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Understanding ethnic and other socio-demographic differences in patient experience of primary care: evidence from the English General Practice Patient Survey
  1. G Lyratzopoulos1,
  2. M Elliott2,
  3. J M Barbiere1,
  4. A Henderson1,
  5. L Staetsky3,
  6. C Paddison1,
  7. J Campbell4,
  8. M Roland1
  1. 1Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
  2. 2Rand Corporation, Santa Monica, California, USA
  3. 3Rand Europe, Westbrook Centre, Cambridge, UK
  4. 4Peninsula Medical School, Exeter, UK
  1. Correspondence to Dr G Lyratzopoulos, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK; gl290{at}


Background Ethnic minorities and some other patient groups consistently report lower scores on patient surveys, but the reasons for this are unclear. This study examined whether low scores of ethnic minority and other socio-demographic groups reflect their concentration in poorly performing primary care practices, and whether any remaining differences are consistent across practices.

Methods Using data from the 2009 English General Practice Patient Survey (2 163 456 respondents from 8267 general practices) this study examined associations between patient socio-demographic characteristics and 11 measures of patient-reported experience.

Findings South Asian and Chinese patients, younger patients, and those in poor health reported a less positive primary care experience than White patients, older patients and those in better health. For doctor communication, about half of the overall difference associated with South Asian patients (ranging from −6 to −9 percentage points) could be explained by their concentration in practices with low scores, but the other half arose because they reported less positive experiences than White patients in the same practices. Practices varied considerably in the direction and extent of ethnic differences. In some practices ethnic minority patients reported better experience than White patients. Differences associated with gender, Black ethnicity and deprivation were small and inconsistent.

Conclusion Substantial ethnic differences in patient experience exist in a national healthcare system providing universal coverage. Improving the experience of patients in low-scoring practices would not only improve the quality of care provided to their White patients but it would also substantially reduce ethnic group differences in patient experience. There were large variations in the experiences reported by ethnic minority patients in different practices: practices with high patient experience scores from ethnic minority patients could be studied as models for quality improvement.

  • Health services research
  • healthcare quality improvement
  • primary care
  • pay for performance
  • patient satisfaction
  • information technology
  • evidence-based medicine
  • healthcare quality improvement
  • patient safety
  • diagnostic errors
  • communication
  • health professions education
  • crew resource management
  • failure modes and effects analysis (FMEA)
  • safety culture

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • Funding The study was funded with a grant from the UK Department of Health. The opinions expressed are those of the authors and not of the funder. The UK Department of Health had no direct involvement in the design and conduct of the study; nor the collection, management, analysis and interpretation of the data, nor in the preparation, review or approval of the manuscript. All authors had full access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests MR and JC act as academic advisers to Ipsos MORI for the survey. All other authors have no conflict of interest to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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