Primary Care Emergency Service Patient Satisfaction Survey July 2010

Primary Care Emergency Service Patient Satisfaction Survey July 2010 Lisa Milligan Service Manager November 2010

TABLE OF CONTENTS PURPOSE OF THIS REPORT... 3 BACKGROUND... 3 ACKNOWLEDGEMENTS... 4 SUMMARY... 5 LIST OF APPENDICES... 5 AIM... 6 OBJECTIVES... 6 METHODOLOGY... 6 RESULTS... 8 CONCLUSIONS...16 RECOMMENDATIONS...16 NHS Fife Clinical Governance Support Team Page 2 of 26 Review Date: N/A

PURPOSE OF THIS REPORT The purpose of this report is to provide feedback on the Primary Care Emergency Service (PCES) Patient Satisfaction Survey which was issued to all attendees at Treatment Centres (appendix 2) or Visited (appendix 3) during July by PCES. All respondents were also issued with a covering letter (appendix 4) explaining the reason for the survey and also inviting them to indicate if they would be interested in participating further through a Focus Group. The survey was initiated to ascertain the level of satisfaction with the out of hours general medical services being provided by PCES through its treatment centres and home visiting clinicians. BACKGROUND Out of Hours/Unscheduled Care is the framework through which NHS organisations provide primary medical services during the out of hours period. The NHS Fife PCES is accountable for the provision of primary medical services to the population of Fife and Kinross (Approx. 375,000) out with normal working hours. The Fife PCES became operational in November 2002 following the amalgamation of 5 GP co-operatives. Since January 2007 PCES has been managed within Dunfermline and West Fife CHP. The General Manager provides regular reports relating to PCES provision through the existing governance structures to the Clinical Services Management Team, CHP Committee, NHS Fife SMT and Fife NHS Board. The PCES operates during the hours of 6pm 8am on weekday nights and from 6pm on Friday until 8am Monday morning (118 hours per week). The service also provides cover for 8 Public Holidays and 5 PLT afternoons during the year. The Service was assessed by NHS Quality Improvement Scotland in October 2005 and achieved Level 3 compliance with the out of hours standards. The primary activities to be undertaken by PCES are: Provision of healthcare services to the community of Fife within 4 centres. Provision of necessary communications systems to facilitate and support healthcare delivery. Provision of appropriate visiting arrangements to support the healthcare delivery. Maintain an overview of the local and national legal, clinical and operational requirements. PCES is a multidisciplinary team providing the Out of Hours service to the patients of Fife and through a Service Level Agreement with Tayside to the patients in Kinross. There are 2 salaried Doctors that are directly employed and supported by over 167 local sessional doctors all providing for the 21,632 hours of coverage throughout the year at 4 sites NHS Fife Clinical Governance Support Team Page 3 of 26 Review Date: N/A

PCES provides an out of hours service to the community of Fife and Kinross, operating from: Queen Margaret Hospital, Dunfermline Victoria Hospital, Kirkcaldy Glenrothes Hospital, Glenrothes St Andrews Community Hospital, St Andrews. PCES service is accessible to anyone requiring medical support within Fife and Kinross region. Contact is through NHS24 and where appropriate directly to PCES. There were over 89,000 Fife patient contacts (appendix 5) with PCES/NHS24 during 2009/10. A variety of contact and communication methods are utilised to ensure patients and PCES service users have ready access: Quality of service to patients, other service users, key partner agencies and PCES staff is monitored By sample checking; questionnaire, direct communication and other appropriate methods of contact/review. By PCES providing access to information via CHP web-site; leaflet and press/media circulations; an Annual Report and other internal communications. PCES will also engages pro-actively with the local and national patient, professional and business community. PCES is represented on a wide range of internal and external groups such as Unscheduled Care, Ambulance liaison, Telecare Board, Stakeholders, Joint Integration Meetings. PCES stakeholders group meets every 2 months with community members invited to attend. Outcomes from this group are channelled through Quality, Health and Safety and Clinical Governance Groups. ACKNOWLEDGEMENTS I would like to acknowledge the following individuals for their help and assistance in supporting the Primary Care Emergency Service Patient Satisfaction Survey: Ann Hatton, Head of Clinical Governance Cheryl Waters, Clinical Effectiveness Facilitator Ruth Lonie, Communication Manager John McGoldrick, Service Manager, Dumfries and Galloway Improving Health Team, Lynebank NHS Fife Clinical Governance Support Team Page 4 of 26 Review Date: N/A

SUMMARY The survey had a high response rate of a combined 37% (1174/3167) broken down to 48% (1099/2305) for treatment centres and 9% (75/862) for home visits. The use of the opinion meters further supported the traditional methodology utilised during this survey and respondents were very positive in the verbal feedback given to reception staff in the centre where this was utilised. The outcome of the survey was overall very positive with a few learning outcomes for the clinicians and support staff involved in the delivery of out of hours care. The main negative feedback is relating to call back times of NHS24 and the assessment and repetition of the confirming of clinical/demographic data. This is required due to the safety/quality requirement of both services. Patients are required to confirm demographic/personal details initially to ensure that if the patient is disconnected from NHS24 then a method of contacting the patient is established. The repetition of the details again in later calls is to confirm the right patient record is being accessed when call back occurs for nurse triage, an appointment time being made or for clinical advice by a GP. It has been very difficult to analyse the improvements which can be made to PCES as the overwhelming volume of positive responses in favour of the service, how it is provided, who it is provided by and appreciation of the clinical staff directly. The respondents also indicated a very high level of response when agreeing to be contacted to participate in a focus group following the publication of results. It was very pleasing to note that 26% (311/1174) respondents were willing to be contacted to form part of the Primary Care Emergency Service Focus Group for future discussions and developments following the publication of the full report. Full report will be available through the Dunfermline and West Fife CHP website. The results will be presented to Dunfermline and West Fife Clinical Governance Group, Dunfermline and West Fife CHP Committee and Public Partnership Forum (PPF) group. LIST OF APPENDICES Appendix 1 - Timeline Appendix 2 - Centre Questionnaire Appendix 3 - Home Visit Questionnaire Appendix 4 - Home Visit Covering letter Appendix 5 - PCES year statistic 09/10 Appendix 6 - Poster Appendix 7 - Media Article Fife Life Appendix 8 - Intranet article news release Appendix 9 - Media Article Dunfermline Press NHS Fife Clinical Governance Support Team Page 5 of 26 Review Date: N/A

AIM To establish the level of patient satisfaction with Primary Care Emergency Service within Fife residents. OBJECTIVES To establish the: Difficulties in contacting out of hours medical services Main reasons for contacting the out of hours medical services Reasons why home visiting was undertaken Levels of satisfaction with the clinician s knowledge of condition Levels of satisfaction with the clinician s manner Perception of involvement in treatment and management of conditions Amount of information about the treatment planned was appropriate Appointment time length allocations as suitable for patients Level of confidence that the treatment was appropriate METHODOLOGY A communication plan was developed to assist in raising the awareness of the patient satisfaction survey with the population of Fife. It outlined the criteria for the survey and that information gathered would be used to develop services and also asked if patients would be interested in joining a focus group following the results becoming available. The patient satisfaction survey was planned, designed and implemented through the development of an already nationally used out of hours survey which had been developed by Dumfries and Galloway Out of Hours service. Successful surveys require clear and well understood questions and these questions were tested on a pilot group prior to general distribution. This ensured the objectives of the survey were likely to be achieved as the pilot group confirmed the layout as easy to interpret with the instructions and questions being easily understood. The length of the survey was also commented on favourably. In conjunction with the Clinical Effectiveness Department, a questionnaire was created using FORMIC, an automated data entry software system with the completed questionnaires being returned to the Clinical Effectiveness Department at Cameron for scanning and analysis PCES Operational Management Group met to discuss why they were conducting the survey and what they hoped to achieve through this undertaking. The reasons agreed were: To demonstrate commitment to the patient To gain feedback about the out of hours service To improve the quality of the service To improve the patient experience To measure the value of the out of hours service NHS Fife Clinical Governance Support Team Page 6 of 26 Review Date: N/A

When developing the survey questions, the practice of Drill down was employed to get specific answers. The objectives of the survey were mapped to the questions presented and evaluated. A mixture of closed and open ended questions were used, with multiple choice and rating also being utilised. Open ended questions are difficult to analyse and measure, however they allow the patient the opportunity for true reflective responses about issues that are important to them. The open ended questions in this survey response were themed for the final outcomes due to a true commonality in the responses. A pack containing guidance on the survey was issued to all PCES clinicians and full guidance was available in all centres issuing the survey for reception and clinical staff. Opinion meters were also utilised in the centres for those who preferred an electronic option. 94 responses were taken from the opinion meters which represented 9% of the total responses received. The following advertising materials were developed to raise awareness amongst the patient and stakeholders such as NHS24, SAS, A & E. Print Media Poster (appendix 6) were displayed in all practices in Fife to advise the public of the survey Additional posters were available in community pharmacies An Article was placed in Fife Life (appendix 7) which is posted through every resident s door. Leaflets were available in all Primary Care Emergency Service Centres Broadcast Media Radio interview arranged with Kingdom FM. This was aired during the week prior to the survey. Online Media A press release (appendix 8) was lodged on the NHS Fife Intranet. The same press release (appendix 8) was advertised on the Dunfermline and West Fife CHP website Local Press/Publications Fife Life (appendix 7) Dunfermline Press (appendix 9) NHS Fife Clinical Governance Support Team Page 7 of 26 Review Date: N/A

RESULTS The survey ran from 1 31 July 2010. The response to the survey showed that 1174 surveys were completed and returned to Clinical Effectiveness. A response rate of 48% (1099/2305) was achieved for patients attending the centres and a response rate for home visits of 9% (75/862). Chart 1: Returns by Centre 9% 1% 16% 12% 41% 21% Glenrothes St Andrews VHK QMH Opinion meter responses Unknown (mailed back) It is clear from the volume of responses that the treatment centre questionnaires were being routinely issued, where as there has been feedback that the visiting clinicians felt uncomfortable requesting patients complete the questionnaire following a home visit due to the increased clinical requirements and worsening patient condition compared to the treatment centres. Chart 2: Difficulty in Contacting the Out-of-Hours Medical Service 100% 80% 60% 40% 20% 0% 96% 99% 2% 1% 1% 1% 0% 0% Centre Visit No Yes - I didn't know where to phone Yes - Other reason Missing data 96% (1056/1099) of centre respondents and 99% (74/75) of home visit respondents had no difficulty in contacting the out of hours medical service. This indicates that the telephony is in place within practices and the general infrastructure to support access contacting out of hours when it is required. NHS Fife Clinical Governance Support Team Page 8 of 26 Review Date: N/A

Reasons noted for those indicating difficulties were: Length of time to be connected to nurse. Phoned several times. Answering voice said other person had hung up? I waited 90 minutes for NHS24 to call back. I thought it would save time if I had to get a prescription. My call did not go through initially Not applicable as I went directly to the hospital. Arrived at the hospital without knowing I had to phone NHS24 Needed an interpreter as she speaks no English. Just came in as live round the corner - panicked as was grandson. Very close to Royal Bank no, tried 0845 242424 etc found no in phone book 08454 60% 40% Chart 3: Main Reasons for Contacting the Out-of-Hours Medical Service 49% 52% 41% 34% 20% 0% 5% 9% 3% 3% 3% 1% 1 2 3 4 5 Reasons Centre Visit Key for Reasons 1 You had a condition which started after your GP surgery had closed 2 You had a condition which became much worse after the GP surgery had closed 3 You had been unable to obtain an appointment with your doctor during a normal surgery 4 Other reason 5 Missing data 83% (913/ 1099) of centre respondents and 93% (70/75) of home visit respondents had a condition which had started or became much worse after their GP surgery had closed, with 5% (58/1099) of centre respondents and 3% (2/75) of home visit respondents being unable to obtain an appointment with their doctor during normal surgery hours. This would indicate that in general the majority of reasons for requiring out of hours are appropriate as a condition had worsened or started during the out of hours period. A small percentage of contacts were due to the inability to obtain an appointment although this may have been due to respondents trying to access appointments later in the day. NHS Fife Clinical Governance Support Team Page 9 of 26 Review Date: N/A

Other reasons listed for problems contacting out of hours medical services were: Advice required An interpreter was required. Did not want to take time off work. Didn't try to make an appointment Holiday visitor Injury GP not reliable and unhappy with diagnosis. Needed an inhaler - couldn't find it. Not registered with a GP surgery. Not specified (5) Went to chemist for medical advice - referred me to out of hours service. Chart 4: Reason for being seen in own home 70% 60% 50% 40% 30% 20% 10% 0% 69% 16% 4% 9% 1% 1 2 3 4 5 Reasons Key for Reasons 1 Your medical condition meant you were too unwell to travel 2 No transport available 3 Other family members at home prevented attendance at a centre 4 Personal mobility reason 5 Missing data 69% (52/75) of respondents requiring a home visit were too unwell to travel; with 4% (3/75) having no transport available or 1% (1/75) had other family members to consider. 16% (12/75) had a personal mobility reason for requiring a home visit. Out of hours supports home visiting when it is clinically appropriate to do so, this would support the appropriateness of home visiting for the conditions and reasons as stated. NHS Fife Clinical Governance Support Team Page 10 of 26 Review Date: N/A

Chart 5: Satisfaction with Clinician's Knowledge of Condition 80% 75% 72% 60% 40% 20% 0% 19% 25% 2% 1% 2% 1% 0% 1% Centre Visit Very Quite A little Not at all Missing data 94% (1037/1099 treatment centre) 97% (73/75 home visit) of respondents found the clinician to be quite or very knowledgeable about their condition, with 2% (26/1099 treatment centre) - 1% (1/75 home visit) choosing a little knowledgeable and 1% (9/1099 treatment centre) felt the clinician was not at all knowledgeable. Chart 6: Found the Clinician Courteous and Considerate 100% 80% 60% 40% 20% 0% 88% 96% 9% 1% 0% 2% 4% 0% 0% 0% Centre Visit Very Quite A little Not at all Missing data 97% (1058/1099 treatment centre) 100% (75/75 home visit) of respondents found the clinician to be quite or very courteous or considerate, with 1% (15/1099 treatment centre) choosing a little courteous or considerate and no-one felt that the clinician was not courteous or was inconsiderate. NHS Fife Clinical Governance Support Team Page 11 of 26 Review Date: N/A

Chart 7: Involved in discussing and agreeing with the Clinician plans for treatment/management of condition 100% 80% 60% 40% 20% 0% 73% 81% 21% 15% 3% 0% 3% 1% 1% 1% Centre Visit Very Quite A little Not at all Missing data 94% (1032/1099 treatment centre) 96% (72/75 home visit) of respondents found the clinician to have involved them in the discussion and agreed with the clinician s plans for the treatment or management of the condition, with 3% (33/1099 treatment centre) - 1% (1/75 home visit) choosing that they felt a little involved and agreeing and only 1% (1/75 home visit) indicating that they had not at all felt involved or in agreement. Chart 8: Amount of information given about the treatment planned 100% 80% 60% 40% 20% 0% 93% 93% 1% 2% 1% 3% 0% 1% 4% 1% Centre Visit Too much Correct amount Not enough None at all Missing data 93% (1017/1099 treatment centre and 70/75 home visit) of respondents found the amount of information the clinicians gave about the treatment planned was the correct amount. 1% (15/1099 treatment centre) - 2% (17/1099 treatment centre) - 1% (1/75 home visit) felt not enough information was given. 1% (12/1099 treatment centre) - 4% (3/75 home visit) felt they received no information at all about the treatment planned. NHS Fife Clinical Governance Support Team Page 12 of 26 Review Date: N/A

Chart 9: Appointment was long enough to allow time to discuss fully concerns 100% 80% 60% 40% 20% 0% 95% 96% 1% 1% 1% 2% 0% 1% 3% 0% Centre Visit Too long Correct length Too short Don't know Missing data 95% (1047/1099 treatment centre) respondents found the length of the appointment was the correct length to allow time to discuss fully any concerns they were experiencing about their medical condition. 1% (6/1099) felt the appointment was too long and 1% (10/1099) felt the appointment was too short. 1% (10/1099) indicated they didn t know. 96% (72/75 home visit) respondents found the length of the home visit was the correct length. 1% (1/75) felt the visit was too short and 3% (1/75) indicated they didn t know. Typical appointment times are 12 minutes in centres. The visiting GP will allocated the time required depending upon clinical presentation and treatment required. Visiting times are generally similar to centre appointment times unless mental health or complex medical cases. NHS Fife Clinical Governance Support Team Page 13 of 26 Review Date: N/A

50% 40% 30% 20% 10% 0% Chart 10: The patient was confident that the treatment that had been given or planned was as good as it could be 39% 49% 46% 45% 10% 4% 3% 3% 0% 0% 0% Centre Visit 0% Strongly agree Agree Unsure Disagree Strongly disagree Missing data 85% (938/1099 treatment centre) - 94% (71/75 home visit) of respondents were confident that the treatment had been given or was planned for them was a good as it could be. 4% (46/1099 treatment centre) - 3% (2/75 home visit) were unsure if the treatment given or planned was as good as it could be and 3% (2/75 home visits) disagreed that the treatment given or planned was as good as it could be. All patients are given a worsening statement at the end of consultation that if the symptoms worsen or fail to improve to recontact their own GP or out of hours. 29% (321/1099 centre respondents) gave comments of things particularly well done by the service. These were consistent across several main themes; Staff being courteous, knowledgeable and helpful Good all round service Appointment system working well Speedy and efficient system Thorough checks being made Very friendly, pleasant and polite 56% (42/75) of home visit respondents gave comments of things particularly well done by the service. These were consistent across several main themes; Good bedside manner Staff being compassionate, knowledgeable and helpful Speedy and efficient system Doctor arriving promptly Well organised 3% (38/1099 centre respondents) gave comments on things that were poorly organised or not particularly well done by the service. Of the 38 comments, 19 comments were actually re-iterating that there were no problems. Therefore of the 19/38 comments received only 1.5% were commenting on poorly organised or not particularly well done. These were across several themes; NHS Fife Clinical Governance Support Team Page 14 of 26 Review Date: N/A

Time taken for phone call to be returned by NHS24 Inability to be seen at A&E Lack of seating in waiting area (shared with A&E) Waiting time too long between phone call and appointment (3 hours) 14% (11/75 home visit) respondents gave comment on things poorly organised or not particularly well done by the service. These were across several themes; Directions to house not being passed on Length of time for visit Duplication of questions between NHS24 and PCES Time taken for phone call to be returned by NHS24 The final part of the questionnaire asked for suggestions for improving the service or for any other comments. 4% (46/1099 treatment centre) responses were received and of these 24/46 were very positive and stated that; the service could not be improved service spot on super efficient 1 st class Very good, very happy, very pleased with service So the remaining 2% (22/1099) felt that; a toilet near the waiting area would improve the service less repetition of personal information would be beneficial more doctors less nurses expand general practice to do small procedures and extend opening hours NHS24 call back times too lengthy Get rid of NHS24 it s a waste of time 32% (24/75 home visit) were received and of these 9 were positive. The remaining 20% (15/75) respondents felt that; More staff on during weekend and holidays would be beneficial Length of time spent on phone to NHS24 is excessive Repetition of information at NHS24 NHS24 should recognise trained professionals and should be treated in a more professional manner Patients notes should be available to enable GPs to have access to complex cases Future involvement 26% (311/1174) indicated that they would be willing to be contacted to take part in a focus group to discuss the results of the survey. NHS Fife Clinical Governance Support Team Page 15 of 26 Review Date: N/A

CONCLUSIONS The survey has been extremely worthwhile and has supported the general feeling of public satisfaction with the service. PCES is providing a high quality service to the patients of Fife and through SLA to Kinross, PCES has many areas of good practice and seeks to involve itself further with the patient through Patient Focus and Public involvement. PCES will continue to seeks to involve itself with it s patients and partners to ensure the patient sees the right clinician, at the right time and in the right place. RECOMMENDATIONS PCES will re-evaluate the patient satisfaction survey after 18-24 months. PCES will produce a patient information leaflet to address the requirement for greater awareness of the component parts of the out of hours journey and will involve the focus group in this development. PCES will continue to provide high quality and will look at further service improvements through its on going commitment to quality and service development. As a result of this work PCES intends to seek the advice in evaluating the long term benefits of expanding its public involvement through the development of the PCES focus group. This information should inform the future service developments aimed at providing effective and efficient unscheduled care to Fife in the future. PCES will continue to conduct quality initiative reviews at monthly Operational Group level specifically looking at Complaints, incidents, audits and service developments. This is then reported through PCES Stakeholder group which has public involvement. PCES management group have identified areas for involvement of the focus group with regards to improvements and information and communication. This will be addressed by offering the focus group the opportunity to; Visit NHS24 for increased awareness of the unscheduled care journey. Progress a patient information leaflet detailing the unscheduled care journey. Review the Survey results and process. PCES will consult with the Public Partnership Forum in relation to other methodology for future surveys and initiatives. PCES utilised an Opinion Meter which was well received by respondents 94/1099 in the Glenrothes centre. The opinion meters were of limited technology and the usage was appropriate and correlated with the main result. There was only 1 Opinion meter working at the time of the survey which meant it was only available in 1 centre. PCES identified that additional opinion meters may have further improved the responses received. NHS Fife Clinical Governance Support Team Page 16 of 26 Review Date: N/A

APPENDIX 1 Page 1 of 2 NHS Fife Clinical Governance Support Team Page 17 of 26 Review Date: N/A

APPENDIX 1 Page 2 of 2 NHS Fife Clinical Governance Support Team Page 18 of 26 Review Date: N/A

APPENDIX 2 Page 1 of 1 NHS Fife Clinical Governance Support Team Page 19 of 26 Review Date: N/A

APPENDIX 3 Page 1 of 1 NHS Fife Clinical Governance Support Team Page 20 of 26 Review Date: N/A

APPENDIX 4 Page 1 of 1 NHS Fife Clinical Governance Support Team Page 21 of 26 Review Date: N/A

APPENDIX 5 Page 1 of 1 Fife Primary Care Emergency Service 01/04/09-31/03/10 Call Type 2009/10 999 6 Clinical Advice 478 District Nurse 3199 Doctor Advice 11139 Home Visit 11825 NHS24 Advice 29032 NHS24 MIHP 20 Nurse Advice 575 Nurse Treatment Centre 13330 See & Treat (SAS) 718 Treatment Centre 19421 Total number of cases 89743 NHS Fife Clinical Governance Support Team Page 22 of 26 Review Date: N/A

APPENDIX 6 Page 1 of 1 NHS Fife Clinical Governance Support Team Page 23 of 26 Review Date: N/A

APPENDIX 7 Page 1 of 1 NHS Fife Clinical Governance Support Team Page 24 of 26 Review Date: N/A

APPENDIX 8 Page 1 of 1 PCES Patient Survey.. Published: 28 Jun 2010 NHS Fife is supporting the Primary Care Emergency Service (PCES) to undertake a patient satisfaction survey, aimed at improving Out-of-Hours services by learning from the experience of patients. Throughout July, PCES will collect information on the healthcare experiences of patients attending Primary Care Emergency Centres as well as those receiving a GP home visit. This will enable best practice to be shared, whilst highlighting areas where improvements may need to take place. Although the survey specifically focuses on the experiences of individuals accessing Out-of-Hours services during July, there will be a further opportunity for a patient focus group following the results of the survey. All patients attending a Primary Care Emergency Centre in St Andrews, Glenrothes, Kirkcaldy or Dunfermline or those receiving an Out-of-Hours home visit from a PCES GP will be invited to complete a questionnaire. The questionnaires are available by post, telephone, online and in translation. Results will be collated centrally and will be available to view publically. Susan Manion, General Manager of Dunfermline and West Fife CHP and (Executive Lead for PCES) said: We are very keen to get feedback on our Out-of-Hours services from the people who have recently used the service. This feedback is essential to allow us to improve care delivery and the services we provide for the people of Fife. We would urge people who receive a survey to take the time to fill one in. Your views are really important to us. NHS Fife Clinical Governance Support Team Page 25 of 26 Review Date: N/A

APPENDIX 9 Page 1 of 1 NHS Fife Clinical Governance Support Team Page 26 of 26 Review Date: N/A