Report to PPG and Surgery on Patient Satisfaction Survey June 2018
137 questionnaires were completed by patients attending the surgery between Monday 4th and Friday 8th June 2018. The main purpose was to measure satisfaction with those aspects of the service which had been shown to be most important to patients in previous surveys, and to compare with the PPG surveys conducted in previous years.
- Satisfaction with the practice has fallen significantly in a number of key areas since the June 2017 survey. These areas are:
- appointment availability, with only 55% of patients being satisfied or very satisfied (compared to 77% in 2017),
- seeing doctor of choice, 54% (70% in 2017), and
- on-line booking, 68% (91% in 2017).
- On the other hand, where comparison can be made with national averages in the Patient National Survey* our results were still at or above national figures except for ‘appointment availability’ where our figure is some 16 points behind.
- It is also notable that satisfaction with doctors and nurses (98%) and receptionists (95%) is still very high.
- In the ‘Friends and Family Test’ question, 88% of patients were likely or extremely likely to recommend the practice (90% in 2017). This is in line with the average for GP practices nationally and in the London region.
- The survey suggests the main action points to improve patient satisfaction are:
- to make enough routine appointments available such that patients do not feel they are ‘having to wait weeks’
- to address not being able to see doctor of choice. This could include, for example, PR promoting the newer partners and doctors
- to encourage use of Patient Access – a number of possible measures are suggested to tackle current difficulties with the service, particularly issues relating to on-line booking of appointments
- to review allocation of appointments, ie appointments available on-line v. only available via receptionists, and the timing of releasing appointments (in view of 24% dissatisfaction with ‘Monday and Friday Book on the day’)
- The practice will give a response to this report, including plans to address the issues raised. The response will normally be published alongside the report.
*The Patient National Survey (PNS) is a national survey. The last published figures, based on 808,000 respondents, are up to March 2017.
Satisfaction levels appear to have fallen significantly in some categories, compared to the generally very high levels reported in the June 2017 survey. The most concerning categories were seeing doctor of choice, where only 54% of patients were satisfied or very satisfied, appointment availability at 55% satisfaction and on-line booking of appointments at 68% satisfaction.
Two other categories of concern were Monday and Friday book on the day at 76% satisfaction and waiting time on the phone at 80% satisfaction, although these results were of a similar order to the 2017 survey.
In the six other categories measured the previous high levels of satisfaction were maintained, in particular receptionists had a 95% rating and doctors and nurses 98%.
Comparing the results with the Patient National Survey (see explanation asterisks at bottom of pages 1 and 2), the practice was still close to or ahead of national figures except for appointment availability which was 71% nationally against our 55%.
Further points of note:
- Seeing your doctor of choice – as stated above there is dissatisfaction with patients not being able to see their preferred doctor. As suggested in previous survey reports, this may be exacerbated by the two longest serving and probably most ‘popular’ partners doing reduced surgery hours, whilst the new partners and staff GPs have not yet become ‘endeared’ to patients in the same way. It may also relate to patients not being able to get a timely appointment with the same doctor for follow-up appointments. (Also it is noted that a Guardian article on 29th June 2018 reported research suggesting growing evidence that continuity with the same consultant or doctor, including GPs, leads to better outcomes.)
- Appointment availability – this has become an issue for nearly half of patients. In the many comments about this that patients added, there were some strong feelings and only one added that they were aware it was a national problem.
- On-line booking – the big fall in satisfaction is actually accompanied by an increase in users (see Section 5). Some patient comments may have suggested that the recent change in the procedure for requesting repeat prescriptions – no longer being able to re-order via pharmacies – has prompted some movement to on-line, but also that the recent revision of the Patient Access website has made on-line use more difficult. Also a number of patients said that there could be less availability of appointments on-line compared to contacting receptionists.
- Monday and Friday book on the day – this service provides some appointments on the day and is intended for urgent cases, mainly on Mondays and Fridays but also on other weekdays. Some patients said they would still prefer the previous walk-in service which ended in 2016, and some have said they are dissatisfied that the appointments are sometimes given out in non-urgent cases, and also that urgent cases cannot be booked the day before – a further call having to be made the next morning when it can be difficult to get through. (It is noted that the practice say they find the new arrangements much more manageable, and feel that generally this should benefit patients too.)
Waiting time on the phone – there were some reports of very long waits, and a suggestion of a link between abruptness by receptionists when dealing with patients in person at the desk and answering phones at the same time.
Overall, there appears to be interaction between different sources of dissatisfaction, with one category being affected by another, eg appointment availability causing dissatisfaction too with on-line booking and seeing doctor of choice.
- Friends and Family Test Question
It is mandatory that patients be invited to answer this question at all points of contact with the NHS, and there are cards at our reception window for this purpose and patients who have given their mobile number are asked the question by text after an appointment. The question is ‘How likely are you to recommend this practice to friends and family if they needed similar care or treatment?’ It is included in our survey and 132 patients answered this question.
The results were: Extremely Likely Likely Neither Likely nor Unlikely Unlikely Extremely Unlikely
50% 38% 10% 1% 2%
With 88% positive answers, this compares well with past years – 86% in 2015, 78% in 2016 and 90% in 2017 – and is in line with GP practices generally as shown on the NHS website for April 2018 (90% for England, 88% for London).
The 3 patients who would not recommend the practice were all dissatisfied with appointment availability and seeing doctor of choice, but in each case there was another issue, which collectively were difficulties with on-line requesting of repeat prescriptions, ‘admin problems’ and some receptionists.
- Patients’ Comments
50 patients added comments. The main themes were:
- 19 positive comments saying the service was good, and mainly referring to the practice in general terms.
- 42 negative comments, including appointment availability (11), seeing doctor of choice (6), waiting time on the phone (5), receptionists (4) and on-line booking (3).
Some representative examples are displayed below.
There were also some one-off miscellaneous comments worthy of note:
- It is really good to receive e-mail reminders and confirmation of appointments.
- Not always able to get copies of test results when request them.
- Takes too long to get blood test results.
- I can’t get the auto check-in to work.
- We should be notified when older age-related services become available eg vaccinations.
- Wheelchair access is difficult because of the angle of the ramp and the dimensions of the door.
- Demographics and How the Surgery is Contacted
98 women and 35 men (plus 4 not stated) took part.
17 were there for their children and 14 for another adult.
Age Distribution: 16-18 18-34 35-54 55-64 65-74 75+
0% 17% 29% 20% 23% 11%
How Appointments Booked: Phone In Person On-line (Patient Access)
70% 33% 15% (Some patients ticked
more than one method)
NPS* 2017 86% 27% 9%
(Our 2017 Survey: 67% 34% 10%)
(Our 2016 Survey: 66% 36% 17%)
How Repeat Prescriptions Requested: In Person 61% (2017:38%, 2016: 41%) (Based on 118 patients who By E-mail 19% ( “ 15%, “ 9%) who ticked at least 1 method)
On-line (Patient Access) 21% ( “ 12%, “ 14%, NPS* 2017: 12%)
Direct to Chemist/Other 6% ( “ 46%, “ 44%)
*National Patient Survey – see footnotes on pages 1 and 2.
Requesting Repeat Prescriptions – There has been a big change in how patients request repeat prescriptions following the withdrawal of the facility to order via their local chemist, which was used by nearly half of patients. Most have changed to visiting the surgery but a significant proportion now use e-mail or Patient Access. The withdrawal of ordering via chemists and getting used to Patient Access, and some recent changes making Patient Access arguably less user-friendly, appear to have been the cause of some dissatisfaction. (It is fully understood that these changes are outside the control of the practice.)
Booking Appointments – There has also been an increase in the use of Patient Access for booking appointments, perhaps stimulated by the repeat prescription situation described above. There is some dissatisfaction here, linked to appointment availability and doctor of choice, that there are fewer appointments available on-line than when contacting by phone or personal visit, especially for near-term appointments.
- Action Points
To address the significant patient dissatisfaction shown in this year’s survey, the practice will have to take action in the following areas:
- Increase the number of appointment slots so that patients can get an appointment sooner. This may only be possible by increasing the number of doctors, but it is the highest priority action point within the practice’s control from a patient’s point of view.
- Take measures to reduce dissatisfaction due to not being able to get appointments with patients’ doctor of choice, eg by PR – explaining the ‘changing of the generations’ of GPs and ‘recommending’ the newer partners and doctors for example with informal biographies on the website/in newsletters. Also seek ways to help patients with an ongoing condition who wish to see the same (maybe newer) doctor on follow-up appointments. (Seeing doctor of choice has been an ongoing issue and was included in previous years’ action points, but it has become more acute, no doubt being aggravated by the other areas of dissatisfaction.)
- Encourage use of Patient Access eg by:
- Producing a leaflet on how to use the current (revised) version of the website, to be given out to new users and any existing users who say they are having difficulty. The PPG would be happy to assist in this.
- Continuing representations to get the current version improved.
- Making more appointments available on-line, to be more in line with what’s available via phoning or calling in at the surgery.
- Review allocation of appointments, ie appointments available on-line v. only available via receptionists, and the timing of releasing appointments (in view of 24% dissatisfaction with ‘Monday and Friday Book on the day’)
- Response from Practice
The practice will give a response to this report, including plans to address the issues raised. The response will normally be included alongside the report wherever it is published eg on the website.
File: Report to PPG and Surgery on Patient Satisfaction Survey June 2018
Response to PPG Patient Satisfaction Survey 2018
In June 2018 the Patient Participation Group (PPG) commissioned their annual survey of patient satisfaction. This information is in response to feedback from their report and aims to highlight the action being taken by the surgery to improve and the reasons we believe that specific issues have been highlighted.
We are happy that the results of the report show good levels of satisfaction in 8 of the 11 areas measured. The highest areas of satisfaction were with the staff themselves at 98% satisfaction with the clinical team and the front of house reception team at 95% satisfaction. This continues on last year’s excellent results. In the last 12 months we have had one new receptionist join us. The front of house team works well together and provides a great deal of support for each other. Our clinical team has consisted of a great many locums this year; however they have all had consistently good feedback. We are now fortunate to have Dr Thomas Dewhurst join us on a permanent basis.
The lower areas of satisfaction were in regards to availability of appointments (55%), being able to see their doctor of choice (54%) and the online system (68%). Two of these areas also reported a lower level of satisfaction last year. This also reflects the challenges primary care has faced nationally; the national GP patient survey (2018) shows lower levels of satisfaction in these areas as well, however the practice is currently lower than the national average.
In terms of appointment availability this is an area the practice is looking at in more detail; it is related to being able to see your doctor of choice; however the practice is aware that this year has seen an increase in the demand for appointments at the surgery. The average waiting time for an appointment is still similar to last year, being approximately 1 week for routine matters; however this changes on a frequent basis as the demand for appointments can also be quite inconsistent. As always where a patient needs to be seen the same day an ‘on the day’ appointment is offered with the duty doctor, and if a patient feels they require an emergency appointment one is offered the same day with the duty doctor.
Many patients like to see their GP of choice which is more difficult to manage. Long standing GPs such as Dr Hall and Dr Brewerton have both reduced the hours that they work at the surgery; many of our female GPs also tend to work quite limited hours as they have commitments to their families. This has been a recurring area of lower satisfaction for several years; despite changing the way the appointments are managed. We will be looking at this as a practice to try and improve in this area. We understand the importance of continuity of care, and it has been a recurring theme in many of the surveys that have been analysed.
Online booking also had a lower level of satisfaction during this year’s survey; this year the new patient online site was released. Unfortunately practices did not receive any communication regarding the change and therefore we were caught by surprise when patients reported the issues they were having with the new site. It took some time for the technical support teams to fix these issues, and even now some patients are still having problems. There is a support team available through the patient online site who can help trouble shoot any issues. Of course the satisfaction could also be due to the availability of online appointments. All of the GP appointments are available at some point through the online access, including appointments that can be booked on the day; however the minor ailment appointments available with our nurse practitioner Loraine have now been removed from online access as the majority of these appointments were not being booked appropriately, and the front of house team, who are already so busy, struggled to check and rearrange the appointments in a timely fashion. Therefore the practice felt that it was better for patients to book these over the phone or in person, to ensure they are signposted to the most appropriate clinician to help them. We also do not offer practice nursing appointments online as the nursing appointments vary in length, currently the online system isn’t able to cope with this.
As noted in the results many of the areas which have lower levels of satisfaction are interlinked. I have decided to undertake my own audit in order to identify learning points for the front of house team and practice as a whole. At all times we strive to provide a high level of service to all of our patients, patient feedback is vitally important in order for us to improve and amend our service.
The results identified some action points which the practice will take into consideration. The first suggestion was to increase the number of appointment slots so that patients can get an appointment sooner. The partners and I are currently looking into the different ways that this could be accomplished. Primary care has changed significantly; now patients can be seen not only doctors but by nurse practitioners, matrons, physicians associates, pharmacists, and other clinically trained people who have not necessarily taken the traditional route into medicine. We are looking at the most appropriate ways to expand our clinical teams.
The second suggestion was to take measures to reduce dissatisfaction due to not being able to get appointments with patients’ doctor of choice. We include as much information as possible on our practice website and also look to update patients on the practice staff in the practice newsletters. The front of house team is always willing to tell you what they can about the clinician you are seeing prior to booking an appointment with them. All the doctors meet on a regular basis to discuss complex cases and referrals; and to ensure that all patients receive the continuity of care needed to manage their conditions effectively. It is unfortunate that not all patients are able to see the same doctor or their doctor of choice each time they visit the surgery. This is for various reasons; only one of the doctors is full time, Dr Ghani, and the clinical team’s annual leave and working patterns also have an effect. We also takes steps to appropriately sign post patients to ensure that everyone’s time is utilised appropriately. For example we discourage patients from seeing a GP to manage minor ailments such as coughs and colds as we have the support of Sister Redican to manage these conditions. Seeing a GP for these minor illnesses is not necessarily the best use of their skills or time. Following discussions with various members of staff, we have found this suggestion a very difficult area to address. We would welcome any ideas on how to improve this area.
The third suggestion is to encourage use of Patient Access. Following this we will look at improving the current paperwork available regarding online access; the assistance of the PPG with this would be greatly appreciated. As patients themselves they have the best insight into the most appropriate way to communicate this information. It was also suggested that the practice makes more appointments available on-line, to be more in line with what’s available via phoning or calling in at the surgery, as I previously mentioned all GP appointments can be booked online; the on the day appointments are released online at 8am, which is before the surgery phone lines actually open.
The final suggestion is to review allocation of appointments including those available online and the timing of those that are available. As mentioned all GP appointments are available online already; in terms of the times appointments are available, we have tried to ensure that our appointments cover most of the day. The practice offers early morning appointments, late evening as well as those during core hours (8am-6.30pm). We are also a base of the extended hours hub which is open until 8pm during the week and 12pm-4pm on Saturday and Sunday. These appointments are not run directly by the surgery which is why they can’t be booked online; they are managed by the Hillingdon Primary Care Confederation. Patients can book these appointments by speaking to the reception or by calling 111.
It has been difficult to learn that satisfaction has dropped in the past year compared to the 2017 results which scored so highly. However the majority of the feedback has been quite positive. We are always keen to improve our service where it is in our power to do so and we would like to thank the PPG for their efforts to not only prepare and analyse the survey but also for it’s support and suggestions following the project. If you feel there are further areas for development or concerns that have not been addressed please write to the practice manager, Louise Perugia.
Thank you for your feedback.
NHS England, (2018), GP Patient Survey, https://www.england.nhs.uk/statistics/2018/08/09/gp-patient-survey-2018/