Mapperley Park Medical Centre Open Access Family GP Practice

Continued from page 1

Stage 2

5. How has the practice sought the PRGs views of priority areas?

As in previous meetings we have started with the published questionnaires conducted by Her Majesty’s Government into patient satisfaction, which can be compared to other practices.  We think this is objective and useful.  In the past, we have discussed items as well, such as whether rhe practice should provide hot drinks or Wi-Fi access in the waiting room, which has lead to debate, but which are not felt to be as important as concentrating on good medical care.  There are risks and regulations involved in these enterprises, and this is not our prime interest. 

The summary of the GPAQ questionnaire is as follows, using percentile position against other practices nationally (so 80% means 20 out of 100 practices scored higher than us nationally, 80 scored lower)

Satisfaction with Receptionists                                                                         80%
Satisfaction with opening hours                                                                       69%  
Satisfaction with Nurse availability                                                                   71 % 
Satisfaction with waiting times                                                                         68%
Satisfaction with phoning through to Practice                                               67% 
Satisfaction with phoning through to Nurse for advice                                68% 
Satisfaction with continuity of care                                                                 75% 
Satisfaction with Nurse’s questioning                                                             84%
Satisfaction with how well Nurse listens                                                         86% 
Satisfaction with how well Nurse puts Patient at ease                                 87% 
Satisfaction with how much Nurse involves Patient                                     85%
Satisfaction with Nurse’s explanations                                                           86%
Satisfaction with time Nurse spends                                                               84%
Satisfaction with Nurse’s patience                                                                   87%
Satisfaction with Nurse’s caring and concern                                                87%
Ability to understand the problem after visiting Nurse                                66%
Ability to cope with problem after visiting Nurse                                          62%
Ability to keep healthy after visiting nurse                                                     61%

The corresponding questions applied to the Doctor are as follows:        
Satisfaction with Receptionists                                                                         77%
Satisfaction with opening hours                                                                       67%  
Satisfaction with availability of particular doctor                                         60 %
Satisfaction with availability of any doctor                                                    69%

Satisfaction with waiting times at the practice                                              57%
Satisfaction with phoning through to Practice                                               59% 
Satisfaction with phoning through to Doctor for advice                              61% 
Satisfaction with continuity of care                                                                  69% 
Satisfaction with Doctor’s questioning                                                            81%
Satisfaction with how well Doctor listens                                                       84% 
Satisfaction with how well Doctor puts Patient at ease                               84% 
Satisfaction with how much Doctor involves Patient                                   81%
Satisfaction with Doctor’s explanations                                                          83%
Satisfaction with time Doctor spends                                                              80%
Satisfaction with Doctor’s patience                                                                  84%
Satisfaction with Doctor’s caring and concern                                               84%
Ability to understand the problem after visiting Doctor                              69%
Ability to cope with problem after visiting Doctor                                        66%
Ability to keep healthy after visiting Doctor                                                   62%

In summary, the practice scored well above average for elements of the consultation that make for good communication in a clinical setting, with the exception of phoning through to the doctor for telephone advice (about 20 centile points below the other scores). 
We also scored lower in terms of educating patients on their problem, to a lesser extent.  Giving informational leaflets is not a large part of our practice, and it may help patients educationally if we were to do more of this.
Waiting time satisfaction was above national average even though our open access system can make for long waits on occasion here, a score we will be keeping a close eye on in future.
We recognised that some replies were difficult to interpret – the doctor here is single-handed, yet the satisfaction score for his availability is only 60% when he offers open access every weekday morning 46 weeks of the year. 
Phoning through to the doctor for advice remained an important finding to explore further.  Because of a trend towards telephone consultation for out of hours, nurse or GP triage of telephone requests for visits and emergency appointments in hours, and the sense that telephone consultation offers the chance of advice without the costs of transportation, the practice/patient representation group decided that it would be appropriate to explore with a further patient questionnaire whether a more formal approach to timed telephone consultations should be offered by the practice at this stage.

The PRG agreed to help me look at the area where we scored most poorly, at the 65th centile, on responding to requests for telephone consultations, which I thought was something to mull over and see if we can improve.

Validate through the local patient participation report. Payment Component 2

6. Please describe how the priorities for the survey were selected - do these reflect those set out by the PRG?

We looked at the results of the GPAQ questionnaire which we had already had performed by the government, and saw an example of an earlier questionnaire we had arranged to decide whether to continue our open access.  We have used questionnaires in the past also when deciding whether to have appointment only sessions in the afternoon (we did decide to do this). 

In a typical 150 person sample we are likely to have reached 20 - 30 patients who do not use the practice often, and 120 – 130 patients who use the practice fairly frequently, and have come to know what to expect here.  On the whole, patients are happy to fill in questionnaires while they wait, and they do so even when not feeling particularly well. 

We discussed postal questionnaires and e-mailing questionnaires ,but we felt the additional reach of these sort of questionnaires had a disadvantage that patients would not be present in the building and thinking about the services here, and their experience of us, when they are filling in the questionnaire if they are doing this at home. 

The PRG felt that in many ways the practice was doing a good job.  The complaints they heard from friends, such as difficulty ringing for appointments and never seeing the same doctor twice in a row, did not apply here as there was only one doctor and all you had to do was come in and he would see you.  The PRG were acting as consultants rather than complainants, and were willing to help in whatever area I wanted to improve the practice.

Considering the results of the GPAQ, it was apparent that getting through to the doctor for advice was not scored as highly as some of the other scores, and we wondered whether we could try and improve this by offering a time when the doctor would take receiving calls from patients on occasions when they ring up.  This may be better than the doctor ringing people back, only to find their phones have been switched off, perhaps because they are busy.  On occasions, this has continued onto two phone calls on a Saturday because a patient’s phone has been switched off following a call to the practice on a Friday afternoon. 

We discussed the idea of triage, and while this can be helpful, it is also known that a more experienced person taking a call can sometimes be quicker and more conclusive than a less experienced person, and the overall time and money savings with triage systems may be less than would be imagined at first sight.

Validate through the local patient participation report. Payment Component 2

Stage 3

7. How has the practice determined the questions used in the survey?

We developed a questionnaire to determine patients’ experience of telephoning the practice, telephoning the doctor  for advice, and asking too about  preferences – would they prefer telephone advice over a traditional face-to-face contact?  We asked about age, sex, ethnicity and occupation as well.

We determined these questions because they were directly relevant to our concerns, and we might find links with some groups having a preference for telephone contact.

Validate the survey through the local patient participation report. Payment Component 3

8. How have the priority areas been reflected in the questions?

The questions related directly to the prority area that had been chosen.

Validate the survey through the local patient participation report. Payment Component 3

9. Describe the Survey - How and when was the survey Conducted?

The survey was conducted by handing it out to patients who were waiting in the waiting room for seeing the doctor or the nurse in February.  We gave the survey out to patients until we had received 150 completed surveys back, 65 male and 82 female (3 people did not disclose gender).  The numbers in each category are shown on the survey example.  The survey was conducted over a week in February 2012 between the two patient reference group meetings.

Validate the survey through the local patient participation report. Payment Component 3

10. What methods practice has used to enable patients to take part?

The survey was conducted by handing it out to patients who were waiting in the waiting room for seeing the doctor or the nurse in February.  We gave the survey out to patients until we had received 150 completed surveys back, 65 male and 82 female (3 people did not disclose gender).  The numbers in each category are shown on the survey example. 

On the whole, patients are happy to fill in questionnaires while they wait, and they do so even when not feeling particularly well. 

We estimate that 80% of the patients visiting the practice do so fairly frequently, and 20% of the patients visiting the Practice visit rarely.    Our survey of 150 patients would therefore be completed by approximately 115 patients who are familiar with the workings of the Practice, and approximately 35 patients who visit the Practice less frequently

We discussed postal questionnaires and e-mailing questionnaires ,but we felt the additional reach of these sort of questionnaires had a disadvantage that patients would not be present in the building and thinking about the services here, and their experience of us, when they are filling in the questionnaire if they are doing this at home.

We collated the results by counting the numbers of patients filling in each field, and looking for patterns. 

Validate the survey through the local patient participation report. Payment Component 3

11. How has the practice collated the results?

We collated the results by counting the numbers of patients filling in each field, and looking for patterns. 

Validate the survey through the local patient participation report. Payment Component 3

12. How were the findings fed back to the PRG?

The group considered the results of the questionnaire and the points made in the analysis.  Each member of the group had the collated data presented to them with a total for the umber of responses to aach answer of each question, and observations of patterns were also presented.

Validate the survey through the local patient participation report. Payment Component 3

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