Consumer-provider relations in family practitioner services.

Abstract

Introduction The majority of Family Practitioners in Malta, or private General Practitioners (GPs) as they are better known, work in solo practices, a minority work in husband-wife teams and a single group pf practitioners work in a group setting. The organisational size of the practice influences the operations of the practice and so dictates the practitioner's availability to his patients, the provision of continuity of care and the personal care provided by the practice. These three factors contribute to the development of an adequate doctor- patient relationship. This study investigates the effect of organisational size in private family practice on consumer satisfaction and the doctor- patient relationship. The study also explores patients' assessment and providers' perceptions of service provision in this sector as a whole.

Method A mixed methodology was used. The quantitative method measured patients' assessment of their practice using the General Practice Assessment Survey - GP AS 2. Multi stage sampling was employed to obtain samples of patients from samples of the three categories of practice. The qualitative procedure involved focus group interviewing of practitioners working in the three categories, eliciting how availability, continuity of care and personal care was provided for in each case. Practitioners' main concerns about

proposed change initiatives in this sector of healthcare provision and their perceptions of patients' assessment of the practice were also discussed.

Results Quantitative analysis 89% of patients were satisfied with the care provided by. their practice. Overall satisfaction was significantly related to continuity of care, availability and doctors' knowledge of patient. Patients of the solo practice reported the highest overall satisfaction with care and the highest doctors' knowledge of patient. Continuity of care was highest for patients of the couple practice whilst availability of care was highest for patients of the group practice. Qualitative analysis The solo and couple practitioners acknowledged that maintaining continuous patient availability was impossible. However the deep personal relationship that they had developed with their patients was very rewarding. These doctors were mostly resistant to any proposals for change in their current organisational set- up fearing mainly the financial implications of such a change. Doctors working in the group practice pointed out that their work arrangements encouraged flexibility for the practitioner whilst solving the availability issue. Their appointment, personal list system and computerised practice database solved the issues of continuity and personal knowledge of patient.

Discussion The high overall satisfaction with care endorses the validity of this sector of healthcare provision. The study identifies that the element of personal care provided by the practice contributes greatly to overall patient satisfaction so that the solo practice where the level of doctors' personal knowledge of patient was highest, is rated as most satisfying. However the strain that full time patient availability poses on the practitioner working alone is evident. The group practice set-up is an ideal alternative method of working that can enhance the quality of life of family practitioners. The high level of patient satisfaction with care in this practice confirms that this system of working is also acceptable to the local patient. The reluctance of doctors to change their current methods of service provision suggests that support rather than any drastic change to the current system is likely to be viewed favourably by the practitioners.

Recommendations Government is encouraged to support the private GP in his provision of personal care to their patient. The FPSU (Family Practitioners Services Unit) will coordinate all resource assistance required by practitioners. FPSU will be instrumental in the development and implementation of national guidelines and protocols of care to promote quality within all primary care practices. FPSU will also facilitate the ongoing education of the primary care physician promoting, amongst others, further research efforts into alternative working arrangements for local family practitioners.

Keywords: family practitioner, organisation of practice, patient satisfaction, doctor-patient relationship.