title: Limited impact on patient experience of access of a pay for performance scheme in England in the first year.
abstract: BACKGROUND
  Improvement of access to general practice is a priority in England. In 2006/07 an annual national survey of patient experience of access was introduced, with financial incentives to practices based on the findings of the survey among their own patients.
  
  
  OBJECTIVE
  To describe changes in patient experience of access over the first two years of the survey and incentive scheme, and identify respondent and practice characteristics associated with patient experience of access.
  
  
  METHODS
  The study included 222 general practices in the east of England, which had completed the access survey in 2006/07 and 2007/08. We compared proportions of patients reporting satisfaction with different aspects of access in each year. In explanatory regression models, we investigated the associations between improvement of reported access and respondent and practice characteristics.
  
  
  RESULTS
  There were some small improvements in reported access between the two surveys, although satisfaction with opening hours declined marginally. The explanatory analysis showed that larger practices, a higher proportion of respondents from ethnic minority groups, and higher deprivation were associated with patient reports of worse access. These variables and practice response rates did not explain the amount of change between the two years.
  
  
  CONCLUSIONS
  The launch of the incentive scheme was not followed by convincing improvements in patient experience of access. Practices with deprived populations or with a high proportion of ethnic minority survey respondents are perceived as offering worse access, were not more likely to achieve improvements, and additional support should be considered to help these practices.
authors.affiliation: Department of General Practice, University Medical Centre Groningen, The Netherlands.
authors.forename: Ryanne W M
authors.initials: RW
authors.lastname: Addink
authors.forename: M John
authors.initials: MJ
authors.lastname: Bankart
authors.forename: Ged M
authors.initials: GM
authors.lastname: Murtagh
authors.forename: Richard
authors.initials: R
authors.lastname: Baker
mesh_terms: D000368:Aged; D004739:England; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000191:economics / Q000458:organization & administration*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care; D012044:Regression Analysis; D012052:Reimbursement, Incentive / Q000191:economics*; D013997:Time Factors