title: Determinants of the choice of GP practice registration in England: evidence from a discrete choice experiment.
abstract: There have been growing concerns that general practitioner (GP) services in England, which are based on registration with a single practice located near the patient's home, are not sufficiently convenient for patients. To inform the decision as to whether to change registration rules allowing patients to register 'out-of-area' and to estimate the demand for this wider choice, we undertook a discrete choice experiment with 1706 respondents. Latent class models were used to analyse preferences for GP practice registration comparing preferences for neighbourhood and non-neighbourhood practices. We find that there is some appetite for registering outside the neighbourhood, but this preference is not uniformly shared across the population. Specifically individuals who are less mobile (e.g. older people and those with caring responsibilities), or satisfied with their local practice are less likely to be interested in registering at a practice outside their neighbourhood. Overall, people feel most strongly about obtaining an appointment with a GP as quickly as possible. Respondents regarded weekend opening as less important than other factors, and particularly less important than extended practice opening hours from Monday to Friday. Assuming a constant demand for GP services, a policy encouraging GP practices to extend their opening hours during the week is likely to decrease the average patient waiting time for an appointment and is likely to be preferred by patients.
authors.affiliation: Policy Innovation Research Unit, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH London, United Kingdom. Electronic address: Mylene.Lagarde@lshtm.ac.uk.
authors.forename: Mylene
authors.initials: M
authors.lastname: Lagarde
authors.affiliation: Policy Innovation Research Unit, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH London, United Kingdom.
authors.forename: Bob
authors.initials: B
authors.lastname: Erens
authors.affiliation: Policy Innovation Research Unit, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH London, United Kingdom.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mays
mesh_terms: D002755:Choice Behavior; D004739:England; D058005:General Practitioners; D018166:Health Care Reform; D006297:Health Services Accessibility; D057240:Patient Preference; D011365:Professional Practice Location; D013222:State Medicine
keywords: Discrete choice experiment; England; Health care reform; Primary care