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

7 Medicines/Treatment

7.1 The 2,774 comments described as 'Medicines/Treatment' (7 per cent of all comments) included themes around whether patients knew enough about how and when to take their medicines. Also in this group were comments regarding referrals, communication between GP and hospital, as well as other practitioners at the surgery, e.g. physiotherapy.

7.2 This group comprised mostly negative comments which is contrary to the main survey findings from the national report. For example they showed that 96 per cent of patients knew enough about what their medicines were for always or most of the time, with 74 per cent always knowing enough. The question which asked about whether patients knew enough about how and when to take their medicines was the most positively answered question in the survey with 99 per cent of patients answering that they knew enough always or most of the time. There were no questions in the survey relating to referrals. The 2010/11 survey introduced a question on this.

7.3 Given the wide range of sub-themes within this group, we have structured the both positive and negative issues around the key issues raised by patients. These are summarised collectively below:

1. Medicines and treatment

Positive

• general feeling of satisfaction and praise for the course of medicines/treatment received;
• felt that they knew enough about their medicines, i.e. what it was for and how to use it;
• praise for systems for repeat prescriptions, e.g. through email, and collection of prescriptions.

Negative

• patients suggesting they don't know enough about their medicines;
• perception that doctors too ready to prescribe drugs rather than look deeper into causes / lack of treatment choices;
• problems with systems for ordering repeat prescriptions - e.g. restricted or lack of user-friendly system for ordering repeat prescriptions, wait to receive prescription and coordination problems;

• lack of regular reviews of long term repeat prescriptions;
• changing medication can lead to confusion.

2. Referrals

Positive

• Satisfaction with the speed of treatment, referral etc. and the level of aftercare provided.

Negative

• Length of time to wait to be referred to, and eventually be seen by, other health professionals/ specialists;
• Poor communication between GP surgery and other health services and vice versa.

Findings

Medicines

7.4 The main theme in this theme related to medicines and there were a sizeable number of negative comments. There were people who felt like they didn't know enough about what they were being prescribed, what it was for, how it worked and how they were to take it.

"I find that my doctor doesn't always tell me how much or how often to use my medicines or creams. I just look on the labels when I go to the chemist for prescriptions. But I don't know if what the doctor says is the same on the chemist labels."

7.5 Conversely there were many patients who reported positive experiences. Typically these patients praised the efforts of staff in explaining how to take their medicines,

"My Dr and nurse explain everything they do and explain all the reason for my medicines."

7.6 The systems for repeat prescriptions were highlighted by a large number of patients. There were those who commended the local systems for ordering repeat prescriptions. Particular features of such systems were: flexibility, different ways of ordering e.g. through email and speed.

7.7 However a large number of patients highlighted problems with the systems for ordering repeat prescriptions. For example, some suggested that it was difficult to do as the system was restrictive:

"Repeat prescriptions can become an erroneous task, the process should be reviewed to allow simple request action and collection at pharmacy."

"The only down side is that you can only phone for a repeat prescription within a small window of time. Would like to see the window increased."

7.8 Others pointed out that the wait to receive prescription was too long and there were coordination problems within GP surgery and between GP and pharmacy.

7.9 A number of people who were on long term medication commented that they didn't think that their medication was reviewed often enough.

"I feel there's no after care. For example I'm on blood pressure medication, but I'm not asked back for check up. I'm on a repeat prescription"

7.10 A small but important finding found within 'Medicines/Treatment' theme, related to patient views changing medicine 'brand'. Some suggested that the change in brand of medicines sometimes led to confusion, for example if they were prescribed a different brand sometimes their medicines looked different.

"Prescription - different 'brands' of same drug can be confusing and lead to error."

7.11 Others commented that they did not like being given a different or non-brand medication because they thought that it didn't work as well and was just a cost-cutting exercise to save money.

"I don't like the way the medicines have been changed from brand names to cheaper versions. I know a lot of them do the exact same thing but from my own experience some of the cheaper ones do not work at all."

Referrals

7.12 One of the key themes in this area was referrals. There were many positive comments about referral processes which suggested that the speed and systems for referrals was more than satisfactory.

"Having several conditions and requiring specialist treatment I have been referred to X on several occasions very quickly and treated very effectively. My GP surgery is very efficient with referrals."

7.13 A number of people commented on the ability to self-refer, for example:

"Excellent that you can self refer to the physio my experience of the referral scheme and physio staff has been excellent."

7.14 There were however many negative comments. The main issue raised in this topic was waiting for referrals. The comments suggested that the time between a first appointment with a GP and getting seen by another health professional was too long.

'While I am perfectly happy with my experiences at my GP surgery, I am not happy about the length of time we have to wait for hospital referrals.

"I waited three months for a referral to hospital only to find I was not referred despite repeated calls to surgery and now I have to wait another three months for hospital appointment."

7.15 A number of patients commented on problems waiting for to see specific health professionals such as physiotherapists.

7.16 In some cases patients suggested that delays could lead to unnecessary health complications. Some patients even commented that they had resorted to self-referring privately because the wait was too long:

"'As a population we always being told to exercise - yet there is no local provision for sports injuries. My health centre does have a self-referral physio department, but a wait of 2 - 3 weeks is no good. I've spent hundreds of pounds on private physio to get me back to work and back to sports."

Summary

7.17 '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.

7.18 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.