal of General Practice, explored aspects of GP-patient relationships over time. It is published on line on Monday September 22. The findings showed that past experience with a particular GP and expectation of continuing care from the same GP in the future are associated with patient trust and cooperation.
Planned changes to the delivery of primary care in the UK are likely to reduce continuity of care. The new polyclinics and super-surgeries will be staffed by large numbers of doctors, and patients will be unlikely to see the same doctor on every visit.
The research findings are in line with predictions from behavioural game theory. Experiences of past cooperation and expectations of future cooperation -- what game theorists call the “shadow of the future” -- are known to promote trust in continuing relationships of other kinds.
Dr Tarrant commented: “The government is setting up numerous polyclinics, super-surgeries, and walk-in centres all over the country. I’m sure they will have various benefits for patients and GPs, but they are bound to reduce continuity of care, and our research shows that this may lead to a decline in patient trust. If patient trust declines, then medical outcomes may be adversely affected.”
The research involved a survey carried out at three Leicestershire (UK) general practices. A random sample of 279 primary care patients who had consulted their GPs over the previous two weeks were posted a questionnaire measuring experiences of trust, interpersonal care, and continuity. Data were analysed using multiple linear regression analysis. Sub-samples of 20 patients and 12 GPs were then interviewed in depth, and the interviews were analysed using qualitative methods.
Patients’ judgements of the GPs’ interpersonal care, past experience of cooperation, and expectation of continuing care from the same GP were all found to be independent predictors of patient trust. The findings highlight the value of continuity in GP-patient relationships.
Dr Tarrant said, "My research showed that when people saw a doctor they felt had treated them well in the past, and when they expected to see that particular doctor again in the future, they had higher trust in the doctor and reported being more likely to follow through with the advice or treatment that the doctor gave them.
"There's a lot of concern that polyclinics will mean a loss of continuity of care for patients - people will be less likely to get see the same GP for most of their care.
"My study shows that seeing the same doctor over time can have real benefits for patients, so I think it's important that in designing primary care for the future, continuity of care is retained as a core principle, partly because of the opportunities it gives for doctors and patients work together more effectively.
"We should be looking at ways of providing primary care that mean people can still build relationships of trust with their doctor, as well as making sure people have good access to a doctor and experience coordinated services."
The study was funded by The University of Leicester School of Medicine Research Committee.
Dr Carolyn Tarrant
Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
Phone: +44 (0)116 229 7251