Feedback From 2013 Survey
37. The Advisory Group's remit included identifying lessons that could be learned from the administration, collation and analysis of the 2013 Survey data. Feedback was encouraged and received from primary care stakeholders throughout the 2013 Survey process. Some of the comments received during the pilot of the In Hours form with SGPC members could not be actioned in time for the 2013 Survey, such as proposed changes to the scope of the Survey, but were relevant to future exercises.
38. During the 6 week main fieldwork period of the Survey, Glasgow LMC and ISD Scotland dealt with a range of queries from GP practices and Boards relating to the completion of the forms. In the course of checking and collating the returns, ISD Scotland and Glasgow LMC were required to follow up a number of issues with individual GP practices and Boards in relation to the data submitted. In 2009, there had been 94 queries. For the 2013 In Hours Survey form, the query rate was slightly more than double at 190 but the nature of the queries was more complex, which had a significant impact on the time required on this early stage and resulted in a slight delay to commencement of the analysis stage. In addition, all of the OOH forms generated queries. In a handful of cases, these were quickly resolved but in most cases, further discussion with the relevant Board official was required in order to clarify the data requested. Most OOH forms were subsequently re-submitted and in several cases, needed to be further amended and re-submitted before they could be considered ready for analysis.
39. The following pages of feedback are a summary of the comments received by the Scottish Government, ISD Scotland and Glasgow LMC. It reflects the experience of those involved in completing the forms as reported to members of the Advisory Group. In some cases, the feedback demonstrates a lack of awareness on the part of some responders of the process undertaken (for example, which bodies had been consulted during the development stage of both forms and the promotional activity undertaken before, during and after the launch) or of the guidance which was included with the Survey forms. It is understood that some GP practices were unable to access the second spreadsheet of the Excel workbook which was circulated. The Survey forms were subsequently re-issued with the guidance notes for both forms issued as separate files to the Survey forms. However, it is evident that some responders were still unaware of the guidance available.
40. The feedback has been split between comments received on the In Hours form and on the Out of Hours form. It has then been sub-divided into the following Survey stages:
- Development of form and guidance
- Content of form and guidance
- Promotion of Survey
- Distribution of Survey to GP practices/Boards
- Collation and checking of returns
- Other comments
Summary of Feedback Received in Respect of In Hours Form and Guidance
Scope of Survey
- Whilst the In Hours form requested information on total GP sessional commitments (in the practice and elsewhere), these commitments did not reflect additional time spent by GPs on other tasks, such as administrative duties.
- It was suggested that information on time spent by GPs on non-primary care, split into activities and sessions, would also have been helpful.
- Neither the In Hours nor the OOH form captured hours worked by GPs/nurses in those 45 practices contracted ('opted in') to provide OOH cover for their own practice patients.
- It was suggested that a fuller exploration of the roles of clinical support staff may be helpful in future Surveys.
- It was suggested that data on sessional commitments and average weekly hours be collected in future, similar to the approach adopted in English GP workload surveys.
- There appeared to be some confusion experienced by some in respect of the difference between extended hours and Out of Hours service.
Development of form and guidance
- It was suggested that Practice Managers, or a representative of Practice Managers, should have been involved in the development of the form and guidance.
- It was also suggested that a fresh appraisal of the 2009 Survey elements and definitions by a multi-disciplinary group, prior to launch of the 2013 Survey, may have identified and provided an early opportunity to resolve some issues which were uncovered later and proved time consuming to address.
Content of form and guidance
- While some found completion of the form straightforward and quick, others struggled to provide the data requested.
- There was some doubt expressed about whether requesting data on a sessional basis was the most appropriate and reliable way to collect data about GP commitments.
- It was suggested that an explanation of what is considered as full time for the purposes of this Survey, should have been included. In addition, it was pointed out that the length of a session may vary widely between practices.
- It was suggested that the form/guidance did not make it clear whether the contracted hours required for healthcare assistants/phlebotomists were total hours worked or only the hours that related directly to HCA/phlebotomy duties.
- It was suggested that questions requesting information about extra hours worked by clinical staff should have requested this data in respect of each individual category of clinical staff, including agency/bank staff.
- It was suggested that data is needed on how often GPs are working day shifts and OOH back to back as this practice may have implications for patient safety.
Promotion of Survey
- It was suggested that promotion of the Survey as having an official/high profile status could be helpful in ensuring a good response rate in future Surveys, as could raising awareness of the benefits of participation in the Survey. However, it was also pointed out that the timing of the Survey and the absence of financial support could also have implications for the response rate.
Distribution of Survey to GP practices
- Apparently key personnel, such as Practice Nurses, in some GP practices, were unaware of the Survey, despite the promotional material circulated.
- It was apparent that not all those involved in completing the Survey form had accessed the guidance note (originally included as a separate spreadsheet in the Excel workbook but later circulated as a separate file).
Collation and Checking of Returns
- It was suggested that a Yes/No option of response may have been helpful with some questions. In other cases, a clearer instruction that a value must be entered in the cell would have been helpful.
- It was pointed out that a 60% response rate is good for a survey of this nature: national, non-routine and conducted by e-mail as opposed to face-to-face questioning and answering.
- It was stressed that engagement with primary care stakeholders should not stop once the deadline for responses has been reached but should continue throughout the Survey cycle to keep them informed regarding reporting/publication plans and next steps.
Summary of Feedback Received in Respect of Out of Hours Form and Guidance
Scope of Survey
- It was suggested that greater consistency across the questions requesting data relating to registered nurses and advanced nursing practitioners would have been helpful (in some questions, these 2 designations were treated individually, while in others they were grouped together).
- Clearer guidance was requested in respect of how to record nurses not solely employed/managed by GP OOH services.
Development of Survey and guidance
- ISD representation at the National OOH Operations Group was welcomed and subsequent discussions with members about the content and completion of the Survey were appreciated.
Content of form and guidance
- While some found completion of the form relatively easy and were able to meet the original deadline, others found provision of the data labour intensive and time consuming.
- Additional time in discussion with the National OOH Operations Group prior to launch of the Survey may have identified and provided an early opportunity to resolve some issues which were uncovered during later stages and proved time consuming to address.
Promotion of Survey
- Although some struggled to provide the data requested, respondents appeared to recognise the value of their participation in the exercise and so worked hard to identify and collate the data required.
Distribution of Survey to relevant Board official(s)
- There appeared to be inconsistency across the Boards in respect of the timing of distribution and receipt by the Health Board lead of the form and guidance.
- It was stressed that engagement with stakeholders should not stop once the deadline for responses has been reached but should continue throughout the Survey cycle to keep them informed regarding reporting/publication plans and next steps.
Email: JOHANN MACDOUGALL