Health and Care Experience Survey 2013/14 Volume 1: National Results

7 GP Practices - Medicines, Tests, Referrals and Mistakes

Medicines

7.1 Medicines are the most frequently used intervention in healthcare. In primary care, there are some 97 million prescriptions dispensed each year with an annual drugs bill of around £1.1 billion^[13] (around 10% of the annual healthcare budget).

7.2 Policies centre on promoting a healthier Scotland, and that everyone can access the medicines they need and make choices about managing and improving their health.

7.3 Importantly, more effective medicine use can help

• deliver better care outcomes for patients
• reduce the incidence of avoidable hospital admissions and
• improve the efficiency and effectiveness of treatment.

7.4 Central to this is supporting the patient with the right level of information and advice in taking his/her medicine as prescribed by a doctor or other trained healthcare prescribers (such as a pharmacist or specialist nurse). This is an objective common to a range of healthcare professionals, including GPs and community pharmacists / chemists and aims to improve health outcomes as well as reduce waste in prescribed medicines.

7.5 Patients were asked how much they agreed or disagreed with six statements about the last time they had been prescribed medicines at their GP surgery:

• It was easy enough for me to get my medicines
• I knew enough about what my medicines were for
• I knew enough about how and when to take my medicines
• I knew enough about possible side effects of my medicines
• I would know what to do if I had any problems with my medicines
• I took my prescription as I was supposed to.

7.6 In general, patients responded very positively about medication . Four of the top five most positive GP questions related to medication. Fully 98 per cent agreed or strongly agreed with the statement 'I knew enough about how and when to take my medicines' and 'I took my prescription as I was supposed to'.

7.7 However, as in the previous survey, the side effects of medication were less well understood. Only 82 per cent agreed or strongly agreed that they knew enough about possible side effects. The next least positive question was knowing what to do if they had any problems with their medicine (90%) (Table 4).

Table 4: Summary results of questions about medicines

Statement	Strongly agree/agree (%)	Neither agree nor disagree (%)	Disagree/ strongly disagree (%)	Change since 2011/12
It was easy enough for me to get my medicines	96	2	2	0
I knew enough about what my medicines were for	97	2	1	0
I knew enough about how and when when to take my medicines	98	1	1	0
I knew enough about the possible side effects of my medicines	82	12	6	-1
I would know what to do if I had any problems with my medicines	90	7	4	-1
I took my prescription as I was supposed to	98	1	1	0

GP Practices - Tests arranged by the practice

7.8 In previous surveys a significant number of freetext comments were received relating to blood tests, x-rays and other tests arranged by GP practices. In response to this, new questions were added to the 2013/14 survey to explore patients' experiences of such tests - a frequent component of primary care.

• 71% of respondents had had a test arranged in the past 12 months

7.9 Those that had were asked whether they agreed with four statements:

• It was explained to me why a test was needed
• I was satisfied with the length of time that I waited for my test results
• I was satisfied with the way that I received the result
• The results of the test were explained to me in a way I could understand

7.10 The most positive result was that 96% of patients agreed or strongly agreed that it had been explained to them why a test was needed.

7.11 However, responses relating to how patients received the results of tests were markedly less positive. 81% agreed or strongly agreed that they were satisfied with the way that they received the result and 82% felt that the test were explained in way that they could understand (Table 5).

7.12 This discrepancy may in part stem from how the different information is communicated. The initial need for a test is likely to be explained in a face to face consultation with a doctor or nurse, whereas results may well be provided over the phone and/or by a non-health professional.

Table 5: Summary results of questions about tests

Statement	Strongly agree/ agree (%)	Neither agree nor disagree (%)	Disagree/ strongly disagree (%)
It was explained to me why a test was needed	96	3	1
I was satisfied with the length of time I waited for my results	86	7	7
I was satisfied with the way I received my results	81	9	9
The results of the test were explained to me in a way I could understand	82	11	8

GP Practice - referrals to another professional

7.13 The referral process is an important component of quality care, which requires coordination and communication between different health and care services. Problems with referrals can lead to poor continuity of care and delayed treatment.

7.14 In this year's survey the questions regarding GP referrals have been modified to reflect the integration of health and social care services, which aims to ensure that health and social care provision across Scotland is joined-up and seamless. The questions now refer to care services as well as health services.

• 52% of patients had been referred to other health or care services
• 1% felt that they should have been referred to services, but were not.

7.15 Respondents who had been referred were asked how they would rate the arrangements for getting to see other health or care services.

• 78 per cent of patients who were referred by their GP in the last twelve months rated the referral arrangements as excellent or good;
• 14 per cent rated the arrangements as fair;
• 7 per cent rate the arrangements as poor or very poor

7.16 These results are more positive than for the equivalent question in the previous survey, (78% compared to 76%). This may in part be down to a broadening of the question wording, which as outlined above now includes care services.

Mistakes

7.17 The 2013/14 survey questionnaire included new questions relating to mistakes made by GP practices in the treatment or care that they provided.

7.18 In line with the healthcare quality strategy outcome for NHS Scotland that 'Healthcare is safe for every person, every time'.' the questions were included in order to provide an insight into the incidence of mistakes as well as patients' experiences of how mistakes were dealt with.

7.19 Respondents were asked whether they believed a mistake was made in their treatment or care by their GP practice.

• 6% of respondents believed such a mistake had been made in their treatment or care.

7.20 Of those that felt a mistake had been made in their treatment or care:

• 7% indicated that it did not require a response

7.21 Of those that required a response:

• 19% were completely satisfied with how it was dealt with
• 44% were satisfied to some extent
• 38% of those where were not satisfied

7.22 These results would suggest that mistakes, where they do occur, are not always being consistently dealt with to patients' satisfaction.

7.23 It is not possible to establish the seriousness of the mistakes that patients are referring to when answering these questions. The survey question itself provided examples of mistakes occurring in 'test results, medicines prescribed [and] diagnosis'.