New research conducted by The University of Manchester has found that GPs' patients can feel alienated by lack of trust, impersonal processes and that this presents problems to improving their safety.
Most research into patient safety focuses on the systems operated by health services. This is particularly focused on hospitals. However, most encounters occur within GP services where relationships between doctor and patient can form a significant part of reaching successful diagnosis and treatment.
The team from the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (PSTRC) at NHS Greater Manchester and The University of Manchester decided to ask patients about their experiences with GPs in the context of their perception of safety.
They interviewed 38 people recruited from nine practices in urban, small town and city locations in North West England. They were asked to share their views about their practice and to put these in the context of their safety.
One of the main themes which developed was about trust and how much this affected their health. Several patients who were smokers were reluctant to tell their GP about their problems for fear of being perceived negatively. Others who had mental health problems were worried that doctors wouldn't take their physical symptoms seriously.
This patient told the interviewers: "[The GP] went in there thinking, 'This woman's got mental health issues. I'm going to completely discount anything she's saying because it's all in her head.' And she let that get in the way of her consultation with me."
Professor Stephen Campbell, Principal Investigator and Lead of the NIHR PSTRC, who led the study said: "Problems of patients' perceptions of how they are treated by their doctors can be a serious safety issue. If people are not attending surgeries or withholding information then they can be putting their health at risk.
"Some instances that we found demonstrate that these issues of psychological safety may outweigh fear of physical illness."
Alongside this research, the academics have been working with the Patients Association to collate a mixture of positive and negative views from patients in a series of 30 videos and audio recordings. In one, a patient talks about an experience with their GP in terms of an examination with a chaperone present which caused the patient not to return to the surgery.
Other patients interviewed in the research talked about being alienated by processes. The triage system operated by receptionists made some feel uncomfortable and other patients spoke of the difficulty in arranging appointments with the same doctor each time they visited - damaging the feeling of trust and continuity.
Professor Campbell said: "From just a small group of patients interviewed in this research and in the video testimony, we've been able to see several themes emerging. On the whole, patients trust their GP and have good experiences.
"However, it's clear that more attention needs to be paid by both doctors and patients to build good communication and trust between patients and their GPs. If it isn't, there is a danger that some people's fears may outweigh their concern for their own health."
The paper, 'Trust, temporality and systems: how do patients understand patient safety in primary care? A qualitative study,' was published in the journal Health Expectations. The research was funded by the National Institute for Health Research School for Primary Care Research.
The video series was made with the Patients Association.
Notes for editors
The video and audio are available from YouTube here: https:/
Interviews with Professor Campbell on request.
The full paper is available on request.
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The National Institute for Health Research
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (http://www.