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PE Patient Experience

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. 

PE 2 Patient Surveys (1)
The practice will have undertaken an approved patient survey each year. 

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 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 seen.

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 during them.

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.

Unusual systems
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 intervals.

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 one
- a leaflet handed out by reception staff or a notice on the side of prescriptions.

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.
 

 

 

 

 

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