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Patient experience ­ how to gain easy and rewarding quality points

The new GMS contract offers quality points around the patient experience which can be earned as follows:

 · 40 points for completing one of the two currently approved patient surveys ­ the IPQ or GPAQ questionnaire.

 · 15 points for reflecting on the results and producing an action plan to address them as a written report.

 · 15 points for discussing the results with a patient group or non-executive director of the PCT and demonstrating some evidence of change.

In the first year, 70 quality points equals some £5,250 for an average practice of 5,500 patients and three GPs and about £8,400 in subsequent years.

These could be some of the easiest quality points to achieve and, in my experience, some of the most rewarding.

In my practice we have performed the IPQ questionnaire twice, discussed the results and created a critical friends group that now meets regularly to address the issues raised by the annual questionnaire and other practice issues. This has proved really useful for us and has helped us improve our overall score.

How to start

Meet as a practice team and choose which questionnaire you wish to conduct. Details of these are available on the websites: for IPQ, and for GPAQ. The IPQ and GPAQ surveys are designed to be issued to patients in the surgery and GPAQ is available in postal format as well. In considering which survey to choose bear in mind the following factors.

 · Cost IPQ costs £60 plus VAT for each doctor (it comes with a full analysis and feedback service). GPAQ is free for practices but comes with no analysis, though this is available from an independent company (see GPAQ website). IPQ provides the questionnaires, whereas for GPAQ the practice has to get these printed.

 · Ease of administration and use

A postal survey will require envelopes, postage, processing and so on and response rates are rarely above 50 per cent.

For busy GPs, a package that provides statistical analysis of the results and a proforma feedback with benchmarks against other practices would seem the most desirable option.

 · Style of questionnaire and whether to do this at practice level or seek individual doctor feedback. (It is likely individual level feedback will be a requirement for appraisal and revalidation in future). Look on the websites, ask colleagues and see which suits you best. I suggest you run both practice- and individual-level surveys to help prepare for revalidation.

Running the survey

 · At a meeting with your practice team explain the survey and how it will run, remembering to include receptionists in particular.

 · Decide whether you want to run individual level surveys and if so whether you want to include nurses, nurse practitioners and so on.

 · Pick a time when few doctors are away so you can collect the forms on all the professionals in a designated period.

 · Ensure receptionists are briefed to issue the questionnaires and provide patients with pencils and pens to complete them.

 · Explain to patients the purpose of the survey and what you hope to achieve at the end of it and listen to their views.

 · Appoint a member of the team to check enough questionnaires are completed.

The questionnaires themselves are user friendly and pretty straightforward. Some 35 questions are asked in the GPAC questionnaire, for example, and tick boxes are offered for responses.

To give an example, patients are asked how they rate the hours their practice is open for appointments ­ six tick boxes being offered for a response, ranging from very poor to excellent.

Again, when patients are asked how long it takes for them to see a particular doctor, seven tick boxes are offered for a response, ranging from same day to five or more working days.

The IPQ questionnaire asks 30-odd questions, such as 'How were you treated by reception staff'. This time respondents are asked to circle an appropriate response (see box, page 33).

Receiving the feedback

If you have chosen the IPQ, which gives you comprehensive feedback, or chosen the data analysis option with GPAQ, it is a matter of disseminating the results to individuals and the practice team.

Do not underestimate the amount of time involved in trying to analyse such data yourselves ­ go for the analysis service.

The feedback will come on two levels: practice level and individual doctor level. Practice level data relates to how the patient finds the practice environment, access, waiting times, the manner of receptionists and so on.

The practice manager is best placed to disseminate this information in a sensitive manner to the practice team. Remember that for some people the feedback may be challenging but is usually less so at practice level.

Individual level results

These in particular must be handled sensitively. I suggest that each doctor or nurse who does the survey addresses a friend or mentor in advance to whom they will confidentially discuss their results.

Reflecting on the results

Normally patients are most satisfied with the skills of the professional and least satisfied with access to them. Look for an analysis system that breaks down the result by age, gender and whether they are seeing their usual doctor, as this provides vital added information.

It is common for there to be a difference in scores from different gender patients.

In my own practice each partner discusses his or her results with his or her mentor and then feels free to share these results with other members of the team.

I personally have shared my results with my mentor and also

my appraiser and we agreed an action plan to address issues raised in the survey in my PDP.

If you are disappointed by the results it is important to have access to support, to discuss the issues raised and see what can be done.

Useful sources of help include the LMC, appraisers, local deaneries and in the case of the IPQ questionnaire their staff can provide suggestions and support on request.

Action planning

Discuss practice level results with the whole practice team, getting comments from all members of staff. Remember most of the negative comments are likely to relate to access. Statistically the lowest-scoring domains are normally about time spent waiting in the surgery. Respect and capture the views of the whole team ­ the practice manager again is usually best placed to do this.

At this point it is really useful to share the data and the initial views of the practice staff on it with patient representatives from your practice. If you already have a patients group this is easy, although it may mean a slight change in role for them and may initially appear threatening to them.

Remember statistics show that 90 per cent of them are satisfied with your service.

If you do not have a patient group think about inviting people who have previously complained and whose complaint you have resolved to act as a sounding board. Sometimes there are clear leaders in your community who are patients who will help form a group.

Alternatively advertise for people through your practice newsletter or posters in the waiting room. The National Association of Patient Participation (www. is a useful contact and resource.

To summarise

In this section of the Q&A framework there are 70 quality points that are relatively simple to obtain. All you have to do is arrange for an annual survey and get your receptionists to hand out the questionnaires.

 · Choose a survey with an analysis service ­ it will be well worth the money as just completing the survey will bring in some £1,000 per GP.

 · Treat the practice level data and the individual level data separately. Individual level data can be sensitive and should be shared with a trusted individual or an appraiser. Don't share this with patients or patient groups unless you are really confident.

 · Agree in advance who individuals will discuss their data with (ie persons outside the practice, perhaps a spouse).

 · Practice level data is everyone's business. It involves a whole team and receives everyone's views. But don't make changes without involving patients or their representatives.

 · Give some thought in advance of how you will involve patients in the feedback (in our practice the patients group helped hand out the questionnaires and explained the process).

 · Enjoy the process and remember most of the data shows that patients are highly satisfied with the individual skills of the practitioner ­ the challenges are in trying to access them.

Discussing the issues with the patient group

Don't be too afraid of this ­ patients are normally only too aware of any pressures you may be working under, for example vacancies, deprived areas and so on.

Share the results of the practice-level feedback with patients in the group, ask them their views and see where these coincide with those of your own team. Home in on those areas where everyone is agreed on the actions needed.

Publicise what you are doing again through newsletters and letters in the waiting room and set a date for the group to meet again to discuss progress. Once you have got used to working together tackle some of the trickier issues. The group will soon become a useful forum.

Section taken from the IPQ questionnaire

Please circle the appropriate number on each line Poor Fair Good Very good Excellent

1. Your level of satisfaction with the practice's opening hours 1 2 3 4 5

2. Ease of contacting the practice on the telephone 1 2 3 4 5

3. Satisfaction with the day and time arranged for your appointment 1 2 3 4 5

4.Chances of seeing a doctor within 48 hours 1 2 3 4 5

5. Chances of seeing a doctor of your choice 1 2 3 4 5

6. Opportunity of speaking to a doctor on the telephone when necessary 1 2 3 4 5

7. Comfort level of waiting room (chairs, magazines) 1 2 3 4 5

8. Length of time waiting in the practice to see the doctor 1 2 3 4 5

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