by Dr Murray Ellender

How can we make primary care better for patients?

Every year since 2007, NHS England has asked patients what they think about their GP practice in a large national survey. The survey is administered by Ipsos MORI and findings are intended to inform patients, healthcare professionals and planners about patients’ experience of the care provided by individual practices. Summary results of the latest GP Patient Survey, which uses data from more than 800,000 completed surveys, are available to view online, along with useful tools for detailed drill down.

There is always much discussion about the creation and use of survey data, and the NHS National Institute for Health Research recently shared its own insights following research that uses the GP Patient Survey data as its starting point. For me, the key question we should be asking ourselves is how can the survey help us make primary care better for patients? And the answer, as the data would seem to bear out, is that patients need to know more about their options when accessing primary care, and we as healthcare providers need to offer them more choice.

Closing the knowledge gap

Among other things, the survey looks at patients’ experience of making an appointment and satisfaction with opening hours. It also asks how people access their practice and what they know about their options. Unsurprisingly, the 2016 survey shows rising levels of dissatisfaction for patients trying to reach their GP surgery on the phone – one in four respondents (26%) said it was not easy to get through to someone, while the proportion of those who found it easy has decreased in recent years.

“The 2016 survey shows rising levels of dissatisfaction for patients trying to reach their GP surgery on the phone”

Most patients book their appointments by telephone (86.9%), while almost three in ten (27.1%) book in person.

It is encouraging to note that awareness of online services has increased. Almost one-third of patients are aware that they can book appointments online (31.3%) and a similar proportion of people (30.9%) know they can order repeat prescriptions online. However, almost half of all patients were unaware of the online services available at their practice, and a further one in ten believed that none of these options was available.

While these figures show an improving trend, clearly there is a way to go in terms of letting patients know that online services are available to them. And where there is more awareness, we still need to do more to encourage uptake. Currently, around 10% of survey respondents say they had ordered repeat prescriptions online in the past six months compared with 9.8% in January 2015. And while only 7.5% of patients reported that they had used online booking, this too has increased since last year’s survey.

Demand versus supply

At eConsult, most of our GP practice customers report that managing patients’ expectations – particularly in terms of when (or whether) they need a face-to-face GP appointment – is chief among the concerns they’re hoping to tackle with online consultation. And if proof were needed that patient perception around this still needs to be addressed, the GP Patient Survey provides it.

When patients last contacted their GP surgery, most of them wanted to see a GP (75.4%), while around 18% wanted to see a nurse. Few said they wanted to speak to a GP or nurse on the phone.

For most people, timing remains an issue too. A lot of patients (more than 40%) report that they wanted to see or speak to someone on the same day as they contacted the surgery, while only 7.3% said they were happy to wait until the following week or later for an appointment. Again, the figure for those opting to consult online was low, at less than 0.5%. We already know that there’s a huge gap between people’s perception of how a GP practice operates and the reality when it comes to allocation of resources, and these statistics point to an urgent need to address the knowledge gap, as well as making more of alternative ways of consulting.

With many patients working on weekdays, surgery opening hours came in for some criticism, with one in five patients saying they were inconvenient and that Saturday opening, or appointments after 6.30pm, would suit them better.

Our experience at eConsult shows that a lot of patients actually prefer to be able to consult with their GP at a time to suit them – which may not coincide with surgery opening hours – and online consultation allows them to do just that, as well as ensuring that, in most cases, they get a response from their GP much sooner than if they had to wait for a face-to-face appointment. But if people don’t know about this option or their practice doesn’t offer it, they will continue to think that a GP appointment is what they need in the majority of cases.

Online consultation addresses many of the concerns expressed by patients in the GP Patient Survey, but while there is a willingness to consider alternative ways to access primary care, much more needs to be done – not just to make those alternatives available, but to tell people what they are and why they need to know about them.