Scottish GP Patient Experience Survey 2009/10, Volume 3: Findings from the Analysis of Patient Comments

1 Executive summary

About the survey

1.1 The GP Patient Experience Survey is a large postal survey which was carried for the Better Together Scotland's Patient Experience Programme in 2009/10. The main purpose of the survey was to seek patients' views about their experiences of using their GP practice over the last twelve months. The main statistical findings from the survey have already been reported and are being used by GP practices to improve services. The national report is available here: http://www.scotland.gov.uk/Publications/2010/07/23150856/0

1.2 This report presents the findings of analysis of the comments left by patients in Question 20 in the survey which asked "If there is anything else you would like to tell us about your experiences at your GP surgery, please write your comments in the box below". Of the 185,989 surveys completed 43,543 respondents (23%) left a comment.

1.3 All comments were reviewed to remove material that could potentially identify patients, their families or staff e.g. names, diagnosis. They were then assigned a high-level theme based on the key issues raised by patients. Generally speaking these themes related closely to the main areas of the patient journey contained in the survey, from first contact with the GP practice, staff involved in care, medicines and treatment, through to overall experience.

1.4 The Table 1 below shows the total number of legible comments within each theme

Table 1: Total number of legible comments within each theme

Theme	Number of comments	%
Access	15,843	38
Overall and other issues	10,850	26
Consultation with doctors	7,578	18
Medicines/ treatment	2,774	7
Receptionists/Practice Manager	2,655	6
Facilities and buildings	1,624	4
Consultation with the nurse	718	2
Total	42,042

Note: percentages do not add up due to rounding
Note: total comments received was 43,730 but some were suppressed e.g. if they were illegible

1.5 Within these themes a number of more specific topics were identified and these are summarised below under each of the high level themes.

Access

1.6 'Access' was the biggest thematic group within the comments: 38 per cent of comments left by patients related to this theme. Although the majority of access comments left by patients were negative, the overall statistical results of the survey were mainly positive: only six per cent rated the overall arrangements for getting to see a doctor as poor or very poor. The equivalent finding was two per cent for nurses.

1.7 However the survey suggested that a sizeable minority of patients experienced problems with access, particularly around being able to book in advance; getting an emergency appointment; and seeing their preferred doctor or nurse. These problems generally correspond with the comments left by patients many of whom emphasised issues with phoning for on the day / emergency appointments; inability to make appointments in advance, including follow-up ones; and lack of ability to book with preferred doctor.

Receptionists/practice manager

1.8 Six per cent of patients' comments related to the theme of receptionists/practice manager. These comments were generally more negative than positive. This is in contrast with the survey statistical results reported in the national report where receptionists received positive feedback. The main issue raised in the negative comments concerned the attitude of some reception staff as well as concerns about having to disclose too much health information at the reception desk.

Doctors

1.9 'Doctor' was the third largest group of comments, representing 18 per cent of all comments. The majority of comments were positive which corresponds with the main statistical findings. Most of the comments left by patients suggested general praise for doctor, particularly around the quality of service provided by GPs, taking time to listen to patients and their commitment and efforts to accommodate patient needs.

1.10 A fewer number of patients left negative comments, but those that did tended to suggest instances where doctors did not demonstrate such positive behaviours described above. Some patients also identified problems around the treatment of mental health problems, for example a perception that some doctors may be too quick to prescribe medicines rather than look into causes and consider other treatments.

Nurses

1.11 'Nurse' was the smallest group of comments, representing two per cent of all comments left by patients. There was a mix of negative and positive comments, although nurses were actually rated very positively in the survey statistical results. Particular praise related to the overall manner and caring approach of nurses as well as the ability of nurses to provide clear explanations around treatment and conditions. Like the comments about doctors, where patients raised concerns, these tended to contradict the positive comments about nurses. The main issues raised by patients included: attitude of some nurses; perception of not enough nursing staff at GP surgery; and perception that some nursing staff lacked enough knowledge about conditions.

Medicines/Treatment

1.12 'Medicines/Treatment' was one of the smaller thematic groups within the comments (7 per cent of all comments). The main issue identified in the 'Medicines/Treatment' comments was the inability to get referral to another health professional or service within an acceptable time frame.

1.13 Other issues highlighted by patients related to medicines. Some patients highlighted a lack of understanding about their medicines, while others suggested that there should be medication reviews carried out by doctors for those on long-term prescriptions. Finally there were concerns raised about repeat prescriptions particularly around the wait for repeat prescriptions and coordination problems between GP surgery and pharmacy.

Facilities/Buildings

1.14 'Facilities/Buildings' was one of the smallest thematic groups within the comments and accounted for four per cent of all comments left by patients. The main issue which arose in 'Facilities/Buildings' comments related to the cleanliness and overall presentation of the surgery, both positive and negative. Another issue related to privacy at the reception desk, with comments suggesting that patients felt uncomfortable discussing health matter in front of other patients.

Overall experience and other issues

1.15 'Overall' was the second biggest thematic group, accounting for 26 per cent of all comments. The overwhelming majority of comments were positive and were simply general praise. This is reflected in the statistical findings from the national report which showed that nine out of ten patients rated the overall care provided by their GP surgery as good or excellent.

Conclusion

1.16 The analysis of the patients' comments at a national level has allowed us to understand in more depth some of issues which are important to patients. In some cases the analysis has provided better insights into the main quantitative survey results reported in the national report. It has also identified other issues not covered by the survey, for example referral processes to other health professionals or services and concerns about treating mental health problems.

1.17 In carrying out this analysis, it has reinforced the importance of viewing, both nationally and locally, the main statistical survey results alongside patients' comments to gain the best insights into the main areas for improvement.