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

3 Access to services

3.1 The patient's journey begins with contacting the surgery. From the comments left, the theme of 'Access' covered anything related to getting an appointment, getting through on the phone, seeing a specific doctor (or being able to see, for example, a female doctor), and the time to wait in the waiting room. It also covered any comments relating to access to repeat prescriptions, test results, appointment length, continuity of doctors, and anything mentioning well-man/woman clinics and preventative screening.

3.2 The comments coded as 'Access' formed the largest thematic group within the framework. There were 15,843 (38 per cent of comments) comments coded as 'Access'. This group is comprised mainly of negative views and only a small number of positive comments. This finding may be explained by the survey statistical results which generally showed that a sizeable minority of patients experienced some problems accessing GP services particularly around booking appointments in advance, seeing a preferred doctor and getting to speak to a doctor or nurse within two working days. However 81 per cent rated the overall arrangements to see a doctor as good or excellent and 87 per cent rated the arrangements to see a nurse as good or excellent.

3.3 The main themes to emerge from the analysis of positive comments relating to access were:

• good appointment system (open surgery/on the day only/advanced booking);
• opening outside normal working hours, for example, early mornings/evenings/weekends.
• able to get an appointment within a reasonable time frame;
• able to see preferred doctor;
• adequate time for consultation;
• children always seen quickly - time is made for them;
• use of technology - e-mail repeat prescriptions, online appointments and electronic check-in;
• use of phone consultations as an alternative to appointments.

3.4 Within the group of negative comments, the major issues identified by patients were:

• difficult to get through on the phone in the morning for on-the-day/emergency appointments;
• not enough on-the-day/advanced appointments/open surgeries - appointment systems are not good, it is difficult to ever see a doctor;
• waiting times too long to get an appointment;
• not able to see preferred doctor, or male/female doctor as either not available or the surgery doesn't have both male and female doctors.
• need to have more clinics such as well-man/woman clinics and other preventative methods - particularly for older patients.
• use 0845 numbers for surgery which due to costs especially for mobiles, and if there are difficulties getting through.

3.5 Patients commented on a range of different appointment systems. Every system received both positive and negative comments; what suited one patient did not suit another. In addition, the acceptable level of time to wait for an appointment varied between patients. However, judging from the large number of comments, it would appear that the system requiring patients to phoning first thing in the morning for an appointment that day was disliked more than the others. This is mainly because it results in very busy phone lines in the morning and uncertainty as to whether patients will get through on time to get an appointment.

"It is very difficult to get an appointment fairly quickly - it is hard to get through to the surgery first thing in the morning as it's always engaged. Sometimes when you do get through there are no appointments left."

3.6 This appointment system was also criticised as being unsuitable for working patients due to the difficulties of calling during travel and work time. It was also felt by some that it doesn't allow for planning time off for appointments.

"I feel the appointment system does not take into account people who work on a shift pattern."

3.7 There were some patients who were positive about a mixed appointment system as it consisted of open surgery and pre-bookable appointments which it was felt were more suited to the wider needs of the community.

"Open surgery system in morning and appt. system in evening. Personally I think this runs very well."

3.8 This ties in with the comments that are praising (or criticising the lack of) early morning/evening/weekend appointments because they allow working people to see doctors and nurses without it interfering with their work day.

"The introduction of late night and Saturday morning surgery is excellent."

3.9 While some people had very positive experiences in getting an appointment; others found it difficult. There were also many comments about problems with the length of time to wait to see a doctor once an appointment had been made.

"It often takes too long to get an appointment - if I phone on a Monday sometimes the next available appointment is not until the following week. There is sometimes quite a long wait in the surgery to see the doctor."

3.10 Comments were also made by patients about the length of the time to wait in the surgery after their allotted appointment time. For some patients, a 'reasonable' wait was felt to be acceptable as it indicated that patients were not being rushed through appointments:

"…appointment times usually run slightly late because you never feel pressured in the consultation. So the doctor takes time to make sure everything is ok without watching the clock."

3.11 Conversely, others were concerned by the wait at the surgery. Some were concerned about waiting for a long time only to be with the doctor for a short period. Others pointed out that if patients were late for an appointment, there was a risk of not being seen:

"If you are late 1 minute they cancel the appointment but the GP can keep you more than 1 hour to wait I think that is not fair."

3.12 Some patients complained about the inability to book follow-up appointments with their doctor or nurse in advance. For example some pointed out that they had been advised to do so by the doctor or nurse but were told by the receptionist that either advance appointments were not available and they should call on the day they required the appointment, or that it was too far in advance and to call back nearer the time.

"When asked to make a follow up appointment could not do it as surgery computer system could only work 2-3 weeks ahead of present date."

3.13 These comments correspond with the main survey findings in the national report which suggested that a sizeable minority of patients had problems booking appointments in advance.

3.14 Another finding of the main survey was that some patients reported difficulties in getting appointments with preferred doctor/ nurse. This was a concern which ran through many of the 'Access' comments. A number of patients suggested that this left them feeling fairly anonymous as the doctors they were seeing would not necessarily know them, their circumstances, and any pre-existing conditions and treatments.

The G.P. who knows my medical problems (which are considerable) is excellent, but there is often a long wait to see her and it is not practical too see another G.P as it would take too long to explain my problems.

3.15 Some went further and suggested that this was detrimental to their care, particularly where they had long term conditions or ongoing medical problems. It was said by some that there was no longer a feeling of having a 'family doctor' which led to treatment of symptoms and no opportunity for further investigation or holistic care.

"I miss having a family doctor one who knows all about me and my family. I rarely see the same doctor as I take easiest appointments. As a result my assigned GP is rarely seen. They seem very rushed and don't have time to look into your medical history in any great depth. I find I prefer some doctors in the practice to others but rarely get the chance to see the same one as I take first appointments available when ill which is not often."

Summary

3.16 '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.

3.17 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.