Objective: To examine associations between the contract
and ownership type of general practices and patient experience
in England.
Design: Multilevel linear regression analysis of a national
cross-sectional patient survey (General Practice Patient
Survey).
Setting: All general practices in England in 2013–2014
(n ¼ 8017).
Participants: 903,357 survey respondents aged 18 years or
over and registered with a general practice for six months
or more (34.3% of 2,631,209 questionnaires sent).
Main outcome measures: Patient reports of experience
across five measures: frequency of consulting a preferred
doctor; ability to get a convenient appointment; rating of
doctor communication skills; ease of contacting the practice
by telephone; and overall experience (measured on
four- or five-level interval scales from 0 to 100). Models
adjusted for demographic and socioeconomic characteristics
of respondents and general practice populations and a
random intercept for each general practice.
Results: Most practices had a centrally negotiated contract
with the UK government (‘General Medical Services’
54.6%; 4337/7949). Few practices were limited companies
with locally negotiated ‘Alternative Provider Medical
Services’ contracts (1.2%; 98/7949); these practices provided
worse overall experiences than General Medical
Services practices (adjusted mean difference 3.04, 95%
CI 4.15 to 1.94). Associations were consistent in direction
across outcomes and largest in magnitude for frequency
of consulting a preferred doctor (12.78, 95% CI
15.17 to 10.39). Results were similar for practices
owned by large organisations (defined as having 20 practices)
which were uncommon (2.2%; 176/7949).
Conclusions: Patients registered to general practices
owned by limited companies, including large organisations,
reported worse experiences of their care than other
patients in 2013–2014.