Appendix 1

Notes about how the General Practice Assessment Questionnaire (GPAQ) was developed

Some aspects of quality are best assessed by asking patients. We reviewed the literature to identify aspects of GP care which are most highly valued by patients. These include:

Availability and accessibility, including: availability of appointments, waiting times, physical access and telephone access.

Technical competence, including: the doctor’s knowledge and skills, and the effectiveness of his or her treatments.

Communication skills, including: providing time, exploring patients’ needs, listening, explaining, giving information and sharing decisions.

Organisation of care, including: continuity of care, and, the range of services available.

In order to assess these aspects of care we started from what we regarded as the best currently available questionnaire, the Primary Care Assessment Survey(PCAS) [i]^, [ii]^, [iii]^, [iv], which had been extensively validated in the

United States

. In collaboration with the Health Institute in Boston, we modified PCAS for use in British general practice. The modified questionnaire was called the General Practice Assessment Survey (GPAS). We have used GPAS in large studies in the

: and detailed research data on GPAS have been published [v] [vi] [vii] [viii] [ix].

For the new GP contract, we were asked to modify our original GPAS questionnaire, and have produced GPAQ. The main differences are that the new questionnaire is shorter. We have also produced two versions, one designed to be sent by post, and one designed to be given to patients after consultations in the surgery.

GPAQ focuses mainly on questions about access, inter-personal aspects of care, and continuity of care. The version designed to be completed after the consultation asks about are given by an individual doctor. These scores will be able to be used by GPs for their appraisals and revalidation folders. The postal version of GPAQ does not allow scores to be calculated for individual doctors. However, it does include questions about the practice nurses.

GPAQ is described in more detail in the manual which can be downloaded from the GPAQ website, www.gpaq.info.

[i] Gelb Safran D et al. The Primary Care Assessment Survey. Tests of data quality and measurement performance. Medical Care 1998; 36: 728-39

[ii] Gelb Safran D et al. Linking primary care performance to outcomes of care. Journal of Family Practice 1998; 47: 213-220.

[iii] Murray A, Gelb Safran D. The Primary Care Assessment Survey: a tool for measuring , monitoring and improving primary care. In: Maruish M (ed) Handbook of Psychological Assessment in Primary Care Settings. 1999. Lawrence Erlbaum Associates.

[iv] Taira DA et al. Asian American patient ratings of physician primary care performance. Journal of General Internal Medicine 1997; 12: 237-242

[v] Ramsay J, Campbell J, Schroter S, Green J, Roland M. The General Practice Assessment Survey (GPAS): tests of data quality and measurement properties. Family Practice 2000; 17: 372-379

[vi] Campbell JL, Ramsay J, Green J. Age, gender, socioeconomic, and ethnic differences in patients' assessments of primary health care. Qual Health Care. 2001 Jun;10(2):90-5

[vii] Bower P, Mead N, Roland M.What dimensions underlie patient responses to the General Practice Assessment Survey? A factor analytic study.Fam Pract. 2002 Oct;19(5):489-95.

[viii] Bower P, Roland M, Campbell J, Mead N. Setting standards based on patients’ views on access and continuity: secondary analysis of data from the general practice assessment survey. British Medical Journal 2003; 236: 258-60.

[ix] Bower P, Roland MO. Bias in patient assessments on general practice: General Practice Assessment Survey scores in surgery and postal responders. British Journal of General Practice 2003; 53: 126-128.