Publication - Statistics

Patient Experience survey of GP and local nhs services 2011/12 Volume 1: Technical Report

Published: 29 May 2012
ISBN:
9781780458359

Scottish Patient Experience Survey of GP and Local NHS Services 2011/12. This is a postal survey which was sent to a random sample of patients who were registered with a GP in Scotland in October 2011. This report contains details the survey design and development.

Patient Experience survey of GP and local nhs services 2011/12 Volume 1: Technical Report
3 Survey Design

3 Survey Design

Survey development

3.1 The questionnaire was based on the one used for the 2009/10 GP Patient Experience Survey. Details on the development of the 2009/10 questionnaire are available in the survey technical report at: http://www.scotland.gov.uk/Publications/2010/07/27085118/0

3.2 The redevelopment of the 2009/10 survey involved discussions with policy areas to find out what areas they would like the survey to cover. We also took into account feedback from users and our experiences of where there had been problems with the questions.

3.3 Early on in the redevelopment we organised a consumer panel to give members of the public a chance to say what was important to them. We also showed them an early draft of the questionnaire for them to complete and offer comments.

Cognitive testing

3.4 Picker Institute Europe cognitively tested the questionnaire. In the two weeks spanning the 12th and the 23rd of September, Picker Institute Europe carried out 24 interviews with Scottish general practitioner (GP) patients. The interviews were completed in three rounds of eight, to allow discussions to be had and amendments to be made in between rounds.

3.5 Participants were recruited via a local recruitment agency, and screened to allow for the most diverse group of age, gender and ethnicity. The group consisted of:

  • 12 males and 12 females;
  • 19 people describing themselves as 'white', 4 describing themselves as 'Asian' and 1 as 'other';
  • Ages ranging from 20 to 77;
  • 6 participants whose first language was not English.

Changes to patient survey 2011/12, compared with 2009/10 survey

New questions

3.6 While the 2009/10 survey was specifically about GP practices, the survey was widened in 2011/12 to ask about more health services in the community. The new sections include outcomes from NHS treatment, as well as questions on out-of-hours services.

3.7 A copy of the 2011/12 patient survey can be found in Annex B. The 2009/10 survey can be found here: http://www.bettertogetherscotland.com/bettertogetherscotland/1061.141.583.html

3.8 New questions in 2011/12 are a shown in Table 1 below:

Table 1 New questions for the 2011/12 survey

Question Number Question Reason for new question
1 What local health services have you used in the last 12 months when you needed treatment or advice about your health? Because the survey is widening out to cover more health services, there was a need to find out what services people had used or accessed during the preceding twelve months.
3 Approximately how often have you contacted this GP surgery in the last 12 months (either for yourself or someone you look after)? Users of the survey results felt that it was important to understand whether people are regular users of the GP surgery.
11 Has your GP referred you to see any other health professionals (including at your GP surgery or local health centre, at home or at another clinic or hospital) in the last 12 months? The questions about referral to other services were added as this was raised as a key concern by people in the patient panels. There were also a reasonable number of comments criticising the referrals process from respondents to the 2009/10 survey. These questions seek to find out whether patients are finding problems with referrals in any geographical areas.
12 Thinking about the last time your GP referred you, how would you rate the arrangements for getting to see another NHS health professional?
15 How clean is your GP surgery or health centre? This question was added because patients identified clean facilities as very important to them. There were also a reasonable number of comments complaining that GP practices were not clean, from respondents to the 2009/10 survey. The question mirrors the English survey.
17a Have you seen a doctor at your GP surgery in the last 12 months? This filter question was added as it was found that some people had been to the GP surgery but were not seen by a doctor.
20 Did you see any health professionals in the last 12 months about something that affected your ability to work? These questions were requested by the Scottish Government Health Works policy team, in order to understand one of the key aspects of implementation which is having conversations about getting back to work.
21 The last time this happened, did they discuss your ability to work with you?
23a It was easy enough for me to get my medicines There have been some reported issues with availability of prescription medicines with patients sometimes only having prescriptions partially filled and needing to return to collect the balance, especially for medicines that are not dispensed frequently.
23f I took my prescription as I was supposed to This was added in response to patient and clinician views about the importance of compliance.
26 In the last 12 months, have you tried to get medical help, treatment or advice, for yourself or someone you were looking after, when your GP surgery was closed (out of hours)? The out of hours questions were added in order to provide data to a national programme of work on Quality indicators for Out of Hours Primary Medical Care Services which includes an indicator on healthcare experience.
27 Thinking about the last time you tried to get help out of hours, which NHS service did you speak to or go to first? This was added to gain some understanding of routes to care that people choose or were directed to.
28 Which service did you end up being treated or seen by? This was needed so it is clear what service people are answering about in the experience questions (questions 29a-29e).
29a The time I waited was reasonable This represents the need for timeliness of care or treatment - one of the six quality dimensions that underpin the Quality Strategy.
29b I felt that the person had all the information needed to treat me This mirrors the doctor/ nurse questions about the consultation and is important because out of hours practitioners should be able to access the necessary information about the patient.
29c I felt I was listened to This mirrors the doctor/ nurse questions about the consultation and is an important aspect of high quality, effective communication.
29d Things were explained to me in a way I could understand
29e I felt that I got the right treatment or advice This question was intended to provide an indication of respondents' feelings about the treatment or advice they received.
30 Overall, how would you rate the care you experienced out of hours? The overall rating question mirrors the one for the GP surgery.
31 What do you think about the opening hours of your GP surgery? This was added to inform discussions about improving access to General Practice.
32 In the last 12 months, have you received NHS treatment or advice because of something that was affecting your ability to do your usual activities? These questions were added on an experimental basis in order to inform the quality outcome indicator on patient reported outcomes. They were developed through consultation with a range of people and reflect three dimensions of health status.
33 Thinking about the last time this happened, how would you describe the effect of the treatment on your ability to do your usual activities?
34 In the last 12 months, have you received NHS treatment or advice because of something that was causing you pain or discomfort?
35 Thinking about the last time this happened, how would you describe the effect of the treatment on your pain or discomfort?
36 In the last 12 months, have you received NHS treatment or advice because of something that was making you feel depressed or anxious?
37 Thinking about the last time this happened, how would you describe the effect of the treatment on how you felt?
41 How would you rate your health in general? Self assessed health is known to be related to reported experience so this question was added to investigate this aspect.
44 What best describes your work status? This was added to tie in with the new Health Works questions, and also to support further investigation of access issues. Available answer options used in other surveys (e.g. Labour Force Survey) were felt to be too detailed for this purpose so these simplified options were developed.
45 Do you look after, or give any regular help or support to family members, friends, neighbours or others because of either long-term physical / mental ill-health / disability or problems related to old age?
Exclude any caring that is done as part of any paid employment.
The question about carers was added to enhance national information about experiences of carers as this is a key area for improvement across Scotland.

Changed questions

3.9 Changes were made to questions where feedback was received that they were difficult to answer - either based on the results of the previous survey or via patient panels or cognitive testing. In addition, the questions about access to the GP practice were reduced to emphasise that these are no longer being used for practice assessment under the Quality & Outcomes Framework (QOF). Therefore the very specific questions were no longer required. The questions could therefore be shortened and also provide more meaningful data.

3.10 Questions that were changed in 2011/12 are shown in below:

Table 2 Questions that were changed in 2011/12

Question Number in 2011/12 Question Question Number in 2009/10 Question Reason for changes
4 Thinking of the last time you contacted this GP surgery by phone, how easy was it for you to get through? 2 In the last 12 months, when you have phoned your GP surgery, could you get through on the phone? The previous question was on an always/ never scale recalling the last 12 months. This was changed to the last time to make the question easier and to make sense with the following question.
5 The last time you phoned the GP surgery, how helpful was the person who answered? 3 When you have phoned your GP surgery, was the person who answered polite and helpful? This was also changed to last time because it was felt that general recall is difficult especially if different people answer the phone. The answers now mirror the question about receptionists when contacting the practice and avoid asking about 2 concepts (polite and helpful)
6 The last time you needed to see or speak to a doctor or nurse from your GP surgery quite urgently, how long did you wait? 4 In the last 12 months, have you contacted your GP surgery because you needed advice fairly quickly because you felt unwell or were worried about something? These questions were specifically included to provide information about the 48 hour access points in the QOF. The questions have been changed as this information is no longer required. The opportunity to ask more about times to wait was taken.
5 The last time this happened, did you see or speak to a doctor or nurse within 2 working days?
7 What was the main reason you waited longer than 2 working days? 6 Why did you not see or speak to a doctor or nurse within 2 working days? This was changed slightly so that people were more likely to only tick one answer.
8 If you ask to make an appointment with a doctor 3 or more working days in advance, does your GP practice allow you to? 7 In the last 12 months, have you tried to book a doctor's appointment in advance? (For example, have you tried to book an appointment for when you get back from a holiday or to fit in with other commitments) With the removal of the points on patient experience results on advance access from the QOF, the opportunity has been taken to cut down the amount of space used for these questions.
8 The last time you tried to book in advance, were you able to get an appointment?
9 Why did you not get an appointment in advance?
13 In the reception area, can other patients overhear what you say to the staff? 13b I was worried because other people could overhear me talking to the receptionist This was previously asked along with other reception questions as When you attended your GP surgery, how often did you experience each of the following? This has been changed to fit with the revised questionnaire layout and to be comparable to the question in the English survey.
14 How helpful do you find the receptionists at your GP surgery? 13a The receptionist was polite and helpful This was previously asked along with other reception questions as When you attended your GP surgery, how often did you experience each of the following? This has been changed to fit with the questionnaire layout and to be comparable to the question in the English survey. It was also recognised that there was no need to ask patients about the receptionist being polite and helpful - as they may be considered to be two different things.
17b The doctor listened to me 14a The doctor listens to me These statements have all been changed to past tense as the question was changed from How much do you agree or disagree with the following about the doctor or doctors you have seen at your GP surgery? to Thinking about the last time you saw a doctor at your GP surgery, how much do you agree or disagree with each of the following? The reason for this change was that further testing showed that it was too difficult for people to generalise about the doctors in the practice, if they had seen more than one and easier to think of a specific occasion. The question on consideration for personal circumstances was found to be difficult to understand in testing so was changed.
17c I felt that the doctor had all the information needed to treat me 14b I feel the doctor has all the information they need to treat me
17d The doctor was considerate and understanding 14c The doctor shows consideration for my personal circumstances in treating me
17e The doctor talked in a way that helped me understand my condition and treatment 14d The doctor talks in a way that helps me understand my condition and treatment
17f I felt confident in the doctor's ability to treat me 14e I am confident in the doctor's ability to treat me
17g I had enough time with the doctor 14f I have enough time with the doctor
18b The nurse listened to me 15b The nurse listens to me As with the doctors question (questions 17a-17g), these statements have all been changed to past tense as the question was changed from How much do you agree or disagree with the following about the doctor or doctors you have seen at your GP surgery? to Thinking about the last time you saw a doctor at your GP surgery, how much do you agree or disagree with each of the following? The questions here are the same as for the doctor questions
18c I felt that the nurse had all the information needed to treat me 15c I feel the nurse has all the information they need to treat me
18d The nurse was considerate and understanding 15d The nurse shows consideration for my personal circumstances in treating me
18e The nurse talked in a way that helped me understand my condition and treatment 15e The nurse talks in a way that helps me understand my condition and treatment
18f I felt confident in the nurse's ability to treat me 15f I am confident in the nurse's ability to treat me
18g I had enough time with the nurse 15g I have enough time with the nurse
19 Are you involved as much as you want to be in decisions about your care and treatment? 17 How do you feel about being involved in decisions about your care and treatment? This was changed slightly during testing to make the question more specific to the response options.
23b I knew enough about what my medicines were for 16b How often have you experienced the following? I know enough about what my medicines are for The response scale for the medicines questions was changed from a never/ always scale to an agree/ disagree scale. The previous question was How often have you experienced the following? This was changed to Thinking about the last time you were prescribed medicines, how much do you agree or disagree with each of the following: This ties in with the move to "last time" for the doctor and nurse questions.
23c I knew enough about how and when to take my medicines 16c How often have you experienced the following? I know enough about how and when to take my medicines
23d I knew enough about possible side effects of my medicines 16d How often have you experienced the following? I know enough about possible side effects of my medicines
23e I would know what to do if I had any problems with my medicines 16e How often have you experienced the following? I would know what to do if I had any problems with my medicines
24b I am treated with kindness and understanding 18b My personal values and beliefs are respected The beliefs question didn't work well as a lot of people said "neither agree or disagree" - because they didn't think it applied to them. This question covers a core aspect of quality.
42 Do you have any of the following? 26 Do you have any of the following? The response options for this question were changed. The specific examples of conditions were removed as based on analysis of the "other" written answers in the previous survey, these had perhaps discouraged people from ticking the correct option. For this reason the "other" category was removed. An option on chronic pain was added to provide information in support of the development of a SIGN guideline and new service model for chronic pain services in Scotland.
46 Which of the following options best describes how you think of yourself? 23 Which of the following options best describes how you think of yourself? There was a very small change in that homosexual was added to the Gay/ Lesbian answer option.
47 What religion, religious denomination or body do you belong to? 24 What religion, religious denomination or body do you belong to? There was a small change to the answer options Based on analysis of the previous survey, the "Another religion (please write in)" option was changed to "Another religion (non-Christian)", with no option to write in. This was because many of the answers provided could be categorised in the other Christian box which had been missed out.
48 What is your ethnic group? 25 What is your ethnic group? In order to create space for the new questions the short form of this question using the 5 main categories was used rather than the full length question.

Questions that were in the 2009/10 survey but not in the 2011/12 survey

3.11 Question 13 asked "When you attended your GP surgery, how often did you experience each of the following?" and then presented several statements. One of these statements was "I felt bothered or threatened by other patients". This question was removed from the survey because it was not an issue for the vast majority of practices. Where this was an issue, this had been identified in the previous survey.


Contact

Email: Gregor Boyd