GP Patient Survey Your doctor, your experience, your say

GP Patient Survey Your doctor, your experience, your say Guidance 2007/08 for strategic health authorities, primary care trusts and GP practices Introduction 1. This document provides guidance on this year s GP Patient Survey. The survey arrangements have changed following lessons from the 2006/7 survey. This document should therefore be read by SHAs, PCTs and GP practices as appropriate to their involvement in the relevant Directed Enhanced Services the survey supports. This document also highlights the valuable resource which the survey results provided last year for PCTs and practices in discussing how best to develop services locally. 2. This document should be read alongside: Sections 7E and 7F of the Statement of Financial Entitlements (SFE), which sets out the legal basis for survey related payments and also Primary Medical Services (Directed Enhanced Services) (England) Directions 2007 for the Improved Access Scheme and the Choice and Booking Scheme - link below: http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationslegislatio n/dh_077188 Letter to GP Practices and PCT Primary Care Leads dated October 29 th 2007, link below: http://www.dh.gov.uk/en/publicationsandstatistics/lettersandcirculars/dearcolleaguel etters/dh_079926

DH INFORMATION READER BOX Policy HR / Workforce Management Planning / Clinical Estates Commissioning IM & T Finance Social Care / Partnership Working Document Purpose For Information ROCR Ref: 0 Gateway Ref: 9202 Title GP Patient Survey Guidance 2007/08 for SHAs, PCTs and GP practices Author Publication Date Target Audience DH 06 Dec 2007 PCT CEs, SHA CEs, GPs Circulation List #VALUE! Description The document provides guidance on this year's GP Patient Survey which will be launched in January 2008. It includes changes in arrangments following lessons learned from 2006/07. GP surgeries should receive questionnaire packs w/c 14 January. Cross Ref Superseded Docs Action Required Timing Contact Details For Recipient's Use Letter to GP practices 29th October 0 GP Patient Survey Guidance 2006/07 0 n/a 0 n/a Judith Guest Primary Medical Care 2E56 Quarry House Quarry Hill, LS2 7UE 0113 25 46738 www.dh.gov.uk 0

Background 3. The GP Patient Survey provides data on patients experiences to help PCTs assess general practices achievement against standards set out in the Improved Access Scheme and Choice and Booking Directed Enhanced Service (DES). 4. The Improved Access Scheme DES aims to reward good GP access based on percentage of patients reporting satisfaction through the survey of national access standards on: consulting a GP within 2 working days booking ahead for non-urgent appointments ability to get through to the practice on the phone making an appointment with a particular GP 5. The survey also links to the Choice component of the Choice and Booking DES by seeking whether patients recall a discussion offering choice of hospital when being referred. 6. The DESs standards are designed to ensure people are able to book an appointment with a doctor as quickly and as easily as possible, and to ensure doctors discuss a choice of hospital with their patients where appropriate. This year s survey will again provide information to PCTs (and practices) on whether or not patients are satisfied with their practices existing opening hours. 7. As last year, the questionnaire on access will be administered nationally as a postal survey, issued first class to recipients and a separate choice questionnaire will again be issued by practices directly to eligible patients. The Department of Health appointed Ipsos MORI, an independent survey agency, to carry out the survey. 2008 Survey timetable January February March April May June Access survey sent to patients January 7 11 th Choice survey issued to patients between Jan 21 st March 28 th th st 1 reminder to patients in access survey February 11 th 15 th 2 nd reminder to patients in access survey March 3 rd 7 th Final return date for Access questionnaires April 2 Final return date for Choice questionnaires April 4 th nd Results available to PCTs and practices May National results published June

Data extraction methodology 8. Last year practices were asked to choose the way their patients details were collected for the access survey. One option was to use software developed by Apollo Medical Systems, which identified a random selection of patients based on their medical notes recording an appointment with their GP during a defined period and extracting their name and address details so that they could receive the survey. The other option was a random sample from the NHS list of patients registered with a GP, irrespective of whether they had had a recent appointment. This is obtained from the NHAIS (National Health Application Infrastructure Service or Exeter ) Patient Registration System. 9. This year, the selection of patients to participate in the access survey will rely on the Exeter system only. Survey recipients details, the sample data (Patients NHS Number, Name, Address, gender and date of birth) will be extracted from the Exeter database. The Exeter system will collect a random selection from the practice list of registered patients. As the Exeter system is maintained by PCTs practices do not need to take any action if they want to participate in the Survey, other than to have signed up to the DESs with their PCT. 10. The selection of patients for the choice survey is reliant on practices identifying eligible choice referral patients. 11. The Healthcare Commission patient survey is due at the same time as the GP Patient Survey. The two sets of samples for each survey have been designed and drawn in a complimentary manner so that they do not overlap and the chances of people receiving both questionnaires are minimised. However this does mean that trusts will not have the opportunity to increase their sample size for the Healthcare Commission survey this year above the 1,200 provided to them. Data Protection 12. The sample database produced from the Exeter system will be transferred to Ipsos MORI. Ipsos MORI will then process this data by using the patient name and address to send questionnaires to selected patients and will process the subsequent responses. The Department of Health does not hold or process any patient identifiable information. 13. To ensure this processing of the sample data for purposes of conducting the GP Patient Survey is lawful, the Department of Health has, in accordance with the Data Protection Act 1998, put in place a data processing agreement with Ipsos MORI to permit the use of this data, including sending out questionnaires on its behalf. The text of this data processing agreement can be found on the DH website at: h ttp://www.dh.gov.uk/en/publicationsandstatistics/publishedsurvey/gppatientsurvey 2007/index.htm

14. This year, there is therefore no need for GP practices or PCTs to put in place individual Data Processor Agreements. Practices that have signed up to the DESs with their PCT need do nothing more to ensure they are included in the survey. Payments to practices Improved Access Scheme 15. Practices will receive payment for participation in the survey at the first quarter end of the 2008/09 financial year based on the outcome of the survey. These payments are linked to the percentage of positive responses received from patients surveyed. The access questions have a graded scoring level attached with high percentage scores receiving higher practice payments. The PCT will assess the levels achieved guided by the Financial Reporting Standard (FRS) 12, rules around provisions. 16. Section 7E of the Statement of Financial Entitlements (SFE) set out the mandatory translation tables that link results from the survey to specific levels of payment to be made to practices. For ease, these are set out in Annex A of this document. Payment levels remain at the same rate as in 2006/07. 17. Practices who choose to opt out of the survey or score less than the minimum levels will not receive payment. However, it is likely that some practices may give reasons for low scores or non-participation in the Survey. The SFE provides no power for PCTs to make any payments where the normal criteria are not met. 18. Each PCT will have access to the results for all of the participating practices in their areas. PCTs should inform individual practices of their results as soon as possible after receiving them. Following receipt of results data, PCTs will need to authorise and process payment to practices as soon as possible. This could take up to 2 weeks. 19. Practices that have signed up for the Improved Access Scheme DES should have already received aspiration payments according to the DES directions. Practices will have received payment for their written practice plan and for making a written commitment to engage in the GP Patient Survey process. Where practices have subsequently chosen to opt out of the DES or where the practice fails to reach the minimum standards for payment, the PCT is entitled to recover part of the aspiration payment as set out in section 7E of the SFE. 20. Any awards that could be made in the event of practice closures, mergers or splits will be for the PCT to determine in accordance with SFE paragraphs 7E 34-38 (mergers) and paragraphs 7E 40-43 (splits). 21. PCTs should make payments based on actual results achieved by the practice. Choice/Choose and Book

22. The 2007/08 DES for Choice and Booking provides that practices will receive a reward payment if 60% or more of their patients who respond to the national GP Patient Survey, agree that their GP talked to them about a choice of hospital. The detailed payment scheme is set out in section 7F of the SFE. 23. The full value of the DES is 96 pence per registered patient and comprises two equal components, one for choice (48 pence) and one for Choose and Book (48 pence). For the survey we are focusing on the choice component. Half of the choice component will be made as an aspiration payment to those GP practices that make a written commitment to ensure that choice is offered to eligible patients. The remaining half will be paid to the practice if at least 60% of patients agree that they were offered a choice of provider based on the results of this survey of patient experience. 24. At the end of the DES period, if practices fail to achieve the minimum (60%) level, PCTs may arrange for repayment of the aspiration payment or for a balancing mechanism, which offsets the repayment against other income due to the practice as set out in paragraph 16 of section 7F in the SFE. Issuing and encouraging completion of the choice survey 25. As identified previously, practices are again responsible for issuing and encouraging completion of the choice survey this year. All practices participating in the DES (i.e. those who have not sent an opt out notice to the DH mailbox) will receive a questionnaire pack from Ipsos MORI in the week commencing January 14 th. The questionnaires will be specific to the practices they have been issued to, identified through inclusion of each practice s national code on the questionnaire. 26. Questionnaire packs will include a covering letter of instructions and a minimum of 150 questionnaires, with more for larger practices. The number of questionnaires practices receive will be sufficient to deliver a reliable result for the purposes of the survey. No more questionnaires will be available for these practices. 27. SHA will have access to blank questionnaires (i.e. those with no practice code on) which are available to PCTs for newly formed practices participating in the DES but whose details were not included on the Exeter system at the time data were collected. 28. Questionnaires will need to be issued by the practice to eligible choice referral patients from 21 January to 28 March. Patients will need to have returned their questionnaire by 4 April in order for them to be processed in time for inclusion in the survey results. 29. It is important that questionnaires are issued to only eligible choice referral patients as failure to do so could have an adverse impact on the assessed level of achievement of offering choice and therefore qualification for the reward payment due under the DES. 30. Eligible choice referral patients are those patient aged over 18 years of age and who have not been referred for:

Cancer Urgent heart conditions Stroke Mental health Maternity services Plus any locally agreed exclusions between the PCT and SHA. Patients referred for these conditions or services should not receive a questionnaire from the practice. 31. This year, practices also have the opportunity to issue the questionnaire to patients who have been the subject of a prior choice referral from 1 st September onwards. For patients who have had more than one referral in this period the practice should confirm the relevant referral with them (i.e. choice referrals only). 32. Practices can identify prior choice referral patients by checking the relevant read code in their patient notes which they were instructed to use from 1 September for purposes of administering the survey i.e. 9kK.. Choice and booking enhanced service administration (4 byte and version 2) XaMJa Choice and booking enhanced services administration (version3) 222711000000102 Choice and booking enhanced services (SNOMED) Administration payments to general practices for issuing the choice survey. 33. Practices will, again, have the opportunity to receive a single reimbursement payment for administering the choice questionnaires to their choice referral patients. 34. The payment will be received from PCTs along with the DES reward at the first quarter end of the 2008/09 financial year. The two payments are completely separate and not dependent on one another. The reimbursement consists of 2.8p per registered patient, subject to Ipsos MORI s analysis for each practice demonstrating that completed choice questionnaires have been received from at least 1.5% of the practices registered patients (patient count as at January 1 st 2008). Survey results Last years results 35. Over 2.5 million responses were received from the separate Access and Choice surveys undertaken for 2006/07 making it the largest ever survey of NHS patients.

36. At a national level, the results were positive most patients across the country indicated they were satisfied with the access and choice provided by their practices. The results of the 2006/07 Survey showed that: > 86 per cent of people were satisfied with their ability to get through to their doctor s surgery on the phone. > 86 per cent of people who tried to get a quick appointment with a GP were able to do so within 48 hours > 75 per cent of people who wanted to book ahead for an appointment were able to do so. > 88 per cent of people who wanted an appointment with a particular doctor at their GP surgery said they could do this. > 84 per cent of people were satisfied with the current opening hours in their practice. > 94 per cent of people who were referred by a GP discussed choice of hospital. 37. However, at a local level there were pockets of dissatisfaction with access to services that needed to be tackled. Making best use of the Survey data 38. The publication of the 2006/07 GP Patient Survey results can be found at: http://www.dh.gov.uk/en/publicationsandstatistics/publishedsurvey/gppatientsurvey 2007/DH_075127 The results have led to actions on a number of levels to understand and improve on delivering improved access to services for all patients, but particularly those reporting poor access to services. This includes: > analysis by PCTs of the rich data to support development of local action plans that will deliver rapid improvements in access to services > publication of better information for patients about their own and other GP practices to support choice when registering with a new practice or switching practices > establishment of a National Improvement Team to support those PCTs and practices with poorest reported patient satisfaction to improve access to services > review of the needs of people from black and minority ethnic communities who report poorest satisfaction with access to services > commitments to explore how to deliver wider responsiveness to patient experience, addressing local issues and concerns.

39. The 2007/08 GP Patient Survey results will be available to PCTs and practices in May 2008 as part of the process of triggering reward payments to practices under the DESs. In those cases practices will be rewarded based on how their patients have rated the access and choice provided by their practice. PCTs will receive a practice level presentation of raw scores and DES indicators to inform payments they will need to make. 40. Following this initial release, a fuller set of results will be available to PCTs. Results will be made available to each PCT for each question in PCT summary form and disaggregated by practice. The results will cover: > demographic questions; > questions about access and choice matters which may trigger payments to practices under the DESs; and, > questions about access and choice that will not trigger any payments to practices under the DESs. 41. This information will, again, offer PCTs and practices insight and understanding in to their patients experiences of access, effectiveness of local actions undertaken to improve access over previous results and how patients might respond to further changes to improve access to services practices offer. The survey results will therefore again provide a resource to contribute to PCTs plans to develop services or improve access and to their discussions with local practices and patients. 42. The data from the survey is also being used from this year for PCTs performance assessment undertaken by the Healthcare Commission. 43. National publication of the survey results planned for June will therefore again attract interest both locally from patients and the public and from the media. As last year, PCTs will need to have their own communications plans in place and should be discussing with their practices how both they, and their practices, respond locally to the publication of the Survey results and how they might best use those results as a resource. 44. The NHS Primary Care Contracting Team and The Improvement Foundation can offer advice and support to PCTs and practices on such matters. They may be contacted at: NHS PCC: pcc.contact@pcc.nhs.uk (also see website www.pcc.nhs.uk/gpsurvey) IF: www.improvementfoundation.org (see website for regional centres contact details)

Frequently asked questions 1.What are the data protection arrangements for the survey? To ensure this processing of the sample data for purposes of conducting the GP Patient Survey is lawful, the Department of Health has, in accordance with the Data Protection Act 1998, put in place a data processing agreement with Ipsos MORI to permit the use of this data, including sending out questionnaires on its behalf. The text of this data processing agreement can be found on the DH website at: http://www.dh.gov.uk/en/publicationsandstatistics/publishedsurvey/gppatientsurvey200 7/index.htm 2. Why are patients being asked about their ethnic group? This is a standard question used in social surveys. The response will enable Ipsos MORI to check that results are representative of all groups registered with GP practices in England. The groupings are those used by the Office for National Statistics. People who do not feel they belong to any of the ethnic groups should write their group in the box marked other. 3. How much is the Survey costing the Department? We have budgeted around 10million this year. This includes costs to conduct both the Access and Choice components of the Survey. 4. Why is first class postage being used? Ipsos MORI has agreed a discounted arrangement with the Royal Mail. First class post is the most cost effective method, as the survey is being administered in a set period of time and swift return of responses reduces the number of reminders sent. 5. Will patients who have not responded be sent a reminder? There will be two reminders, the first in February and the second in March. Efforts will be made to prevent reminders being sent to patients who have already returned a survey, however, processing times and postage times might mean that some patients will receive a reminder even though they have already responded. They should therefore ignore the reminder. There will be no reminders for the Choice questionnaire. 6. What happens if patients complete and return the original questionnaire and the reminder/s? Won t this skew the results? Any duplicate responses will be identified by the unique reference/user name and removed from the system. 7. Some patients don t see their GP, only the practice nurse. Should they complete the Survey? The Survey is about booking appointments with the GP, not the nurse or any other healthcare provider. We encourage everyone who has received a questionnaire to take part. Those who have not had a GP appointment recently may find that not all questions apply to them.

8. How should patients answer questions where no appointment system is available? Patients should attempt to answer all questions. Q3 and Q5 should be answered according to what the patient has tried or wanted to do, regardless of the system in place at their surgery. However, where it is impossible to answer, they should leave it blank. 9. What about patients who can t remember the number of appointments they have made in the last 12 months? Patients should estimate the number of appointments to give an idea of how frequently they visit their GP. 10. Why are children excluded from the Survey? Children are excluded from the Survey following advice from researchers that aiming this type of question directly at children would be inappropriate. Ethics advice was that those under 18 year of age should only be included in surveys where necessary. Given thatthe main aim of the Survey is to demonstrate the extent to which GPs are achieving the standards set out in the Improved Access Scheme, the inclusion of children was not considered essential. The Survey also raised confidentiality issues for patients within the 16-18 year age group. 11. What payment will be made to practices that are not participating in the Survey? Practices that do not participate in the Survey will not have any results for the PCT to pay against and therefore will not receive payment. 12. What payment will be made to practices that close, split or merge during the 07/08 DES period? It will be up to the PCT to decide with the practice what awards will be made in respect of the DES based on advice set out in the SFE paragraphs 7E 34-38 (mergers) and 7E 40-43 (splits). Directors of Finance should ensure that appropriate arrangements are in place to consider challenges. 13. What payment will be made to practices(including new practices) that sign up to the DES(s) too late to participate in the Survey? Practices are entitled to sign up for the DESs until February 1 st 2008, However this will be too late for Ipsos MORI to include them in the Survey and there will be no results to pay against. As in Q11, it will be up to the PCT to determine what level of payment should be made in these circumstances. 14. When will PCTs get the information necessary to make DES payments? Raw results and indicators will be made available to PCTs at the end of May to enable PCTs to calculate payment to practices in the first quarter of financial year 2007/08. 15. What happens if the GP Patient Survey results differ from the results in the QOF questionnaire? Other surveys may seem to be asking about similar things, but each one is looking at different aspects related to healthcare and will provide different results. 16. Does the GP Patient Survey mean that practices no longer need to do the QOF survey?

Indicators for the QOF survey remain in place. Practices wishing to receive payment for these indicators must continue to carry out the QOF survey. 17. Why is the Choice DES being measured by a survey issued by GPs? The NHAIS (Exeter) registration system is unable to target patients who have recently had a hospital referral. It was therefore decided that last year s direct issue to patients should be repeated. 18. In August, GPs were advised to use Read Codes to record choice referral patients as it was expect the survey would be administered differently. What will happen now? The Read Codes introduced for recording choice referrals from September 1 st 2007 can still be used. Patients can use them to identify eligible patients to whom they may want to issue the Choice questionnaire during the Survey period. The relevant codes are: 9kK.. Choice and booking enhanced services administration (4 byte and version 2) XaMJa Choice and booking enhanced services administration (version 3) 222711000000102 Choice and booking enhanced services (SNOMED) 19. Why is there a question included in the access questionnaire about choice when there is a separate choice questionnaire? This was included to maximise response rates on the choice component of the survey, as around 12% of the access patients may be eligible to answer. The inclusion in the choice results will provide a more accurate analysis. 20. Are both components of the Choice and Booking DES (i.e. Choice and Choose and Book) being measured through the choice questionnaire? No. The purpose of the questionnaire is to generate data to inform payment of the Choice component of the Choice and Choose and Book DES. The Choose and Book element of the DES is being measured through a separate monthly report generated by the Choose and Book system. Practice Choose and Book utilisation data will automatically be generated by this report. Practices wishing to take part in the Choose and Book element of the DES should inform their PCT. 21. Why are we reimbursing GPs to hand out the survey? To compensate practices for the additional cost incurred in identifying eligible patients, explaining the process for returning the survey and distributing the survey tool. However only practices that receive responses from 1.5% of their registered lists will be eligible for this payment. 22. Why isn t the Apollo Medical System software available this year to extract patients details? The Department had intended to make available Apollo software this year. The software was developed and ready to support the delivery of a single questionnaire covering both Access and Choice DES questions. That was to deliver a more efficient survey by removing the need for two questionnaires and minimising practice workload by removing the need to hand out Choice questionnaires. However, the Patient Information Advisory Group (PIAG) felt unable to support the planned approach because of concerns that an appointment or referral may have been used to select Survey recipients.

23. What is PIAG? The Patient Information Advisory Group was established to provide advice on issues of national significance involving the use of patient information and to oversee arrangements created under Section 60 of the Health and Social Care Act 2001 that permit the use of confidential patient information where patient consent cannot be obtained. Its membership is drawn from patient groups, healthcare professionals and regulatory bodies. 24. Why does PIAG object to selecting patients using Apollo? The Advisory Group s judgement was that the benefits to the public of conducting the Survey did not, in their view, outweigh their concerns over the use of confidential information on the scale of the Survey without prior patient consent. The concern being potential risk to individuals receiving a Survey letter linking to a recent appointment or referral. 25. Does this mean the Survey this year breaches patient confidentiality? No not at all. The NHAIS (Exeter) registration system selects patients at random from GP practices registered lists so there are no such concerns over confidentiality and practices will hand out the Choice questionnaire directly to relevant choice referral patients. This is the Advisory Group s preferred solution for this year. 26. What is the NHAIS (Exeter) system? NHAIS (National Health Applications and Infrastructure Services) known as Exeter is a software suite used by all local health organisations in England and Wales. 27. What about last year s Access Survey, did that breach patient confidentiality? No. Last year, the Department s Caldicott Guardian was content that arrangements put in place to conduct the Access Survey were sufficient to address the needs of the Data Protection Act 1998. That saw required data processing agreements put in place between all relevant parties. 28. Why can t the Survey be delivered in one single exercise? The NHAIS (Exeter) registration system is unable to target patients to take part in the Survey in the same way as the Apollo software i.e. it extracts Survey recipients randomly from registered lists. For Choice DES questions, this would mean payments to practices would rely on patients self-selecting themselves as having had an appropriate choice referral. It was therefore decided that last year s direct issue to patients from GP practices should be repeated. Further Information Information for patients about the survey is available online at www.gp-patient.co.uk. SHAs and PCTs can access further information, including FAQs via the Primary Care Contracting website (PCC) at www.primarycarecontracting.nhs.uk. SHA and PCT queries should be emailed to the PCC Helpdesk: gppatientsurvey@pcc.nhs.uk

Practice and general public enquiries can be emailed to the DH mailbox: GPPatientSurvey@dh.gsi.gov.uk. Department of Health website Primary Medical Care Contracting section: www.dh.gov.uk/policyandguidance/organisationpolicy/primarycarecontracting/fs/en Primary Care Contracting website under Resources Key Support Areas Contracting & Commissioning section: www.primarycarecontracting.nhs.uk Primary Care Contracting GP Patient Survey Helpdesk: gppatientsurvey@pcc.nhs.uk Department of Health Mailbox: gppatientsurvey@dh.gsi.gov.uk Ipsos MORI GP Patient Survey Website for Patients: www.gp-patient.co.uk Ipsos MORI GP Patient Survey Helpline for Patients: (live January 8 th April 1 st 2008). Free phone 0808 2385 385 (Monday to Friday, 9am to 9pm; Saturday 10am to 5pm)