1. The tick and the talk: do patients’ survey responses relate to their narrated experience of primary care consultations? Newbould J, Burt J, Davey, A, Llanwarne N, Elmore N, Campbell J, Roland M HSRUK Spring meeting, Exeter 2016

2. Patient experience

3. The IMPROVE study

4. Questionnaire completed by patients

5. Method - Video elicitation interviews Video of GP consultation + patient questionnaire [+ patient + researcher] = Video elicitation interview

6. Study participants Gender: Male Female 16 36 Age*: 18-24 25-34 35-44 45-54 55-64 65-74 75-84 85 or over 3 7 5 2 13 14 6 1 Ethnicity*: White British Other white Black African Asian Indian Other black 44 3 2 1

7. Questionnaire completed by patients

8. Disconnect between the ‘tick and the talk’

9. Factors which affected how participants completed the questionnaire 1.the patients’ relationship with the GP; 2.their expectation of the consultation; 3.perceived power asymmetries between patients and GPs.

10. 1. Relationship with GP Affiliation with the practice Affiliation with the GP …but I mean I’ve known him for - I mean he actually phoned when my mum died, you know. So that was nice of him, you know. Janice

11. 2. Expectations Expectations compared to other GPs Expectation of a particular GP Expectation of outcome from the consultation

12. 2. Expectations Expectations compared to other GPs Expectation of a particular GP Expectation of outcome from the consultation I, I worry that, like, yeah, that he’s just going to be really dismissive. So the fact that he gave me medicine meant that it was higher than I expect-, you know, I…like it was better than I expected it to be, em, but perhaps by the more standards it wasn’t amazing. Sarah

13. 3. Perceived power asymmetries Dependency Reluctance to criticise Explanations for the doctors behaviour Patients’ view of their own behaviour

14. I:What makes you say that you weren’t a very good patient? P:Because I was spending too much time…I wasn’t giving out information as clearly as I should do, and, you know, I had gone in with an agenda. Philip

15. Findings and implications Patients are inhibited in providing feedback to GPs through a questionnaire.

16. Findings and implications Patients are inhibited in providing feedback to GPs through a questionnaire. The factors we identified may, in part, account for the tendency of most patients to score consultations highly. Patients struggled to transform their perceived experiences into a representative quantitative evaluation of GP performance.

17. Findings and implications Patients are inhibited in providing feedback to GPs through a questionnaire. The factors we identified may, in part, account for the tendency of most patients to score consultations highly. Patients struggled to transform their perceived experiences into a representative quantitative evaluation of GP performance. Patient surveys, as currently used, are limited tools for enabling patients to feed back their views about consultations and hence for doctors to improve their practice.

18. www.cchsr.iph.cam.ac.uk www.cchsr.iph.cam.ac.uk/slides twitter.com/cchsr This work was funded by the National Institute for Health Research Programme Grants for Applied Research (NIHR PGfAR) Programme (RP-PG-0608-10050). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.