• Nicola Mead and Martin Roland.
• NIHR School for Primary Care, University of Manchester, Manchester M13 9PL.
• BMJ. 2009 Jan 1; 339: b3450.

ObjectiveTo examine why patients from ethnic minorities give poorer evaluations of primary health care than white patients.DesignCross sectional analysis of patient surveys collected in general practice.Setting1098 English general practices that undertook a routine survey of patients using the General Practice Assessment Questionnaire between April 2005 and March 2006.Participants188,572 survey respondents, 95.8% of whom identified themselves as "white," "black/black British," "Asian/Asian British," or "Chinese." Analyses were restricted to between 133,441 (71%) and 147,686 (78%) respondents with complete data on relevant variables.Main Outcome MeasuresPatient evaluations of waiting times for general practitioner appointments, time spent waiting in surgeries for consultations to start, and continuity of care.ResultsAll aspects of care were rated substantially lower by respondents from the three ethnic minority groups than by white patients. Poorer evaluations of time spent waiting for consultations to begin (rated lowest by Asian patients) and continuity of care (rated lowest by Chinese patients) appeared to reflect worse reported experiences by ethnic minority groups. Substantial differences between white and ethnic minority patients' ratings of appointment waiting times persisted, however, even after adjusting for the actual time patients reported waiting. This effect disappeared for Chinese and black respondents after adjusting for evaluations of reception staff and doctors' communication skills, but Asian patients' ratings remained considerably lower than those of white respondents.ConclusionsImportant differences in assessments of care exist in different ethnic minority groups. Some negative evaluations may reflect communication issues. Among Asian patients, lower ratings of waiting times for appointments may also reflect different expectations of care. Adjusting survey results for ethnicity may be justified when comparing healthcare providers; however, health services also have a responsibility to meet legitimate patient expectations.

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