Health and Care Experience Survey 2015/16 - National Results

9 Out-of-Hours Healthcare

Summary

• The overall positive rating for out-of-hours healthcare has remained steady from the previous survey at 71 per cent.
• Responses varied depending on the out of hours service that patients were treated by. Taken as a whole, the results for patients treated by Primary Care Emergency Centres and by ambulance/paramedics were the most positive.
• In addition, patients that were treated by doctors were generally more positive in their response than those treated by pharmacists, chemists or someone else.

Introduction

9.1 From 1 April 2004, the Primary Medical Services (Scotland) Act 2004 placed a duty on NHS boards to provide 'primary medical services' for everyone living in the NHS board area. These are the services provided by GP practices to patients registered with them. NHS boards have a legal responsibility to ensure these services are provided at all times, including out-of-hours.

9.2 The out-of-hours period is: the period beginning at 6.30pm from Monday to Thursday and ending at 8.00am the following day; the period between 6.30pm on Friday and 8.00am the following Monday; and Christmas Day, New Year's Day and other public or local holidays.

9.3 Since 2004, GPs have had the option of continuing to provide a service during the out-of-hours period or to opt out of providing this service on condition that there is an acceptable alternative. Over recent years alternative arrangements for providing out-of-hours care have been established. In many cases this involves a number of agencies and healthcare professionals working together to provide an integrated service for patients.

9.4 Many patients contact the NHS in a way that is unplanned, for example if they become ill during the day or night, or at the weekend. It is crucial that the NHS responds in a way that meets the needs of the patient in a timely, person centred, safe and clinically appropriate way. Often the journey of care will involve more than one part of the healthcare system so it is important for systems and process to be joined up, and for patient information to be shared by the healthcare professionals involved in supporting patients.

Use of out-of-hours NHS services

9.5 Of patients surveyed, 25 per cent had tried to get medical help, treatment or advice, for themselves or someone they were looking after, when their GP surgery was closed. This is the same as the previous survey.

9.6 For these patients by far the most common first port of call was NHS 24, which was contacted first by 65 per cent patients (Figure 14). The response options for this question have changed slightly since the previous survey so direct comparisons are not advisable.

9.7 The next most common was A&E/casualty services which 15 per cent of patients approached first. (Figure 14)

Figure 14: Service patients spoke or went to first when they tried to get help out of hours (%)

9.8 Over half of patients who contacted a service outside their GP surgery opening hours ended up being treated by either A&E/Casualty services or an out of hours service (35 per cent and 15 per cent respectively). Another 16 per cent of patients received phone advice only (Figure 15).

Figure 15: Service patients ended up being treated by when they used out-of-hours services (%)

9.9 For the respondents to the survey, the most common journeys through out-of-hours services, accounting for around 60 per cent of instances were:

• Patients contacted NHS 24 first and were then treated in A&E/ Casualty (17 per cent);
• Patients contacted NHS 24 and received phone advice only (15 per cent);
• Patients visited A&E / casualty first and were treated there (14 per cent);
• Patients contacted NHS 24 first and were then seen by an out-of-hours service (13 per cent)

9.10 The third bullet point partially reflects the fact that 91 per cent of patients who visited A&E as their first port of call were ultimately treated there. This is by far the highest percentage of patients being treated at their first port of call of any service (Table 6). This could suggest that patients are generally able to judge when a trip to A&E is appropriate, or alternatively could reflect a reluctance to redirect patients who present at A&E to alternative out of hours services.

Table 6: Percentage of patients who approach each service that are ultimately treated by that service

Service	%
A&E/Casualty	91
Primary Care Emergency Centre	79
Pharmacist/Chemist	62
Other	55
999 Emergency service (treated by ambulance/paramedics)	54
Own GP practice	38
NHS 24	23

Experience of out-of-hours healthcare

9.11 Patients were asked to rate their overall experience of the care provided by out-of-hours services.

9.12 In total 71 per cent of patients rated the overall care they received out of hours as excellent or good (Figure 16). This is the same figure as last year and noticeably lower than the overall positive rating for care and treatment from GP practices (87 per cent).

Figure 16: Overall rating of out-of-hours care (%)

9.13 The survey also asked patients who had tried to get help out of hours how much they agreed or disagreed with seven statements:

• The time I waited was reasonable
• I felt that the person had all the information needed to treat me
• I felt I was listened to
• Things were explained to me in a way I could understand
• I felt that the person who treated me was the right person
• I felt that I got the right treatment or advice
• I felt that people took account of the things that matter to me

9.14 The most positively rated statement were that things were explained to patients in a way they could understand (85 per cent) and that they felt listened to (84 per cent).

9.15 In line with results for GPs and nurses, the statement that the fewest patients agreed with was that people took account of the things that matter to them (74 per cent). (Table 7)

9.16 The statement regarding whether treatment was received from 'the right person' is a new addition to the survey and therefore comparisons with the previous survey are not possible. Of the six statements where comparisons are available, the results for four have grown more positive (Table 7).

Table 7: Summary results of out-of-hours services

Statement	Strongly agree/agree (%)	Neither agree nor disagree (%)	Disagree/strongly disagree (%)	Change since 2013/14
The time I waited was reasonable	74	10	17	-1
I felt that the person had all the information needed to treat me	78	12	10	2
I felt I was listened to	84	9	7	0
Things were explained to me in a way I could understand	86	9	5	1
I felt that the person who treated me was the right person	80	12	7	N/A
I felt that I got the right treatment or advice	81	11	8	1
I felt that people took account of the things that matter to me	75	16	9	1

Differences between services

9.17 Responses varied depending on the out of hours service that patients were treated by. Taken as a whole, the results for patients treated by Primary Care Emergency Centres and by ambulance/paramedics were the most positive (Table 8).

9.18 Those that ultimately received out of hours treatment from their own GP practice or received only phone advice via NHS24 gave the lowest overall ratings for out of hours care (62 per cent positive) (Table 8).

Table 8: Percentage of patients responding positively to out-of-hours questions, by service they were ultimately treated by.

	Time waited was reasonable	Person had all information to treat me	Felt listened to	Things were explained in a way I could understand	I felt it was right person treating me	I felt I got right treatment or advice	People took account of the things that matter to me	Overall rating of out-of-hours care
Phone advice only from NHS24	69	72	79	80	71	73	68	62
Pharmacist/chemist	85	83	91	90	77	83	77	68
Primary Care Emergency Centre	80	81	88	90	85	85	79	79
Own GP practice	78	81	85	87	82	81	77	62
Home visit from GP or Nurse	75	78	87	87	83	84	80	75
Ambulance Paramedics	80	82	85	87	84	85	79	79
A&E/Casualty	69	78	84	86	81	81	75	72
Social Care Services	62	72	72	76	70	73	69	63
Other	71	76	80	82	76	76	73	67

Practitioner that provided treatment

9.19 A new question was included in this survey relating to who actually provided the patient's out-of-hours care. Patients were asked: 'who ended up providing most of your treatment or care?'.

• 71 per cent of patients received most of their care from a doctor
• 17 per cent received most of their care from a nurse
• four per cent received most of their care from a pharmacist
• eight per cent received most of their care from 'someone else'

Table 9: Percentage of patients responding positively to out-of-hours questions, by practitioner that provided most of their treatment.

	Time waited was reasonable	Person had all information to treat me	Felt listened to	Things were explained in a way I could understand	I felt it was right person treating me	I felt I got right treatment or advice	People took account of the things that matter to me	Overall rating of out-of-hours care
Doctor	75	80	87	88	84	84	79	74
Nurse	71	77	83	86	75	78	72	70
Pharmacist	81	79	86	86	75	80	73	68
Someone else	60	62	67	70	61	62	57	51

9.20 Patients that were treated by doctors were generally the most positive in their responses. This included a noticeably more positive response for the new question relating to whether it was 'the right person' treating the patient (84 per cent for doctors, 75 per cent for nurses and pharmacists) (Table 9.

9.21 Patients treated by someone other than a doctor, nurse or pharmacist were the least positive in their responses (Table 9). It is not possible to say what sort of practitioner these patients were treated or seen by.