Operational failures in general practice: a consensus-building study on the priorities for improvement

Abstract

Background: System problems known as operational failures can impact greatly on the work of general practitioners (GPs), with negative consequences for patient and professional experience, efficiency, and effectiveness. Many operational failures are tractable to improvement, but which should be prioritised is less clear. Aim: To build consensus amongst GPs and patients on the operational failures to prioritise for improvement in NHS general practice. Methods: We conducted two modified Delphi exercises online between Feb-Oct 2021: one with NHS GPs, and a subsequent exercise with patients. Over two rounds, GPs rated the importance of a list of operational failures (n=45) that had been compiled using existing evidence. The resulting shortlist was presented to patients for rating over two rounds. Data were analysed using medians and interquartile ranges. Consensus was defined as 80% of responses falling within one value below and above the median. Results: Sixty-two GPs responded to the first Delphi survey, with 53.2% (n=33) retained through round two. This exercise yielded consensus on fourteen failures as a priority for improvement which were presented to patients. Thirty-seven patients responded to the first patient Delphi survey, with 89.2% (n=33) retained through round two. Patients identified thirteen failures as priorities. The highest scoring failures included inaccuracies in patients’ medical notes, missing test results and difficulties referring patients to other providers because of problems in referral forms. Conclusion: This study has identified the highest priority operational failures in general practice, and indicates where GPs and patients feel improvement efforts in general practice should be focused.