Perth and Scone Medical Group - Taymount Surgery, Perth and Scone Surgery, Scone
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Introduction
Patient Satisfaction
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2006/07 Patient Survey Results

INTRODUCTION

Perth & Scone Medical Group has always recognised the importance of the whole primary healthcare team working together to provide a high quality service to our patients. We are fully committed to quality and continually strive to encourage, foster and maintain the highest possible standards of general practice. Against this background the practice took the decision to apply for the RCGP Quality Practice Award and with enormous commitment, enthusiasm, and hard work by the whole team, we achieved the Award in 2004.

We remain committed to the concept of continuous improvement, and through the regular use of clinical and organisational audit, significant event analysis, and the motivation, participation and commitment of staff at all levels of the organisation, we try to ensure that we are providing a high quality service to our patients at all times.

PATIENT SATISFACTION

At Perth & Scone Medical Group we continue to look at ways to involve patients in giving us feedback on how satisfied they are with the service we provide, and how this can be improved. We do this in a number of ways, including patient surveys, significant event analysis, qualitative interviewing, comments and suggestions box, a feedback section on our website, and by "listening" to what patients tell us.

DATA COLLECTION

At Perth and Scone Medical Group we have been conducting patient satisfaction surveys for some years now using the General Practice Assessment Survey (GPAS) which was developed to assess the aspects of care regarded as the most important by patients, which are detailed below. We have done this in various ways - using a Touchscreen, sending out a questionnaire to randomly selected patients, and handing out to patients when they attend surgery.

In addition, for QPA we also used a trained market researcher to interview patients using a semi-structured qualitative method of enquiry, which focused on particular areas of experience, but allowed the individual to respond freely within that framework.

With the introduction of the new GMS contract in April 2004 the majority of practices began to use the GPAQ questionnaire (adapted from GPAS), which is a much shorter version, and in our view did not gather the same useful information. However, due to the extra workload we have had this year with the change of our clinical system from GPASS to InPS, we made a decision to use this adapted version, which is easily downloaded from the GPAS site.

To ensure as wide a spread as possible across the different doctors and our two surgery sites, we handed out 300 questionnaires in Taymount Surgery and 150 in Scone Surgery. For doctors who only consult at Taymount Surgery for instance, we handed out 50 questionnaires for each. For doctors who consult at both sites, we handed out 25 questionnaires for each at Taymount and Scone. This turned out to be a more complex and time-consuming exercise due to doctor availability and incomplete questionnaires, but over 2-3 weeks we did eventually reach our total target of 450 completed questionnaires.

RESULTS

According to Wensing (1998) satisfaction levels are likely to be greater where a high quality of service reflects the areas identified as being of the greatest importance to patients. In this regard the questions in the GPAQ questionnaire described above looked to gather feedback in relation to these prime objectives - access and availability, communication skills, continuity of care, and inter-personal attributes.

  1. Access and Availability

    1. Appointment Availability

      Of the 409 respondents who were willing to see any doctor, 94% said they were seen within 2 days (73% the same day, 14% the next day, and 7% within 2 days). When asked to rate this 80% said this was 'excellent', 'very good' or 'good'.

      Of the 358 respondents who wanted to see a particular doctor, 68% said they were seen within 2 days (44% the same day, 9% the next day, and 15% within 2 days). When asked to rate this 80% said this was 'excellent', 'very good' or 'good'.

      Of the 310 respondents who were asked 'if you need to see a GP urgently can you normally get seen the same day' 95% said YES.

      Overall we were very pleased with these results and they confirmed the success of the robust management of our 'advanced access' appointment system to ensure overall capacity and demand figures remain at an optimum level. We are also happy that even with the use of our GP Registrar, GP Retainer, FY2 SHO doctor, two GPs heavily involved in teaching and training, an episode of maternity leave, and female doctors who only work part-time, our figures for patients able to see a particular doctor are very respectable.

      It is also worth noting that we carried out this survey at the busiest time of year for the practice (i.e. in January) and we were aware that this could potentially affect our availability figures. However, this is also the time of year when we have all our doctors available in the practice, which does ensure we have feedback for each individual doctor.

      We feel strongly that we work extremely hard to ensure good access for patients in line with Government targets, and yet this work does not appear to be valued. There is no doubt that as demand for health care continues to rise inexorably, the capacity to respond to that demand becomes compromised. We remain committed though to constantly monitoring the situation and will continue to look at more innovative ways of providing good quality care.

    2. Waiting Times

      As a training practice we have operated 10 minute appointments for many years, but there is no doubt that if the GP is faced with a few complex problems, or indeed an emergency during a consultation session, this can lead to patients being held up. However, once again the results were encouraging and showed that 98% of patients were seen within 20 minutes (17% less than 5 minutes, 56% 6-10 minutes, and 25% 11-20 minutes).

      It was interesting to note that despite the very high percentage of respondents being seen within 20 minutes, only 72% rated this highly.

      These figures are very satisfying though when we consider that we had a change of clinical system this year with limited training on how to use the system. Coupled with the fact that the doctors now struggle to complete all the tasks expected from a patient-centred consultation in 10 minutes, it is very pleasing indeed that such a high percentage of patients waited less than 20 minutes for the doctor. There is no doubt that as the work increases for GPs during the consultation, a 10 minute appointment will no longer be appropriate, leading to more pressure on appointment availability.

    3. Opening Hours

      When asked to rate how satisfied they were with our opening hours, 97% thought they were 'excellent', 'very good' or 'good'.

    4. Telephone Access

      Of the 443 patients who responded to the question asking them to rate their ability to get through to the practice on the phone, 83% thought this was 'excellent', 'very good' or 'good' with 14% rating this 'fair'.

      Of the 284 respondents who have phoned the practice to speak to a doctor on the phone, 84% rated this 'excellent', 'very good' or 'good'.

      We were very pleased indeed with these results as they confirm that the use of telephone consultation slots within each GP consulting session is proving very successful.

  2. Communication Skills

    The vital part of every service industry is to be found in the interaction between the service provider and the service 'customer'. Staff in any service organisation, particularly in general practice, will occupy a key position in influencing patient perception of quality. These meetings have been called "moments of truth" for an organisation - where the service is decisively judged by the client.

    1. Receptionists

      How reception staff communicate with patients will inevitably go some way to help form the patient's opinion of the practice as a whole. We are fully committed to staff training and development to ensure that as the first point of contact, all staff will have the necessary communication skills required to better cope with these "moments of truth" referred to above.

      When asked to rate the way they are treated by the receptionists at the practice, 97% said they were 'excellent', 'very good' or 'good'.

      These very positive results were very rewarding to all concerned and they reflect the hard work and commitment of the reception and administration staff in refining and implementing our robust procedures and systems. We remain committed to ensuring ongoing commitment to this very important part of the service.

    2. Doctors

      In trying to strike a balance between offering enough appointments to ensure easy access for patients, and allowing enough time within a consultation for patients and doctors to 'communicate' the doctors can at times feel overwhelmed. However, all the doctors in the practice consider themselves to be approachable and friendly, with a commitment to involving the patients in a 'partnership' approach to their medical care.

      It was very reassuring, therefore, to note the very high satisfaction ratings of 98% (86% 'excellent' or 'very good' and 12% 'good') with how thoroughly the doctor asked about symptoms, how well the doctor listened to what was said, how much the doctor involved the patient in decisions about care, and how well the doctor explained the problem and any treatment needed.

  3. Continuity of Care

    Many patients appreciate the choice between a speedy appointment with a doctor who may not be known to them, but are prepared to take a later appointment with a doctor more familiar to them. Many patients who visit the doctor very infrequently, for instance, are usually happy to see any doctor. Those who attend more regularly normally expect to see the doctor of their choice, and whom they feel knows them and their medical condition better. Again the survey findings detailed above pointed to high satisfaction ratings, with 81% of respondents able to see their doctor of choice either the same day, or within 2-3 days.

    We remain committed to a team approach to patient care and our computerised medical records and regular clinical meetings for doctors, nurses, and community nurses, ensures that the patients' medical records are fully updated to assist doctors who may see a patient if a colleague is unavailable.

  4. Inter-personal care

    As patients become much more knowledgeable about their medical care, the doctors continue to encourage them to become fully involved in understanding and coping with their particular illness, so they can make better decisions around treatment options for example. It was very pleasing, therefore, to note the very high satisfaction ratings of 95% with the time the doctor spends with a patient, 97% with the doctor's patience with questions and worries, and 97% with the doctor's caring and concern.

    It was also encouraging to note that when asked if after seeing the doctor the patient felt able to understand their problem or illness, 88% said 'much more' or 'a little more'. 82% felt able to cope with their problem or illness 'much more' or 'a little more' after seeing the doctor, and 78% said they were able to keep themselves healthy 'much more' or 'a little more' than before the visit to the doctor.

  5. General Findings

    Once again it was interesting to note that 72% of respondents said they had seen the doctor 3 or more times per year, and of those 37% had seen the doctor 5 times or more per year. If we add these figures to the number of patients being seen by our Practice Nursing Team (5 nurses and 3 healthcare assistants), not surprisingly we continue to have some cause for concern when future capacity and demand figures are considered. There is no doubt they have implications for the ability of the current clinical staff to continue to provide a high quality service to our patients. Nevertheless, they do reflect very much the pivotal role that general practice has in dealing with chronic disease management.

    Of note it is worth mentioning here a major flaw in the GPAQ questionnaire compared to the more comprehensive GPAS questionnaire we have used in the past. There is no question asked of the care given by the Practice Nurses, and we certainly found in previous years that the satisfaction ratings matched those for the doctors and were a good morale boost for the nursing team.

    Of particular satisfaction to the whole team was the response to patients satisfaction overall with the practice, with 90% saying they were 'completely' or 'very' satisfied. We consider ourselves to be a very 'patient centred' practice and these results confirm that our commitment to continuous quality improvement is proving to be a successful process.

CONCLUSION AND RECOMMENDATIONS

The very positive feedback from the survey was, of course, very rewarding for all staff concerned, although the practice accept that a 'one-off' survey will only provide a 'snapshot' of the current situation. Of considerable satisfaction was the high satisfaction rating with the doctors and the reception staff. The findings appeared to confirm that these "moments of truth" which were previously stated to be critical for an organisation, were being managed to a consistently high level by all staff.

For QPA we did use a market researcher to do some critical incident interviewing with patients attending the doctor on a particular day, and we did gain valuable additional information which helped us address issues of concern. For this reason we do appreciate very much when patients use the comments box on the questionnaire as we feel we get a better understanding of what they are thinking. We are fortunate that quite a number of our patients did take the opportunity to respond, and although the majority of these responses were very positive, they did raise issues that we will work to address over the coming months.

Although we have invested a huge resource in our telephone system, and we have 5 incoming lines for patients, particularly in the very busy first two hours in the day, there still seems to be a problem with access in Scone Surgery. One of the reasons for this may be that we have a high percentage of elderly patients who often need extra time on the telephone, and because of staffing issues - particularly as we have to staff two sites and we get no additional support for this despite agreement that this would come when the new GP contract was in place. Another concern was later appointments and we have already discussed this within the practice and arrangements are now being made to add an additional one or two later appointments each day to try and deal with this demand.

Effective use of patient feedback is without doubt dependent on its integration into other activities, and on its being viewed not as a 'one-off' but as requiring to be continued over time. We remain committed to involving our patients as much as possible in providing feedback to us on the quality of the services we provide, and will continue to look at more innovative ways of doing this in the future.

PROPOSED ACTION PLAN

  1. Telephone Access

    Although we were very pleased with the satisfaction ratings for telephone access to the practice, the more qualitative comments showed that there were some problems, particularly accessing Scone Surgery in the morning. As noted above, we have invested in a telephone system that allows us to have 5 incoming lines between both sites. However, we feel it would be worthwhile speaking to our telephone system supplier to look at ways to maximise the potential of the system and improve patient access further.

    As can also be seen from our exceptionally high access figures for appointment availability (94% of patients being seen within 48 hours - 73% on the same day) we do have the capacity to cope with a better spread of telephone calls throughout the day. This is confirmed when we check our weekly figures and note that we often have days when we still have appointments available at the end of the day. However, despite leaflets, posters, and face to face contact with patients when we introduced our advanced access appointment system, there is still pressure on the telephone system at 8.00 am. It was agreed, therefore, that it might be a good time to reinforce our access arrangements.

    Recommendations:

    • Arrange a meeting with our telephone system supplier to discuss different ways for our patients to access the practice - e.g. one shared telephone appointment line which could be answered by any staff member at either site.
    • Organise new leaflets, posters, and an entry on the practice website to encourage patients to spread their appointment requests throughout the day.
    Lead Person:Agnes Ramsay, Practice Manager
  2. Late Appointments

    Again we were delighted with the response from our patients when asked how satisfied they were with our opening hours, with 97% stating they were 'excellent', 'very good' or 'good'. However, anecdotally and in some of the qualitative comments, patients were finding it difficult getting later appointments. There is no doubt this will cause fierce debate amongst the doctors on how best to offer these appointments, as all our consulting sessions start at 8.30 am in the morning and all the doctors are available in the practice by 8.00 am.

    Recommendations:

    • Collect advanced access satisfaction figures to ascertain 'peaks' in demand for appointments and arrange meeting with whole team to discuss the best ways of meeting this demand, including increasing the number of later appointments and/or lunchtime appointments.
    Lead Person:Lyn Williamson, Office Manager
     Dr David Shackles, Clinical Lead

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