PE Patient Experience
1 Length of Consultations
The length of routine booked appointments with the doctors in
the practice is not less than 10 minutes. [If the practice routinely
sees extras during booked surgeries, then the average booked consultation
length should allow for the average number of extras seen in a surgery
session. If the extras are seen at the end, then it is not necessary
to make this adjustment.]
For practices with only an open surgery system, the average face-to-face
time spent by the GP with the patient is at least 8 minutes.
2 Patient Surveys (1)
3 Patient Surveys (2)
The practice will have undertaken an approved patient survey
The practice will have undertaken a patient survey each year,
have reflected on the results and have proposed changes if appropriate.
4 Patient Surveys (3)
The practice will have undertaken a patient survey each year
and discussed the results as a team and with either a patient group
or Non-Executive Director of the PCO. Appropriate changes will have
been proposed with some evidence that the changes have been enacted.
PE 1 Length of Consultations
The length of routine booked appointments
with the doctors in the practice is not less than 10 minutes. [If
the practice routinely sees extras during booked surgeries, then
the average booked consultation length should allow for the average
number of extras seen in a surgery session. If the extras are seen
at the end, then it is not necessary to make this adjustment.]
For practices with only an open surgery system,
the average face-to-face time spent by the GP with the patient is
at least 8 minutes.
Practices that routinely operate a mixed economy
of booked and open surgeries should report on both criteria.
PE 1.1 Practice guidance
The contract includes an incentive for practices to provide longer
consultations. This has been included as a proxy for many of the
things which are crucial parts of general practice, yet cannot easily
be measured - eg listening to patients, taking time, involving patients
in decisions, explaining treatments etc, in addition to providing
high quality care for the many conditions not specifically included
in the quality and outcomes framework.
Practices can claim this payment if their normal booking interval
is 10 minutes or more. 'Normal' means that three quarters or more
of their appointments should be 10 minutes or longer. Deciding whether
a practice meets this requirement depends on the booking system.
Practices with appointment systems
For practices where three quarters of patients are seen in booked
appointments of 10 minutes or more, and surgery sessions are not
normally interrupted by 'extras', the contract requirement is met.
Extras seen at the end of surgeries and patients seen in emergency
surgeries should then not amount to more than a quarter of patients
If extras are routinely seen during surgeries, this will reduce
the effective length of time for consultation. For example, if a
surgery session has 12 consultations booked at 10 minute intervals,
but 6 extras are routinely added in, then the average time for patients
will be 120/18 = 6.7 minutes, and these slots would not meet the
10 minute requirement. Practices will generally find it easier to
decide whether they meet the 'three quarters' requirement if extras
are seen at the end of routine surgeries, rather than fitted in
Some practices use booking systems which contain a mixture of slots
booked at different lengths within a single surgery. In these practices,
the overall number of slots which are 10 minutes or more in length
should be three quarters of the total.
Practices without appointment systems or with mixed systems
Some practices do not run an appointment system. In this case, or
where some surgeries are regularly 'open', practices should measure
the actual time of consultations in two sample weeks during each
year. It is not necessary to do this if fewer than a quarter of
patients are seen in open surgeries and the rest of the surgeries
are booked at intervals of 10 minutes or more, as the 'three quarters'
requirement will already be met.
For practices using computerised clinical systems, the length of
consultations can be recorded automatically from the computer, providing
the doctors know that it is being used for this purpose during the
week. Where actual consultation length is measured, the average
time with patients should be at least 7.25 minutes. This assumes
that the face-to-face time has been 8 minutes in three quarters
of consultations (equivalent to the face-to-face time in a 10 minute
booked slot), and 5 minutes in the remainder.
Practices organise consulting in a wide variety of different ways.
This Guidance covers the majority of systems. However, if the practice
believes that the spirit of the indicator is met but that the evidence
it can provide is different, it should have discussions with the
PCO at an early stage.
PE 1.2 Written evidence
If submitting on length of consultation, a survey carried out on
two separate weeks of consultation length or a computer printout
which details the average consultation length should be available.
PE 1.3 Assessment visit
If the practice operate an appointment system, inspection of the
appointments book (whether paper or computerised) should be carried
out, looking at a sample of days over the preceding year.
If the practice has submitted a survey of consultation length, this
should be reviewed.
PE 1.4 Assessors' guidance
The assessors may need to look at a number of sample days to confirm
that 75% of consultations have been booked at least at 10 minute
If a manual survey of average consultation time has been submitted
the assessors should question the doctors and reception staff on
how and when this was carried out.
PE 2 Patient Surveys (1)
The practice will have undertaken an approved
patient survey each year
PE 2.1 Practice guidance
A practice will meet the contract requirement if it has carried
out a survey of patient views in the previous year, using one of
two currently approved instruments (GPAQ - the General Practice
Assessment Questionnaire, and IPQ - the Improving Practice Questionnaire).
Both these instruments have been widely used in the NHS and are
currently being modified from their originals in order to meet the
requirement of the GP contract. It is likely that other instruments
will be added to the approved list following submission to and approval
by the National Panel.
GPAQ is a shortened version of GPAS which has been developed for
the new contract. GPAS is available with full instructions at www.gpaq.info.
IPQ is available at http://latis.ex.ac.uk/cfep/ipq.htm
Practices have a choice of how to administer their survey. IPQ and
GPAQ can both be administered by giving them to patients attending
the surgery, and filled in after consultations with the GP. In addition,
GPAQ is available in a version designed to be administered by post.
In some cases, if practices consent, a PCO may take responsibility
for carrying out a postal survey of all practices in its area.
One advantage of administering questionnaires in the surgery is
that they can relate to an individual GP, who will then also be
able to use the results in his or her revalidation folder. Surveys
carried out by post do not generally relate to a named doctor, except
in single-handed practices.
The aim should be to have questionnaires returned by at least 50
patients for each doctor. Only doctors who are permanently in the
practice need be included. However, non-principals may benefit from
inclusion in order to provide evidence for their revalidation folder.
If surveys are carried out in the surgery, these should be conducted
on consecutive patients. If carried out by post, adult patients
should be randomly sampled, and sufficient questionnaires should
be sent out to get 50 questionnaires back.
PE 2.2 Written evidence
Practices should provide evidence that the survey has been undertaken
including the date and methodology.
PE 3 Patient Surveys (2)
The practice will have undertaken a patient
survey each year, have reflected on the results and have proposed
changes if appropriate
PE 3.1 Practice guidance
The practice will undertake one of the surveys detailed in PE 2.
The practice should examine the results of the survey and consider
whether there are areas where changes could be made to improve the
services and quality of care for patients. This could take the form
of a practice meeting involving members of the team.
The practice at level 2 need not provide the results of the survey
but should provide an overview of its analysis of the survey and
any subsequent proposals for change. Some proposals for change may
have resource consequences which need to be discussed with the PCO.
This could take the form of a report from a team meeting.
PE 3.2 Written evidence
A report from the practice should be available.
PE 4 Patient Surveys (3)
The practice will have undertaken a patient
survey each year and discussed the results as a team and with either
a patient group or Non-Executive Director of the PCO. Appropriate
changes will have been proposed with some evidence that the changes
have been enacted
PE 4.1 Practice guidance
Practices should have undertaken a recommended patient survey and
have discussed it as a team. (See PE 2 and PE 3.)
Subsequently the team should share its results with a Non-Executive
Director of the PCO or with a patient group at a practice meeting.
If the practice has a patient participation group then this group
may be utilised.
If no patient group exists, one could be convened using one or more
of the following methods:
- an advertisement placed in the waiting room at least two weeks
before the meeting
- a random sample of patients who are written to and invited by
the practice at least three weeks in advance of the meeting
- an advertisement in the practice newsletter if the practice has
- a leaflet handed out by reception staff or a notice on the side
Practices may wish to convene a focus group with particular service
needs, eg mothers with young children, the elderly etc, with which
to share the results of the survey.
PE 4.2 Written evidence
Practices should submit a report of the meeting which should be
agreed with the Non-Executive Director or copied to patients who
have attended the meeting. The report should propose changes as
appropriate. In subsequent years, evidence that some change has
been achieved should be provided by a report or by demonstrating
a positive change in the patient survey.