Hurley Clinic Patients’ Participation Group
Summary of comments in 2013 patients’ survey
There were comments from a lot of respondents, around 200 or nearly half those
who completed questionnaires, whether on-line or manually. A small-ish number
(probably about 25) were positive but the rest were overwhelmingly negative. That is
not surprising as people are more inclined to comment on the negative rather than
the positive. The comments are in distinct contrast to the significantly more positive
results of the answers to the actual questions.
Some aspects of the replies to the survey are considered below.
Question 1: how many times have you seen a doctor or nurse in the last 12 months?
60% of respondents had seen a doctor or nurse 3-6 times and 13.3% had seen a
doctor or nurse more than 7 times, so almost three-quarters of respondents had seen
someone during the previous 12 months. How does that compare with other local
practices or the wider population?
Question 2: how do you rate the way you were treated by the reception staff?
83% of respondents said their treatment had been acceptable or better, which is very
encouraging. However, there were also numerous complaints in the comments
about the attitude of reception staff so it looks as though there are some problems
that need to be addressed.
Question 3: in the past 6 months, how easy have you found the following: getting
through on the telephone; speaking to a doctor on the telephone; getting test results
on the telephone; e-mailing the surgery; getting repeat prescriptions; booking
appointments on-line; getting repeat prescriptions on-line?
These replies are not easy to analyse except that 58.7% of respondents had
experienced difficulties in getting through on the telephone and 29.9% had had
difficulty in speaking to a doctor. This suggests that the adverse comments are an
accurate reflection of what happens in practice. On the other hand, around 27% of
respondents replied ‘As expected’ to the first three questions so some have cracked
the system.
There are some complaints about the difficulties of getting repeat prescriptions but
that appears to be an individual matter as the numbers of responses to the question
do not suggest a major problem. The same applies to getting test results on the
telephone. There were several people who wanted improvements (simplification in
particular) in the on-line service for making appointments and renewing prescriptions.
Question 4: what additional provision of appointments would you like?
26.3% of respondents wanted more evening appointments and 35.3% wanted
Saturday mornings; the comments showed that most of those who wanted weekend
or evening appointments were working and found it difficult or impossible to take time
off work, or did not want to. There were also people who wanted weekend
appointments because the other parent was around to provide childcare.
The figures suggest that around 60% of those who answered the question (which
coincides exactly with the 60% of respondents who said they were in full-time work)
want more work-friendly appointment times. The two groups presumably overlap
pretty closely. The answers beg a lot of questions about employer attitudes to time
taken off work for doctor/hospital appointments but that is not our problem, or at least
not directly.
There were similar answers to this question a couple of years ago when Rafik did the
survey. The PPG then suggested that the practice should consider reverting to
providing Saturday morning appointments. We were told pretty firmly that to do that
would be extremely expensive for the practice and experience elsewhere showed
that there was often a high proportion of no-shows for weekend appointments. Is
there any other information about this? Is there real evidence of need? Are the early
morning appointments (for which there is no significant demand in the survey but
which are supposed to help those in work) always taken?
Question 5: how quickly do you get to see a particular doctor?
Only just over 5% of respondents saw a particular doctor on the same day or the next
working day; 9.5% saw one within a week, 25.9% within two weeks and 12.6% in
over two weeks. In other words, just over 80% of respondents see the doctor of their
choice within two weeks but only 5% within anything like the 2-3 days that several of
the comments suggested was desirable (ideal?).
How does this compare with earlier years? And with other practices? And how can
this be reconciled with the desire of many patients to have more continuity of clinical
care and see the same doctor all the time, if possible?
Question 6: how quickly do you get to see any doctor?
30% of respondents did not know the answer but 30% said they saw a doctor the
same day or on the next working day and 25% within one week. In other words, 55%
saw a doctor within a week. 12.6% said they had to wait over two weeks.
This is not entirely consistent with the numerous complaints about very long waits to
see a doctor but that may be partly the nature of the complainers. We also know that
there have been times in the past year or so when there have been delays of a
month or more for pre-booked appointments with named doctors.
The complaints paint a very different picture from the answers to this question. This
cannot all be attributed to strong feelings about the difficulty of getting an
appointment, so what is the real picture?
Question 7: how quickly do you get to see a nurse?
Again, at least 30% did not know but nearly 25% saw a nurse within a week and
nearly 25% on the same day or next working day.
This looks fairly good but the comments imply that nurses are second best and
people do not have proper confidence in them. The total responses are quite high.
Question 8: if the need is urgent, have you see a member of the clinical team within
a day, or on the next working day?
For 37.5% of respondents, this need had not arisen but for 36.8% for whom it had,
the answer was no. Only 25% had seen someone on the same day or next working
day.
The comments suggest that the inability to see a doctor soon because of what the
patient deemed an urgent need is one of the principal complaints, even though for
over a third of respondents the need had not arisen. Again, it may be partly the
nature of the complainers.
Question 9: how late is the doctor or nurse usually when you attend the surgery?
Over 50% of respondents claimed to have waited less than 15 minutes, which seems
a reasonably satisfactory performance and there are not all that many comments
about unpunctuality. On the other hand, there is anecdotal evidence that on
occasions things go very wrong and there are complaints about not being told about
delayed appointments and the reasons for them.
Question 10: do you have a regular doctor? If not, would you like one?
50.8% of respondents said that they did not have a regular doctor and would like
one. Lack of continuity of care is also one of the main complaints listed in the
comments.
Question 11: if yes, how often do you see him/her?
13.6% said ‘almost always’ but 40.8% said ‘almost never’ which tends to confirm the
complaints about lack of continuity of care.
Is there anything more that can be done to encourage people to have more than one
‘preferred’ GP? And can the practice do anything to alter its recruitment and
employment practices so that more continuity is easier to achieve?
Question 12: are you happy with the range of services offered?
A total of 63% of respondents were satisfied or more than satisfied which is
encouraging although 11% did not know and 25% were dissatisfied.
This needs to be looked at in the light of the withdrawal of the diabetic nurse service.
Question 14: is access to the surgery difficult, acceptable or easy?
Only 2% found it difficult although there were a couple of complaints about doors that
were difficult to manage. Not clear which door(s) that meant.
Question 15: is the surgery dirty, as clean as expected or cleaner than expected?
77% found it as expected and 17% cleaner. There were 5.5% who found it dirty and
there were quite a few complaints about the condition of the waiting area (lack of
magazines, disappearance of the fish tank etc).
Question 17: what is your age group?
Over 50% of respondents were aged between 25 and 44, which may be a fair
reflection of the age distribution of the Hurley’s patients but certainly does not reflect
the much higher usage by the young and the old. It does, however, explain the
relatively large number of respondents who are in full-time work. It may also explain
some of the complaints such as those about repeat prescriptions and test results.
Question 18: what is your employment status?
60.6% of respondents said that they were in full-time employment and this needs to
be checked against other sources as it is almost certainly not fully representative of
the total among all patients. It explains the high level of demand among the
complainants for more evening and weekend appointments. 10% said they were
unemployed which is probably lower than the area average.
Question 19: ethnic origins.
53.5% said they were white British and 16% black African or black British. How do
these figures compare with the practice’s own records?
Lack of time prevented a proper analysis of the comments but some points stand out:

Lack of availability of urgent/emergency appointments coupled with dislike of
August 2013 changes. Despite the queue, the old system seems to have
been surprisingly popular with some, probably because it was seen as an
effective way of getting short-notice/emergency/walk-in appointments.

There appears to be some resistance to the need to go through a nurse with
the new system and a lack of trust in the judgment of nurses, especially when
young children are involved. Some complaints about not being rung back
within the time specified.

Difficulty of getting through on the telephone in the mornings.

Long waits (often 2-3 weeks or more) for any normal pre-booked
appointment, particularly with named doctors.

Similar complaints about general lack of appointments and consequent
difficulty of getting an appointment at short notice

Lack of continuity of care because of high doctor turnover and many part-time
doctors

Lot of requests for more appointments outside normal working hours
(evenings and weekends in particular) for those in work

Relatively few complaints about being kept waiting for

On-line appointments and access need improving

Some general complaints about negative staff attitudes – doctors and other
clinical staff appearing dismissive etc. Also about racism, particularly among
nursing staff.

Lot of complaints about attitudes of reception staff

Quite a few problems with repeat prescriptions

Complaints about loos – lack of paper and soap as well as general
cleanliness

Several complaints about waiting area and how grubby/gloomy it is

Lots of complaints about the Tannoy, particularly for those with hearing
problems, and suggestions that patients would prefer to be fetched by the
doctor

A few complaints about the lack of the diabetic nurse and poor phlebotomy
service

Some grumbles about the difficulty of getting test results

Some suggestions for more services – portable x-ray, etc

Some respondents clearly have particular issues which cause them problems
and which could probably be resolved if they were able to discuss those
problems with the right person.
The difficulty of getting an appointment at short notice when required, long waits for
any pre-booked appointment and never seeing the same doctor twice were the three
most frequent complaints. Several respondents thought it should always be possible
to get an appointment within 2-3 days, claiming that that was what used to happen
(did it?). There was also a worryingly large number of complaints about poor staff
attitudes, particularly among the reception staff but also among some of the clinical
staff. Of particular concern are the charges of racism although as the questionnaires
are anonymous it is impossible to follow those up.
For the fairly numerous patients who took the trouble to comment, there is clearly a
gap between their expectations of the service the Hurley should provide and what
they are actually getting. Some of the expectations are unrealistic and probably
based on a system that did not exist in the past. What should the practice be doing
now?

There is a significant number of people who say they need appointments
urgently, or think that they do, and who consequently ask for same-day or
next-day appointments but mostly can’t get them so they go to A&E, with
consequences we know. They also seem to think that under the previous
appointments system (ie the infamous 8.00 am queue), they had what
amounted to a walk-in or drop-in system for emergencies. If they are right,
should the practice be thinking of having proper drop-in appointments on a
first-come, first served basis?

Everyone involved agrees that the present delays for non-urgent
appointments are far too long. The responses to the survey (as opposed to
the comments) do not entirely support that view, but what level of provision
would reduce the delays to a reasonable level? There is a widespread
perception that more appointments (ie more doctors and other clinical staff)
ought to solve the problem of excessively long waits for an appointment but is
that the whole story? Is everyone (the practice, the PPG and others) doing
enough to try to manage the demand?
PJB
3 November 2013