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Patient experience

Dr John Couch continues our series by examining the requirements needed to earn points from patient experience

Points achieved with complete ease

Although none of the indicators is completely easy the number of points available makes patient experience too rewarding to ignore.

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Points achieved with good planning

PE 1 The length of routine booked appointments with the doctors in the practice is not less than 10 minutes. (If the practice routinely sees extras during booked surgeries, then the average booked consultation length should allow for the average numbers of patients seen in a surgery session. If the extras are seen at the end, then it is not necessary to make this adjustment.) For practices with only an open-surgery system the average face-to-face time spent by the GP with the patient is at least eight minutes. Practices that routinely operate a mixed economy of booked and open surgeries should report on both criteria.

Value 30 points

Although many practices already achieve this indicator, those that do not face considerable planning and effort. Practices with large lists may find this particularly difficult.

The indicator specifies that on average three-quarters of consultations must be 10 minutes or longer, including extras and urgent cases. Check you can achieve and prove this. Practices should also keep half an eye on the 50 bonus points for advanced access. Although PE 1 and advanced access are not mutually exclusive, both have initial implications on workload.

To achieve and maintain PE 1, workload management, clinical protocols and manpower must be carefully addressed. Study and monitor patient demand. Review the frequency of acute and chronic disease

follow-ups. Consider the benefits of telephone triage, at least for same-day requests. Always have some contingency plans for increased demand or staff illness. If your demand still exceeds capacity consider whether you should invest some of your aspiration payments in increased health care assistant, nurse or GP manpower. It is vital to have one team member with overall responsibility for your system.

PE 2 The practice will have undertaken an approved patient survey each year

Value 40 points

The large number of points makes this indicator a must. Read the Blue Book guidance on the approved questionnaires (GPAQ – General Practice Assessment Questionnaire and IPQ – Improving Practice Questionnaire). At least 50 completed forms must be returned for each permanent doctor in the practice. Surveys may be done in the surgery, forms being completed after seeing the GP, and must be done on consecutive patients to avoid bias. Alternatively a postal survey is allowed but patients must be randomly selected for the same reason.

As the return is likely to be poorer from postal surveys, in-surgery versions will be more effective to organise. They can be done over a concentrated two or three days or until the required number of adequately completed forms has been achieved. In-surgery surveys can also be related to individual GPs and used in revalidation folders. Brief staff in advance and appoint a project leader who can produce the written evidence, including methodology, required for the assessment visit.

PE 3 The practice will have undertaken a patient survey each year, have reflected on the results and have proposed changes if appropriate

Value 15 points

It is pointless achieving PE 2 without also going for this indicator. Your project leader can collate the results in tabular or spreadsheet format. Surveys will confirm the areas that you do well and illustrate those where your patients feel you do not. The results are often surprising! You need to be able to show reflection on the results. The indicator does not define this so you may chose to discuss this, informally or formally, among the partners, all clinicians or the whole team (see PE 4).

It would be a foolish business that did not listen to its 'customers' so any changes that seem reasonable, logical and achievable ought to be considered. The indicator does not insist that changes are implicated nor do the full survey results have to be presented as evidence. A written overview/analysis and proposals for change are sufficient.

Points achieved with real striving

PE 4 The practice will have undertaken a patient survey each year and discussed the results as a team and with either a patient group or non-executive director of the PCO; appropriate changes will have been proposed with some evidence that the changes have been enacted

Value 15 points

This is the most contentious indicator, extending PE 1 and PE 2. Discussing the results with a patient group or the non-executive director of the PCO may make the survey process seem more intimidating. Any proposed changes run the risk of being on a less comfortable, more extensive and costly scale. To achieve the indicator the practice is committed to action changes. An alternative view is that the changes may be more productive if 'consumers' also have a say in planning – the NHS Confederation certainly thinks so.

Practices must decide individually which view they take. There is more at stake here than simply framework cash. If a positive view is taken, then start the relevant changes. Include a monitoring process. Keep a report of the meeting and results of changes (including positive comments in future patient surveys) as evidence.

John Couch is a GP in Ashford, Middlesex

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