Patient-led healthcare is more prominent in the organisational domain of QOF2. Dr Nigel Watson discusses the updated patient experience indicators


   

The patient experience section of the organisational domain of QOF2 is substantially different from QOF1 and has increased in value from 100 to 108 points (Table 1).

The Government has indicated through the recent White Paper "Our Health, Our Care, Our Say: a new direction for community services" that patients will be given a greater choice and voice.1 It is not surprising therefore that a much greater emphasis has now been placed on acting on the results of patient surveys rather than just carrying them out (Table 2).

Length of consultation – PE1

The length of routine booked appointments with the doctors in the practice is not less than 10 minutes. (If the practice routinely sees extras during booked surgeries, then the average booked consultation length should allow for the average number of extras seen in a surgery session. If the extras are seen at the end, then it is not necessary to make this adjustment.)

For practices with only an open surgery system, the average face-to-face time spent by the GP with the patient is at least 8 minutes.

Practices that routinely operate a mixed economy of booked and open surgeries should report on both criteria.

PE1 increases in value from 30 points to 33 points but the contents of the indicator remain the same.

Practices have largely met the requirements for this indicator (see www.dh.gov.uk). Some practices had already moved to 10-minute appointments prior to the introduction of the nGMS contract.2

Other factors that led to practices moving to longer consultations included:

  • the increased workload within a consultation, created by the QOF
  • more time-consuming and complex care required for the significant percentage of patients with long-term conditions
  • patient satisfaction with longer consultations
  • the incentive this indicator gives to move to longer consultations.

It should be remembered that for the average practice of 5,891 patients, in 2004/05 this indicator was worth approximately £3,800, which would only purchase 9 or 10 days of locum time.

Table 1: Points available for patient experience indicators
     
 

QOF1 (2004)

QOF2 (2006)
PE1
30
33
PE2
40
25
PE3
15
removed
PE4
15
removed
PE5
not present
20
PE6
not present
30
 
 
 
Total points available
100
108

 

Table 2: Patient experience indicators
Indicator

Points

PE 1 Length of consultation
The length of routine booked appointments with doctors in the practice is not less than 10 minutes. (If the practice routinely sees extras during booked surgeries, then the average booked consultation length should allow for the average number of extras seen in a surgery session. If the extras are seen at the end, then it is not necessary to make the adjustments)
For practices with only an open surgery system, the average face-to-face time spent by the GP with the patient is at least 8 minutes
Practices that routinely operate a mixed economy of booked and open surgeries should report on both criteria
33
PE 2 Patient surveys (1)
The practice will have undertaken an approved patient survey each year
25
PE 5 Patient surveys (2)
The practice will have undertaken a patient survey each year and, having reflected on the results, will produce an action plan that:
1. Summarises the findings of the survey
2. Summarises the findings of the previous year’s survey
3. Reports on the activities undertaken in the past year to address patient experience issues
20
PE 6 Patient surveys (3)
The practice will have undertaken a patient survey each year and, having reflected on the results, will produce an action plan that:
1. Sets priorities for the next 2 years
2. Describes how the practice will report the findings to patients (for example, posters in the practice,
a meeting with a patient practice group or a PCO approved patient representative)
3. Describes the plans for achieving the priorities, including indicating the lead person in the practice
4. Considers the case for collecting additional information on patient experience, for example through
surveys of patients with specific illnesses, or consultations with a patient group
30

Patient surveys (1) – PE2

The practice will have undertaken an approved patient survey each year.

The PE2 indicator decreases in value from 40 points to 25 points but the contents of the indicator remain unchanged.

The practice must use one of the two approved questionnaires to carry out an annual survey of their patients:

The survey can either be carried out on consecutive patients in the surgery or by post, selecting patients at random. Questionnaires administered in the surgery can relate to a particular GP. That doctor will be able to put the results in his or her revalidation folder.

A minimum of 25 returned questionnaires per 1000 registered patients is required. Our practice had an above-average response rate of 50%; a normal response is nearer 25%.

Patient surveys (2) – PE5

The practice will have undertaken a patient survey each year and, having reflected on the results, will produce an action plan that:

  • 1. Summarises the findings of the survey
  • 2. Summarises the findings of the previous year's survey
  • 3. Reports on the activities undertaken in the past year to address patient experience issues.

PE5, worth 20 points, did not exist in the original QOF and replaces PE3, which required the practice to reflect on the survey and take appropriate action if required.

PE5 now requires the practice to compare the current year's survey with the previous year's and consider areas where improvements could be made to better the quality of care for patients.This will include comparing respective scores, considering a summary of the patients' comments, and producing an action plan to address these issues.

Survey results from one practice showed that patients were generally satisfied with the time they had to wait when they had made an appointment.

However, when the practice looked at the results of its individual GP surveys it found that one GP regularly started their surgery 15 minutes late. Patients were often waiting and by the end of the surgery the doctor was running 40 minutes behind.The practice took action by delaying the start of morning surgeries and increasing the time interval between appointments from 8 minutes to 10 minutes.

Survey results from another practice showed that patients were dissatisfied with the telephone system and were unhappy that they were often unable to speak to a doctor.The practice looked at telephone access and found that they were unable to cope with the volume of calls at peak times. They have now installed two new phone lines and introduced telephone consultation slots which can be booked in advance.

Patient surveys (3) – PE6

The practice will have undertaken a patient survey each year and, having reflected on the results, will produce an action plan that:

  • 1. Sets priorities for the next 2 years
  • 2. Describes how the practice will report the findings to patients (for example, posters in the practice, a meeting with a patient practice group or a PCO-approved patient representative)
  • 3. Describes the plans for achieving the priorities, including indicating the lead person in the practice
  • 4.Considers the case for collecting additional information on patient experience, for example through surveys of patients with specific illnesses, or consultation with a patient group.

PE6, worth 30 points, replaces PE4 which required the practice to discuss the results of the survey with either a patient group or the PCO's non-executive director.

PE6 requires each practice to identify a lead person for patient experience. The practice should produce an action plan which should be discussed with a practice's patient group or with the appropriate PCO patient representative.

If no patient group exists, the contract documentation suggests that one could be convened using one or more of the following methods:

  • an advertisement placed in the waiting room at least 2 weeks before the meeting
  • a random sample of patients who are sent a written invitation by the practice at least 3 weeks in advance of the meeting
  • an advertisement in the practice newsletter if the practice has one
  • a leaflet handed out by reception staff or a notice on the side of prescriptions.

It is also suggested that practices might wish to consider establishing focus groups to consider specific issues such as:

  • mothers with young children
  • the elderly
  • patients with mental health problems
  • patients whose first language is not English.

Conclusion

The agenda has moved on from simply carrying out a patient satisfaction survey, to reflecting on such surveys and producing a practice plan to address the issues it raises.

Most new policies which relate to healthcare place a greater emphasis on patients' views and there is a determination to build this into all reform. Practices ignore patients' views at their peril and now additionally at their cost.

 

Guidelines in Practice, May 2006, Volume 9(5)
© 2006 MGP Ltd
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  1. White Paper: Our Health, Our Care, Our Say: a new direction for community services. London: Department of Health, 2006.
  2. The new GMS Contract. www.bma.org.uk