Patient Satisfaction - Assessing and Achieving?

The best way to improve patient satisfaction is to use methods of assessing patients' views over a wide range of specific issues. Then the conclusions can be used to work with patients to develop a service that is of the greatest benefit to those who use the service as well as a pleasure to those who provide the service.
Patient satisfaction is affected by every stage of the pathway; from the phone call to make an appointment, to the outcome of the consultation. Therefore satisfaction will be influenced by many specific issues including:

• How easy it is to get through to the practice on the phone.
• How polite and helpful the receptionist is.
• How effectively the practice appears to be organised.
• How nice the practice premises are.
• How long after the designated appointment time the patient waits to be seen.¹(Although research has shown this is of less importance than the amount of time spent in consultation.²)
• How receptive, sympathetic and effective the doctor or nurse appear.
• Whether the effectiveness of the consultation is improved with written information or leaflets.
• Whether the outcome of the consultation leads to the patient feeling better.

Patient satisfaction can be assessed:

• Anecdotally; general perception of patients' attitudes, gifts, complaints, or
• Systematically; by questionnaires

Audit of specific patient satisfaction issues, e.g. how many patients see the doctor of choice, on the day of choice, is also a useful tool.

Assessment of patient satisfaction by questionnaires is being given increasing importance within the NHS and is part of the New GMS Contract.³
Although the validity of questionnaires can be questioned i.e. whether they are truly representative or if they are affected by the well-being of the patient who completes it, they can be used to identify key areas of the practice that are working well, and those that are working not so well. They can therefore be a useful tool in evaluating the services provided for patients, and provide a direction for future change and development.
Patient surveys require a lot of effort from the whole practice team. Therefore involvement and getting the enthusiastic support of the team is very important.

Patient groups also provide an excellent opportunity to incorporate the views of patient for the development of the practice. ⁴
However patient groups may not be truly representative of the whole practice population and may not provide a broad range of specific conclusions for practice priorities and development.
Therefore patient groups and satisfaction surveys should be seen as having additional benefits rather than being alternatives.
The group could either be a cross-section of all patients or be a focus group with particular service needs e.g. mothers with young children, or the elderly.
If there is not a patient group already, a meeting with patients could be organised by:

• Advertisement in the waiting room at least two weeks before the meeting.
• Write to a random sample of patients at least three weeks before a proposed meeting.
• Advertisement in the practice newsletter.
• Leaflet handed out by reception staff or a notice on the side of prescriptions.

A practice will meet the contract requirement if it has carried out a survey of patient views in the previous year.
The two currently approved surveys are:

• The General Practice Assessment Questionnaire (GPAQ)⁵
• The Improving Practice Questionnaire (IPQ)⁶

The practice needs to take time to decide which of the questionnaires is right for them. They differ in terms of cost, time and effort, style and feedback.
Both questionnaires can be given to patients attending the surgery, to fill in after consultation with the GP.

• GPAQ is also available in a version designed to be sent out by post.
• In some cases, with the agreement of the practice, the PCT may take responsibility for carrying out a postal survey of all practices in the area.
• An advantage of giving out the questionnaires in the surgery is that they can relate to an individual GP; postal surveys do not generally relate to a named doctor.
• However, one disadvantage of surgery-based questionnaires is that they exclude the views of housebound patients.

There are 100 points available in total.

Level 1 (40 GMS quality framework points)

• The questionnaires should be returned by at least 25 patients per 1000 registered patients on the practice's list. Patient selection should be on consecutive patients in the surgery or randomly sampled if using postal survey.
• In order to be eligible for the 70 QMAS points practices must provide evidence that the survey has been undertaken including the date and method.

Level 2 (additional 15 GMS quality framework points)

• The practice must undertake a patient survey each year, reflect on the results and propose changes where appropriate. The practice does not need to provide the results of the survey but should provide an overview of its analysis of the survey and any subsequent proposals for change.
• The practice needs to produce a report.

Level 3 (additional 15 GMS quality framework points)

• The practice must undertake a patient survey each year and discussed the results as a team and with either a patient group or Non-Executive Director of the PCT. Appropriate changes will have been proposed with some evidence that the changes have been made or initiated.
• Following a meeting with a patient group, practices should submit a report of the meeting which should be agreed with the Non-Executive Director or copied to patients who have attended the meeting. The report should propose changes as appropriate.
• In subsequent years, evidence that some change has been achieved should be provided by a report or by demonstrating a positive change in the patient survey.