GP practices are providing excellent services and are improving – but patients want them to stay open for longer.
This is the message that practice managers need to take on board from one of the largest-ever surveys of patient experiences conducted between April 2004 and December 2005.
The good news is that more NHS patients are finding it easier to see their GP within 48 hours, according to the survey of 800,000 patients from 2,000 practices. Also, practices are achieving the largest improvement in providing patients with the opportunity to speak with their doctor on the telephone when necessary – up from being rated "fair" in 2005 to "good" this time.
The Improving Practice Questionnaire (IPQ) survey – conducted by CFEP-UK Surveys, a licensed provider of patient surveys supporting the new GP contract – also reported significant improvements in patient satisfaction with clinical services and supporting services. Doctors and other health professionals achieved high scores on their interpersonal skills and perceived capability.
The overall score did not fall below "good" in any of the 27 categories surveyed, while in 11 categories the overall score was "very good" or "excellent".
An open and shut place?
The only area of performance that gained a significantly worse score was the level of satisfaction with practice opening hours. This is an issue that practice managers need to sit up and take notice of because it is also a top government priority, says Dr David Jenner, a Devon GP and clinical director of CFEP-UK Surveys.
This was clearly stated in the primary care white paper, Our Health, Our Care, Our Say, published last year, in which the government outlined proposals encouraging practices to make their opening hours more convenient for patients. The white paper promised that, in future, practices will be offered financial incentives to do this. From the end of this year, new standardised patient surveys will ask patients their opinions on opening hours and whether their practices offer early morning, evening or Saturday morning opening.
Dr Jenner believes offering patients longer opening hours should not be as difficult as it might first appear, and that clinicians can often achieve this simply by improving their time management.
In his own practice, for example, Dr Jenner says he now starts consulting early at 8am and finishes at 6.30pm instead of 5.30pm, but still manages to leave the practice at the same time. He has managed to do this by building time into his working day to catch up on paperwork in between seeing patients.
Another option would be to offer later opening hours on certain days of the week and to compensate by closing the surgery earlier at other times – a concept Dr Jenner believes patients would find acceptable from looking at comments from the IPQ survey.
In larger practices there are likely to be one or two GPs who will be prepared to work a Saturday morning in return for time off during the week. Smaller practices will either have to collaborate with other practices in order to provide an extended service in rotation or hand the problem over to their primary care trust (PCT), which may commission the service from an independent provider.
Listening to patients
Dr Jenner believes it is important that practices start to take on board the views of their patients on issues such as opening hours: "The new GP contract has been designed to make practices more patient-friendly by introducing basic customer sensitivity measures backed by incentives. What other business would not survey their customers?" he asks.
He adds that practice managers can easily introduce other changes to improve their patient satisfaction scores. Improving access to a doctor or nurse on the telephone can be achieved by an overhaul of the telephone system and an agreement about how to cope with phone calls – for example, by having a doctor or a nurse practitioner on duty each day solely to deal with same-day urgent calls.
Acting on feedback
Feedback from patient surveys can also be used by clinicians to improve their consulting skills. Issues that patients raise can be discussed with appraisers or practice partners.
"I shared the results of a patient survey on my consulting skills with a colleague because we had different learning needs. Patients said I was not good on empathy, whereas my partner was brilliant at empathy but not good on time management. Sometimes you have the resources amongst your own practice team to compare feedback and help each other to improve your communication skills," says Dr Jenner.
Surveys can also provide valuable feedback on the manner of reception staff. This is something that can be easily improved by sending receptionists on customer care workshops or even be dealt with inhouse. A simple measure, such as encouraging staff to smile while they speak on the phone, can improve the tone of their voice.
When such patient surveys are conducted annually, they can provide a mine of information that can help the practice to improve. But for now, the main message from CFEP-UK's recent patient survey is that practices have much to be proud of but must do more work on increasing patients' satisfaction with their opening hours.
Dr Jenner says: "British general practice is rather like tomato sauce – most people love the product but have traditionally had trouble getting it out of the bottle. Now that's getting easier and the sauce remains as popular as ever, but people do want the shop open longer."