title: Extended opening hours and patient experience of general practice in England: multilevel regression analysis of a national patient survey.
abstract: The UK government plans to extend the opening hours of general practices in England. The 'extended hours access scheme' pays practices for providing appointments outside core times (08:00 to 18.30, Monday to Friday) for at least 30 min per 1000 registered patients each week.
  
  
  
  To determine the association between extended hours access scheme participation and patient experience.
  
  
  
  Retrospective analysis of a national cross-sectional survey completed by questionnaire (General Practice Patient Survey 2013-2014); 903 357 survey respondents aged ≥18 years old and registered to 8005 general practices formed the study population. Outcome measures were satisfaction with opening hours, experience of making an appointment and overall experience (on five-level interval scales from 0 to 100). Mean differences between scheme participation groups were estimated using multilevel random-effects regression, propensity score matching and instrumental variable analysis.
  
  
  
  Most patients were very (37.2%) or fairly satisfied (42.7%) with the opening hours of their general practices; results were similar for experience of making an appointment and overall experience. Most general practices participated in the extended hours access scheme (73.9%). Mean differences in outcome measures between scheme participants and non-participants were positive but small across estimation methods (mean differences ≤1.79). For example, scheme participation was associated with a 1.25 (95% CI 0.96 to 1.55) increase in satisfaction with opening hours using multilevel regression; this association was slightly greater when patients could not take time off work to see a general practitioner (2.08, 95% CI 1.53 to 2.63).
  
  
  
  Participation in the extended hours access scheme has a limited association with three patient experience measures. This questions expected impacts of current plans to extend opening hours on patient experience.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Cowling
authors.affiliation: Centre for Health Policy, Imperial College London, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Harris
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
mesh_terms: D004739:England; D058006:General Practice / Q000458:organization & administration*; D058005:General Practitioners; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D011216:Practice Management, Medical; D011320:Primary Health Care; D012044:Regression Analysis; D011795:Surveys and Questionnaires
keywords: General practice; Health policy; Health services research; Patient satisfaction; Primary care