QOF Plus Year 1 - Imperial College London

The recently published national Picker Institute survey of patient satisfaction with GP serviceshighlighted the many positive aspects of the patient experience. The majority of Hammersmithand Fulham patients reported that:69% could pre-plan or get an appointment within 2 working days,60% were seen within 15 minutes of their appointment time,76% thought the doctor listened carefully to what they had to say,66% thought they had enough time with the doctor,56% thought they were involved as much as they wanted to be in decision about theircare and treatment,66% had confidence and trust in their doctor and 89% felt they were treated with respectand dignity,71% thought the doctor knew enough about their condition/treatment, and58% thought that the main reason for their visit to a practice had been dealt with to theirsatisfaction.Most patients are highly appreciative of the care they receive. However, the survey resultshighlight that there is also room for improving the patient experience. The Picker Institute uses asimple summary score to show where patients think there is a problem or room for improvementregarding a specific aspect of care. Hammersmith and Fulham scored worse than the nationalaverage in 2 particular categories: ‘Making an Appointment’ and ‘Seeing a Doctor’. While thenational survey is a useful high level tool it does not allow analysis of individual practiceperformance and for this reason the plan is to carry out a local version of this survey. It isproposed that the PCT involves practices in innovative interactive feedback sessions resulting inindividual plans for addressing areas of concern.Review of evidence to support the proposed indicatorsPatient surveysA review by Coulter et al. (2006) concludes that direct and indirect feedback from patients is seenas a means of stimulating quality improvements, and that one of the main ways in whichfeedback can be obtained is through patient surveys.Patient surveys generally show relatively high levels of satisfaction with primary care. However, areview by Coulter (2006) of findings of patient surveys in six countries has shown that patientengagement tends to be lower in the United Kingdom (the comparison countries were the UnitedStates (US), Australia, Canada, New Zealand and Germany). This review found that doctors in theUK were reported as less likely than doctors in other countries to involve patients in decisionmaking,to give information on self-help or self-management, or to give information about theside-effects of medication.The two currently approved patient survey instruments (IPQ and GPAQ) have several limitationsand have not been designed to address important areas such as engagement and continuity.80