Whilst the NHS centrally has in the past conducted an annual survey, we at Southover are interested in learning the views of our patients on specific issues that affect their experience of the service that we provide.
To find out your views via a general survey we again initially sought the views of a focus group as this worked well in previous years as it provides us with an indication of certain patient issues. Our present focus group is “virtual” in that we correspond via the internet. We try and get as representative a cross section of patients to reflect the demographics of our patient base. Unfortunately we are still unrepresented in the under 18 age group; anybody in this age group would be more than welcome to join. We are also looking to expand the “Virtual” Patient Participation Focus Group and anybody interested in being involved should contact the Practice Manager, John Burnham for more details.
Following the thoughts of the focus group we conducted our survey, not only asking patients that attended the surgery but also those that we have e mail addresses for, additionally the “ticker” on our web site linked into the survey when “clicked” on. The survey was open for just over 2 weeks and in that time we obtained results from 5% of our patients, our highest response yet.
Rationale Behind This Year’s Questions
There has been a long standing issue in the Health Service regarding getting appointments with G.P.’s. Only recently a national report suggested that the average patient wait to see their G.P. was 4 weeks. A number of ideas have been tried across the country, two years ago we asked patients views on telephone triage which wasn’t generally liked, last year we followed this up with a question on G.P. telephone consultations which the majority of patients indicated they would accept. The Doctors have always spoken to patients on the phone but in the past 12 months we have increased the number of telephone consultations but have not gone to all telephone consultations like some surgery’s. Rather we opted to employ an additional female G.P. in an attempt to create extra capacity for patients as well as having another regular G.P. here for a session a week.
So Q 1) was to see if our strategy had been successful. When asked some 90.39% of patients said that they were able to get an appointment with a G.P. within 48 hours of when they wanted to. Our second question asked if patients, were happy to wait longer to see a specific G.P. as opposed to seeing a different G.P. the same day. Only 4.61% of responses said that they would not wish to wait to see a specific G.P. whilst 51.77% of replies gave the proviso that it was dependant upon the problem being urgent for that day as opposed to a routine or ongoing issue.
The third question was designed to ascertain if having an extra doctor was resulting in an improved service to patients
26.16% of people questions said that in the past 2 years it was easier to get an appointment with a G.P. at Southover, whilst 67.38% said it was about the same. In that time our patient numbers have increased so in many respects even staying the same is a positive answer. Only 18 people said that they felt that it was more difficult to get an appointment and whilst this is a small number we need to look at how we can improve access further.
Our 4th question sought how our patients viewed the service that we provided. 97.51% of patients said they would recommend us to a friend or relative, only 7 people said they would not recommend us. The two main gripes were that the doctors spent too much time looking at the computer screen and not enough time looking at the patient and the other was that often the doctors run late. All the comments are being discussed within the surgery. With regard to the late running issue, unfortunately this is not easy to solve, some patients take longer than anticipated when they booked the appointment or the doctor get called out on an urgent visit or has to deal with an urgent phone call, all this can put them behind on the clinic which throws the schedule out. A learning point is that we need to inform patients better when the doctor is running late, possibly explaining the reason for it and giving patients a clearer idea of how late their appointment is likely to be. Whilst our automated self check-in screen in reception does advise how late the G.P. is running not all patients use this facility so we are revisiting a T.V. style information board that can also give information on late running clinics.
So having covered the areas of patient access to one of the clinical team at Southover the next set of questions looked at the current issue raised by the Prime Ministers of 24 hour, 7 day a week cover from G.P.’s.
Even before the Prime Minister made his announcement the G.P.’s in Torbay had been exploring ways this could be achieved. Whilst there are many barriers the two main problems are a) there simply aren’t enough G.P.’s to extend the 5 day a week service to 7 days a week and b) despite political spin there is no new money to facilitate it, any money will have to be taken from other areas of health service budget.
There are however a number of possible solutions centred around existing services and looking at new models for integrated primary care to provide a seamless in-hours and out-of-hours service with the patient at the heart. To facilitate this will require many improvements, one key issue will be better access for clinicians to patients records enabling them to make a more informed decision about the appropriate course of treatment for the patient. An area that would benefit would be the Out of Hours service as the G.P.’s who provide this service usually have little or no knowledge of that patient and can only assess the patient on what they see in front of them; they rarely have the benefit of previous consultations, test results and medication. This problem is not confined to the Out of Hours Service, it extends to clinical staff in the hospital, the District Nursing team and Social Care team. Again there are a number of problems but the main two are data protection and too many different computer systems that don’t “talk to each other”.
So one of the action points locally is looking at I.T. solutions but there still remains the problem of data protection of patient information. There are solutions but these are not simple, so the first step is to see if patients are happy for a clinician who is treating them to have access to their medical records. Question 5 looked at the patient experience of the Out of Hours service and Question 6 dealt with patients’ feelings regarding the sharing of their medical records between a member of the local health community (other than their own G.P.) who is treating them. Of the patients that answered 89.42% were happy for their information to be made available to the clinician treating them with 7.3% happy for certain clinicians having access but not all. Some 3.28% of patients did not feel their records should be shared with anybody even if this meant that the level of treatment they received was compromised as a result.
Question 7) Looked at one of the possible options for 7 day a week G.P. cover, when asked 33.33 % of patients said they would use a different G.P. practice working on a rota sharing basis at weekends although 62.06% said they would only use it for urgent matters and not routine check-ups. Only 4.61% of patients said they would not use a different G.P. practice that was working on a rota basis with ourselves. From this there does appear to be patient appetite for weekend G.P. cover although to achieve this both the I.T. and Data Sharing aspects would need to be addressed.
The last question, Q8, took this a step further. In providing a weekend G.P. service even on a rota basis with neighbouring practices then the compromise would be that the doctors would need to have time off during the week; the consequence would be fewer appointments available Monday to Friday resulting in a reduced ability for patients to see their own G.P. during the week. When we asked patients if they would still support the introduction of weekend G.P. clinics some 52.86% of patients asked then said they would not if it adversely affected their ability to be seen Monday to Friday by their own G.P.
So going forward the action points are :-
- we need to communicate better to patients in the surgery especially when a doctor is running late on the clinic and why that has occurred.
- the majority of patients are content for their medical records to be seen by a clinician (other than at their own surgery) who is treating them for a specific problem, so we can explore possible I.T. solutions to enable this.
- that patients would welcome G.P. cover at weekends, not necessarily from their own doctor, provided that it didn’t compromise access to their doctor during the week. A possible solution may be for an enhanced G.P. Out of Hours service.