Perth and Scone Medical Group - Taymount Surgery, Perth and Scone Surgery, Scone
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Introduction
Data Collection
Results
Conclusions & Recommendations
Proposed Action Plan

2008 Patient Survey Results

INTRODUCTION

At Perth & Scone Medical Group we have been conducting patient satisfaction surveys since 2003, and are very pleased that the results remain consistently high each year. This is despite an increasing list size (over 1000 new patients have registered with the practice since 2004) with a resultant demand on appointment availability for both doctors and practice nurses. During this time we have taken on two new doctors to help us deliver a high quality service to our patients - Dr Angie Martin and Dr Alison Lewis.

DATA COLLECTION

We continue to use an adapted version of the recommended General Practice Assessment Survey (GPAS), and to ensure as wide a spread as possible, we handed out a total of 350 questionnaires (230 in Taymount 120 in Scone). Because of doctor availability and incomplete questionnaires this exercise always takes longer than anticipated, but we did eventually have a reasonable return rate of 316 questionnaires.

RESULTS

As already mentioned above, the results are comparable over the last 5 years and we again looked to gather feedback in relation to four prime objectives - access and availability, communication skills, continuity of care, and inter-personal attributes.

  1. Access and Availability

    1. Appointment Availability

      Of the actual respondents who were willing to see any doctor, 94% said they were seen with 2 days (80% the same day, 11% the next day, and 3% within 2 days). When asked to rate this 91% said this was 'excellent', 'very good' or 'good'.

      Of the actual respondents who wanted to see a particular doctor, 80% said they were seen within 2-3 days (41% the same day, 10% the next day, and 29% within 2-3 days). When asked to rate this 78% said this 'excellent', 'very good, or 'good'.

      Of the actual 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 once again 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 also remain pleased that even with the use of our GP Registrar, Foundation 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 their doctor of choice remain very respectable.

      We continue to work extremely hard to ensure good access for patients in line with Government targets, using a mixture of 'pre-bookable' and 'on the day' appointments. However, there is no doubt that as demand for health care continues to rise inexorably, and with an increasing patient list size, the capacity to respond to that demand becomes compromised.

      We also remain concerned about the increasing number of patients who do not attend for their appointments, even when they have been given a 'on the day' appointment with their doctor of choice. We now operate a zero tolerance approach to this problem, and patients are sent a letter immediately advising them that if they continue to miss appointments they may be asked to leave our list.

      We are committed though to constantly monitoring our appointment availability and continue to look at more innovative ways of providing good quality care.

    2. Waiting Times

      As a longstanding Training Practice we have operated the recommended 10 minute appointments for many years now. The results showed once again that 96% of patients were seen within 20 minutes (11% less than 5 minutes, 54% 6-10 minutes, and 31% 11-20 minutes), although only 75% of respondents rated this highly.

      There is no doubt that the doctors can struggle to complete all the tasks expected from a patient-centred consultation in 10 minutes, and they are very pleased that such a high percentage of patients are waiting no longer than 20 minutes.

    3. Opening Hours

      When asked to rate how satisfied they were with our opening hours, 86% thought they were 'excellent', 'very good' or 'good'. This was a reduction from our previous survey when 97% of respondents rated this highly. From individual comments made on the questionnaires last year, we introduced some earlier morning appointments and some later evening appointments.

    4. Telephone Access

      When asked to rate their ability to get through to the practice on the phone, 80% of respondents thought this was 'excellent', 'very good' or 'good'.

      Of the actual respondents who had phoned to speak to a doctor on the phone, 85% rated this 'excellent', 'very good' or 'good'.

      We were very pleased with these results as they confirm that our telephone consultations are proving very successful. We have five incoming lines (3 to Taymount and 2 in Scone) available for patients only, and we ensure that there is always the appropriate number of staff available to cover the phones.

      There is no doubt that there are certain times of the day, particularly when the phones open at 8.00 am, when there is an overwhelming amount of calls coming in, but staff are trained to manage these as quickly as possible. The fact that we have so many appointments available each day does help the staff to deal with each call quickly and efficiently. We continually monitor the situation though to try to improve the service where possible.

  2. Communication Skills

    As noted in previous surveys, we pay particular attention to the interaction between our patients and staff. We are very much aware that general practice staff, in particular, will occupy a key position in influencing patients' perception of quality.

    1. Receptionists

      We were once again delighted with the very positive results for our reception staff, where 90% of respondents rated them 'excellent' or 'very good' and 8% rated them 'good'. The staff found these results very rewarding and they do reflect the hard work and commitment of the reception and administration staff in providing patients with a quality service.

    2. Doctors

      The doctors continue to try 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'. All the doctors in the practice consider themselves to be approachable and friendly, with a commitment to involving patients in a 'partnership' approach to their medical care. It was very reassuring, therefore, to note the very high satisfaction ratings of 94% (81% 'excellent' or 'very good' and 13% 'good') with how thoroughly the doctor asked about symptoms, 99% (90% 'excellent' or 'very good' and 9% 'good) with how well the doctor listened to what was said, 99% (86% 'excellent' or 'very good' and 13% 'good) with how much the doctor involved the patient in discussions about care, and 98% (89% 'excellent' or 'very good' and 9% 'good') with how well the doctor explained the problem and any treatment needed.

  3. Continuity of Care

    We were pleased that once again the survey findings detailed above pointed to high satisfaction ratings of 80% of respondents able to see their doctor of choice either the same day, or within 2-3 days.

    We are particularly pleased with these results when we consider that we have a Government access target of all patients being seen within 48 hours by a healthcare professional. Coupled with the 94% of patients who are being seen by a doctor within this target time (80% on the same day), and the 80% of respondents able to see their doctor of choice within 2-3 days, we feel justifiably proud of our commitment to ensuring that we are offering enough doctor appointments to meet our current demand.

    We do, of course, 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 at each contact to assist clinical staff who may see a patient if a colleague is unavailable.

  4. Inter-personal care

    All our doctors are committed to encouraging patients to become fully involved in understanding and coping with their particular illness, so that 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, 96% 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, 82% said 'much more' or 'a little more', 79% felt able to cope with their problem or illness 'much more' or 'a little more', 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

    It was interesting to note that our figures remained constant for the number of respondents seeing their doctor more than 3 times per year (72%). The number of respondents seeing their doctor more than 5 times per year has increased from 37% to 43% which reflects very much the pivotal role general practice continues to have in dealing with chronic disease management.

    If we add these figures to the number of patients seen by our Practice Nursing Team (5 nurses and 3 health care assistants), not surprisingly we have some cause for concern when future capacity and demand figures are considered. To assist the practice to cope with the increased workload around blood tests, BP monitoring, ECG monitoring and other minor procedures, we have appointed another health care assistant. This should free up some of the more experienced nurses to concentrate on more specialist nursing care.

    Of particular satisfaction to the whole practice team was the response to the satisfaction overall with the practice, with 92% 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

There was no doubt that the results from the patient survey were once again of a particularly high standard, with no individual area standing out as needing particular attention. However, as is usual with this type of exercise, it is often the qualitative statements that provide more meaningful points for potential action.

Our proposed action plan last year had two areas we were to address - i.e. telephone access and late appointments. Despite notices, leaflets and ad hoc opportunities informing patients of our advanced access appointment system, we still have a large majority of patients, particularly at Scone Surgery, who will phone at 8.00 am, and not surprisingly they can get frustrated getting through if the lines are busy. We still get comments that patients cannot pre-book an appointment, but every consulting session has a number of pre-booked slots (usually around one-third) and the remainder are 'on the day' appointments.

In our view this system gives every patient the opportunity to get their doctor of choice much quicker, but of course, if the doctor is part-time or absent for any reason, then the pre-booked appointment slot could be some time away. We continue to encourage patients to get the most benefit from our appointment system, which as can be seen from the results above, is extremely successful in the main.

Our discussions with our telephone system supplier did not come up with an ideal situation for us, but we have increased our staff levels in Scone Surgery in the mornings to ensure both lines are manned during the very busy early period. This appears to have been successful and we have had fewer comments about the Scone phone system this past year.

Our second action point from last year was offering some later appointments. After discussion in the practice we altered some consulting sessions to ensure we have an early consulting session starting just after 8.00 am, increased lunchtime sessions, and ensured we had some later appointments up to 5.50 pm.

The survey results showed that 86% of patients were happy with our opening hours, and out of a total of 59 questionnaires with comments, 9 patients said they would appreciate a later surgery in the evening until around 7.30 pm.

It may be that general practice will be encouraged by the Government to introduce evening appointments, and if this is the case our practice may consider taking up the enhanced service. However, as this has the potential to impact on how we organise our normal daily workload, we would require more details before making a final decision.

FEEDBACK

As in previous years we will post a copy of this report on our website and give feedback to patients via a notice in the waiting room.

PROPOSED ACTION PLAN

Introduce Evening Consulting Sessions:

Although the results from our survey showed that 86% of patients were happy with our opening hours, there is no doubt that having even one additional evening surgery until 7.30 pm would provide added benefit for the minority of patients who may work away from home.

As this is an area being looked at currently by the Government as part of a change to the GP Contract, our view would be to wait until the actual detail of the enhanced service is available before making a decision on whether or not to consider taking this up. We currently have surgeries running throughout the whole day from 8.00 until 6.00 pm and introducing a later consulting session has the potential to impact on our current very successful access figures.

Recommendation:

Await local detail for extended hours DES and arrange a meeting with the whole team to discuss whether we take this up or not.


Lead Person:Agnes Ramsay, Practice Manager
 Dr David Shackles, Clinical Lead


 
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