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Big Health Debate

Problem definition:

Much information has been gathered during 2006 to understand Liverpool residents’ and key stakeholder groups’ opinions and attitudes towards the concept of outside-of-hospital health care provision. The combined findings have developed a number of key issues and trade-offs which PCT are keen to pursue and quantify to enable the formulation, implementation and evaluation of the outside-of-hospitals strategy.

Design:

Based on the four attributes of the outside-of-hospital health care provision, namely time spent travelling to their local GP practice, opening hours, range of services available and their preference for consulting their own GP:

  • Evaluating the relative importance of these four attributes among local residents
  • Establishing within each attribute, local residents’ preference for a particular level of service (services levels will be outlined in the section ‘Methodology’)
  • Gauging which service levels or combinations of service levels they would be prepared to trade-off to achieve what they consider to be important.
  • Ascertaining to what extent preferred service levels are favoured by certain demographic groups and rejected by others.
  • Deriving the ‘optimum’ mix of service levels to recommend to Liverpool Primary Care Trust to help them shape the future of outside-of-hospital health care provision in the City.

To satisfy the objectives of the research, we recommended a multivariate analytical technique known as Conjoint Analysis. Based on these findings, four service attributes were derived for further in-depth appraisal at Phase 3 of the Big Health Debate – opening hours, travelling time, GP access and services available. Each attribute has a number of service levels, which are outlined below:

Opening hours:

  • Current weekday opening hours (Mon-Fri 8am – 6.30pm)
  • Extended weekday opening hours (Mon-Fri 8am – 10pm)
  • Current weekday opening hours (Mon-Fri 8am – 6.30pm) and additional Saturday hours
  • Extended weekday opening hours (Mon-Fri 8am – 10pm) and additional Saturday hours

Travelling time:

  • Up to 15 minutes
  • 15 to 30 minutes
  • 30 to 45 minutes

GP seen:

  • Mostly see the same GP
  • Sometimes you will see a different GP to the usual one

Services available:

  • The Practice can provide advice, treatment and some clinics, but you may be required to attend elsewhere for investigations and tests;
  • The Practice can provide some extra services on site such as taking blood, lung and heart tests, more specialised clinics such as Warfarin clinics and some minor surgery. Other clinical services such as pharmacy and dentistry may be available; (some extra)
  • The Practice can provide extra services on site such as taking blood, lung and heart tests, more specialised clinics such as Warfarin clinics, some minor surgery and technical testing (e.g. scans and X-rays). Other clinical services such as pharmacy and dentistry may be available along with some social care services; (extra)

All possible combinations of these attributes, and levels within attributes, result in 72 permutations. The software we used for this analysis automatically generates a minimum number of permutations, in this case 24.

Analysing the data:

The conjoint analysis rates each of the attributes in terms of their relative importance. In order of importance, the four attributes are ranked as follows:

  • Travelling time from home to GP practice
  • Opening hours of surgery
  • Services available
  • Own GP availability

Further findings were as follows:

  • The current service level is ranked in 30th place out of the 72 possible service combinations
  • The most preferred option is extended availability including Saturdays, time spent travelling less than 15 minutes, same GP and all extra services, which is 6 times more popular than the current service level.
  • The model derives a combination perceived as the least preferred option – current availability, travel time 30 – 45 minutes, see a different GP, and advice, which is over 7 times less popular than the current service level.
  • The second most preferred option shows a desire to relinquish some services available – extra services are traded-off for some extra services to maintain extended hours of availability, short travelling time and same GP status. The 3rd most preferred option shows a desire to relinquish hours of availability to maintain short travelling time, same GP but at enhanced service levels.
  • The top nine most preferred options all had time spent travelling @ less than 15 minutes. To travel further (15 – 30 minutes), they would require enhanced availability and extra services whilst maintaining the same GP. This service combination is almost 4 times as attractive as the current service level combination.
  • The dominant factor governing combinations less desirable than the current service level is time spent travelling @ 30 – 45 minutes

Reflection on learning:

It appears that the most critical factor determining choice is the time spent travelling from their homes to their GP – the shorter the better. It appears that to achieve a better level of service from their GP, local residents may be prepared to travel a bit further, but would expect the practice to offer extended availability including opening on a Saturday, and to be able to see their own GP.

If one hypothesised that to double the utility derived from the current service, whilst not overburdening their own GP, the practice would have to offer extended opening hours, Saturday opening, and all extra services. If this was available, then Liverpool residents would be prepared to travel up to 30 minutes for this level of service. However, one must consider that this is not of appeal to all residents – there are certain demographic groups, for example older people and those with a long-term illness.

“The Murray Consultancy applied a ‘ground breaking’ methodology which has enabled us to plan the provision of Primary Health Care for the next few years.” John Prescott, Head of Evaluation and Planning, Liverpool Primary Care Trust.

 

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