1 Introduction and Background
1.1 The Better Together Patient Experience Survey of GP and Local NHS Services is a postal survey which was sent to a random sample of patients who were registered with a GP in Scotland in October 2011. The survey is the successor to the 2009/10 GP Patient Experience Survey.
1.2 Like the 2009/10 GP Patient Experience Survey, it asked patients about their experience of accessing their GP practice, making an appointment, visiting reception, seeing either a doctor and/or nurse at the surgery, receiving medication and the overall care provided by the practice. New questions were added to find out about patients' experiences of referrals to other health professionals, out-of-hours services and outcomes from NHS treatments.
1.3 The focus of this report is on the survey development, design and analysis. The national report provides the national results and is available at: http://www.scotland.gov.uk/gp-survey-national-report-2012
1.4 Individual reports for each GP practice, Community Health Partnership (CHP) and NHS Board are available at: http://surveyresults.bettertogetherscotland.com.
Better Together Programme
1.5 Better Together is Scotland's Patient Experience Programme, using the people's experiences of NHSScotland to improve health services.
1.6 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.
1.7 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. Through the Better Together programme, people in Scotland are being given the opportunity to comment systematically on their experience of healthcare and its impact on their quality of life. The Scottish GP / local NHS services survey is one example of this work. The Scottish Inpatient Patient Experience Survey also allows patients to comment on inpatient services. Further information on the inpatient survey can be found at: http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/InpatientSurvey
1.8 Further information about the Quality Strategy can be found at: http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/NHSQuality
Aims of the survey
The survey's specific objectives were to:
- Provide GP practices with structured feedback on their patients' experience of their service, relative to other practices in Scotland;
- Provide information on patients' use and experience of local NHS services;
- Identify areas of best practice and areas for improvement;
- Monitor the NHSScotland HEAT standards on accessing GP services;
- Assess if and how the level of positive and negative experiences change over time, between GP practices and between NHS Boards;
- Assess the types of outcomes patients had from any NHS treatment to inform the quality outcome indicator on patient reported outcomes;
- Contribute to the patient experience quality outcome indicator;
- Explore if there are variations in the experiences of different groups of patients.
1.9 The survey was redeveloped during summer 2011 with an aim to cover other local NHS Services as well as general practice. We included questions on local NHS services in this survey to help address the growing interest in understanding how people use a range of local NHS services and help support further improvement outside general practice. Consultation workshops were held with members of the public to find out what was important to them. We also consulted key stakeholders from NHSScotland, Scottish Government and Royal College of General Practitioners (RCGP).
1.10 The survey was then cognitively tested with patient and public panels to ensure that the new questions worked well in terms of understanding the purpose of the questions and the response scales.
Survey fieldwork and response
1.11 The sample was designed to provide results for individual GP practices as well as providing information for use by NHSScotland, NHS Boards and CHPs. 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 the Information Services Division (ISD) of the NHS National Services Scotland1. The survey was administered by Picker Institute Europe2, a charity which provides support for patient experience surveys, with assistance from ISD and SG. Fieldwork for the survey began on 4 November, 2011 and ended on 31 January, 2012.
1.12 In total 605,896 surveys were sent to patients and 145,569 were returned completed, giving an overall response rate of 24 per cent. The expected response rate was 23 per cent. This response rate appears low compared to that achieved for the previous survey (38 per cent). This is because we sent two reminders for the previous survey, but this year's survey was designed to achieve the required number of responses for each practice without reminders. It proved to be cost effective to send more surveys initially than to send fewer surveys and reminders. The response rates have been analysed by ISD and are discussed in Chapter 8 of this report.
Data analysis and reporting
1.14 The survey data collected and coded by Picker Institute Europe were securely transferred to ISD. The main analysis contained in the national report was carried out by ISD. In addition, ISD prepared the supplementary tables showing analysis of results for NHS Boards and CHPs in conjunction with Scottish Government.
1.15 The national report was released on 29 May 2012. It presents national results for each survey question and compares the results with those from the 2009/10 survey. It is available at: http://www.scotland.gov.uk/gp-survey-national-report-2012
1.16 Throughout the national report, weighted average percentages have been presented. This accounts for the different sizes of GP practices. Weighting the results in this way provides results more representative of the population at Scotland and NHS Board level.
1.17 All changes from the 2009/10 national results that are discussed in the national report are statistically significant at the 5% level. Due to the large sample size, even small changes of one per cent in the national results are statistically significant. For tables showing changes in results for NHS Boards, statistically significant differences are highlighted in bold within the national report.
1.18 The national report also explores the variation in results between GP practices and NHS Boards. Comparisons are made with the results from similar surveys undertaken in England, Wales and Northern Ireland. International comparisons are made using the results of the 2010 Commonwealth Fund International Health Policy Survey3.
Email: Gregor Boyd