The impact and use of patient feedback in general practice
: A realist review

  • Deborah Baldie

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Patient feedback about practitioners’ and practices’ care is commonly used in UK general practice, sometimes by practitioner choice but often embedded in quality assurance and quality improvement programmes. Significant resources in NHS Scotland are spent gathering and reporting on patients’ reported experiences of care using a national GP patient experience survey – Better Together. There is however limited reference in current health policies to strong evidence demonstrating that this is an effective strategy to stimulate improvements in practice and patients’ experiences of care.
    This research study used realist review of existing literature to understand the impact of patient feedback at practice and practitioner level on patients’ experiences of general practice care, and realist evaluation of three general practices to understand how patient feedback is viewed and used for quality improvement in everyday general practice.
    Findings from the realist review indicate that there is little or no evidence that practice or practitioner level patient feedback leads to improvements in patients’ experiences of general practice care. The realist evaluation demonstrated great variance in how practice teams gather and respond to patient feedback and significant concerns about the validity of the Better Together survey. Variance in the strategies used to gather feedback and responses to it were predominantly influenced by collective staff beliefs about the quality of service they provided, their estimates of patients’ views of the service and their perceptions of patients’ preferences for providing feedback. While GPs mostly perceived that patients would be likely to tell someone in the practice when dissatisfied, interviews with patients indicated they had little understanding of how they could give feedback and an overall preference for doing this anonymously. One practice team was seen to initiate significant changes aimed at improving patients’ experiences but their ability to demonstrate improvements in experience were limited by changes in their workforce, conflicting externally set targets and methodological limitations of current patient experience measures. Further research is needed to understand how the findings from this study apply to general practice across Scotland and how practices can be best supported to use patient feedback to improve services.
    Date of Award2014
    Original languageEnglish
    SupervisorBruce Guthrie (Supervisor), Thilo Kroll (Supervisor), Vikki A. Entwistle (Supervisor) & Brian Williams (Supervisor)


    • Patient experience
    • General Practice
    • Feedback

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