Table 1.

Perceived challenges to credibility of feedback from the GP Patient Survey

General challenge	Specific issues
Practical aspects of the survey
Responders are not representative	Over-representation of infrequent attenders and people with extreme views; under-representation of those with literacy/language difficulties, older people, single parents, and busy working adults
Hidden assumptions	Questions on care planning and shared decision making assume that all patients want written documents about their treatment and involvement in their own care
Order of questions	Important questions about consultations occur too late in the questionnaire, when the responder’s concentration may be reduced
Important questions missing	No questions about whether patients understand their medical condition, side-effects of drugs, options open to them, and long-term consequences
Low response rate	Not a ‘fair reflection’ of all patients
Questionnaire is too long	Systematic exclusion of certain groups with less time on their hands
Leading questions	These create artificially low scores, especially about surgery opening times
Interpretation of scores
Contradictory scores	Questions about immediate access/seeing a preferred doctor deal with conflicting elements of care; it is difficult for a practice to score well on both
Unclear meaning of scores	High scores for low waiting times may not indicate good-quality service; giving patients more time may indicate more successful care
Limitation of numerical data	Numerical data alone is insufficient or even misleading, as the context of responses is unclear. Has limited potential to inform improvements
Individual feedback	Feedback is at practice level and gives no indication about individual practitioners. It is, therefore, difficult to identify areas for improvement
Confounding factors	Results are presented out of context, ignoring level of affluence or deprivation, cultural differences in patients’ expectations, incidence of chronic disease, staff illness, size of practice, number of part-time staff
No new information	The survey does not provide information that is not already known through patients’ comments, in-house surveys, or formal complaints
Political influences
Survey is a political tool	Patient-experience surveys are a political tool designed for political purposes
Political motives introduce bias	Content of the questionnaire is influenced by political aims, some important questions may be overlooked
Link between GP Patient Survey and QOF payments is unacceptable	Basing pay for performance on patient surveys is punitive and unjust
Patients have unrealistic expectations	Successive governments have misled patients into having unrealistic expectations of primary care, but additional funding has not been provided
Improving services does not lead to improved scores	Attempts to improve services made in response to the survey have not improved scores, casting doubt on the credibility of the survey

QOF = Quality and Outcomes Framework.