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

2 Introduction

2.1 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 survey was sent to a random sample of people who were registered as GP patients in Scotland. The main purpose of the survey was to seek patients' views about their experiences of using their GP practice over the last twelve months. In particular, the survey asked about: making an appointment; visiting reception; seeing a nurse and/or doctor at the surgery; receiving prescribed medicine; and overall care provided the practice. The main statistical findings from the survey have already been reported at local and national levels 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

2.2 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.

Better Together Programme

2.3 Better Together is Scotland's Patient Experience Programme, using the people's experiences of NHSScotland to improve health services.

2.4 The Better Together programme supports the Healthcare Quality Strategy for NHSScotland (or Quality Strategy) by providing a basis for the measurement of quality as experienced by service users across Scotland, in addition to support for local improvement.

2.5 The ultimate aim of the Quality Strategy is to deliver the highest quality health and care services to people in Scotland, and through this to ensure that NHSScotland is recognised by the people of Scotland as amongst the best in the world. The Better Together programme provides opportunities for people in Scotland to comment on their experience of healthcare and its impact on their quality of life and the 2009/10 Scottish GP survey is an example this work. Since the 2009/10 GP survey, another modified GP survey has been carried out, this time incorporating other local NHS services, including out of hours services. Further information on the results of this survey can be found at:
http://www.scotland.gov.uk/gp-survey-national-report-2012

2.6 The Better Together programme also includes the Scottish Inpatient Patient Experience Survey. Further information on the inpatient survey can be found at:
http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/InpatientSurvey

2.7 Further information about the Quality Strategy can be found at:
http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/NHSQuality

Survey fieldwork and response

2.8 The sample for the 2009/10 GP survey was designed to provide results for individual GP practices as well as providing information for use by NHSScotland and NHS boards. Patients who were sent the survey were randomly sampled from the lists of patients registered with each GP practice in Scotland. This was done confidentially by Information Services Division (ISD) of the NHS National Services Scotland^[1]. The survey was administered by Picker Europe^[2], a charity which provides support for patient experience surveys, with support from ISD and the Scottish Government. Fieldwork for the survey began on November 20, 2009 and ended on April 16, 2010.

2.9 In total 485,380 surveys were sent to patients and 185,989 were returned completed giving an overall response rate of 38 per cent. Patients were asked to only respond to the survey if they had contact with their GP surgery in the last 12 months.

2.10 More information on the 2009/10 GP patient experience survey design, response rates and methodology can be found in the technical report
http://www.scotland.gov.uk/gpsurveytechnicalreport

Processing and analysing patient comments

2.11 There were 43,543 patients who left comments from the 2009/10 GP Patient Experience survey. These required to be processed so that they could be uploaded onto an online system for GP practices to access. There were four elements to this process:

1. review of the comments to remove disclosive material such as patient or staff names - undertaken by Picker Europe;
2. comments were rechecked to ensure they did not contain any details that could disclose a patient's identity;
3. identification key themes arising from the comments;
4. comments were identified as positive, negative or neutral.

2.12 Given that the population of some remote rural practices is small, it was important that all comments were rechecked to ensure they did not contain any details that could disclose a patient's identity. Details such as diagnosis, age, place names, were removed using a coding and sanitisation guide.

2.13 As a result of reviewing the comments 1,501 were unable to be shared with GP practices as they were deemed unusable, partly because they no longer made sense due to a large amount of disclosive information having to be removed. In addition some comments were not shared with GP surgeries if they were completely illegible.

2.14 As part of the comment review process, key themes were identified. In the first instance the comments were 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. This enabled us to provide comments for an individual GP practice by topic to make them easier to review locally.

2.15 Within the high level themes, a number of more specific topics areas were identified and comments were classified as positive, neutral or negative. Where a comment contained a mix of positive and negative points with the main focus of the comment being negative, this was classed as negative. The reason for this approach was to highlight any areas which were identified by patients as requiring attention. For example the following comment was coded as negative.

"Overall the GP surgery is good. However the receptionists are very rude inappropriate and sometimes can be quite offensive. I am not happy with this."

2.16 Table 2 below shows the total number of comments within each theme

Table 2: 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	42042

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

This Report

2.17 Using the comments made by those who responded to the survey allows for a deeper understanding of what is important to patients and means that areas of service achievement can be reinforced. It also highlights areas which need improved. The comments have already been made available to each GP practice. This report is based on collective analysis of the comments at a national level to highlight areas of success and areas for improvement.

2.18 Given that the comments closely reflected the main themes within the patient journey, the report is structured around: access to services; doctors and nurses; medicines; facilities/environment; and overall experience. Within these areas, subthemes are also reported which provide more detailed understanding of the specific areas patients identified as important. Quotes have been used in this report as they help to substantiate findings.

2.19 One of the most noticeable things about the comments is that there are more negative comments than positive ones. However, this does not reflect the overall results of the survey, as these were in the main positive. It is unclear the precise reasons for this and further analysis of the relationships between responses to quantitative survey questions and the comments is required. It may be that patients, who were less positive in answering the quantitative survey questions, were more likely to leave a comment which was negative. However it is also possible that patients who provided overall positive responses in the main survey, made negative comments on specific issues. For example, in assessing whether the receptionist was polite and helpful, patients may have responded positively to this question if the majority of reception staff were felt to be polite and helpful and only one was not helpful. In these cases patients may have been inclined to comment on the one staff member who was unhelpful.

2.20 It is also worth noting that some comments were classed as negative because they contained mostly negative points, but they may also have contained positive points (see para 2.15). This is a limitation of the analysis and we have therefore avoided specifically quantifying the number of positive and negative comments but the analysis has allowed us to provide a broad indication of the spread of comments. Given the differences between the comments and survey results, we have presented the findings from the comments in context of the overall findings of the survey.