Editor's blog 8th January 2009: Answering the 2009 GP patient survey

On the day when it was revealed that BMA Chair of Council Dr Hamish Meldrum has got into media embarrassment over his practice's involvement in a polyclinic (see www.guardian.co.uk/society/2009/jan/08/hamish-meldrum-response), I got a special-looking letter.

Awesome! I've been asked personally by Health Minister Ben Bradshaw to give my views on local NHS services. Me and a few others, probably. Let's take this together, dear readers.

OK, onto the world-wide interweb, otherwise I'm just creating work for the postmen. What a good start! Despite the warning 'Logging in may take a few moments so please wait', I've got straight in. Nice work, IPSOS MORI fellas!

Question 1 is about ease of physical access - a real issue in various cities, where practices have been located in residential housing stock. Not mine, though, so this is a 'very easy'.

Question 2 is about how clean my GP practice is, and the options are:
Very clean
Fairly clean
Not very clean
Not at all clean
Don't know

This is quite tricky. The waiting room looks OK, on the occasions I've been waiting there. But do I have a clue whether they hoover under the tables, and disinfect all handle-able materials like door handles or drink dispenser controls frequently? No I do not. I haven't seen clinical waste lying about in any of the consulting rooms I've been into, but do the doctors clean their keyboards? My only possible answer here is 'don't know'.

Question 3: In the reception area, can other patients overhear what you say to the receptionist?
Yes, but I don't mind
Yes, and I am not happy about it
No, other patients can't overhear
Don't know

Yes, unless they are fairly deaf, they can overhear. I don't mind, because if it were really so excruciatingly personal, I could write a note for them. So it's a yes and don't mind.

Question 4: How helpful do you find the receptionists at your GP surgery or health centre?(Very, fairly, not very or not at all).
It saddens me to have to report that this is a definite 'not very' - especially on the phone. I don;t know if it's a London thing, a gatekeeping thing, a 'dealing with sick people grinds you down' thing, or a bad wages thing. But my usual experiences (my own, and my observations of others') of GP practice receptionists at almost every practice I've been registered with has been unfavourable. At my current GP practice, I've seen staff with English as a distant second language who struggle with the basics; and other English staff being really rude and patronising to one older patient and to another who apparently had learning or speech difficulties. Not good.

Getting through on the phone
Onto section B - "getting through on the phone". Think about times you have phoned your GP surgery or health centre in the past 6 months. In the past 6 months, how easy have you found the following?
1) Getting through on the phone (Haven't tried; very easy; fairly easy; not very easy; not at all easy; don't know)
Not easy at all. On the plus side, they don;t (yet) have an 084 number. On the minus side, unless you phone between 08.30 and 08.40, you are going to have to beg for a same-day appointment, even when you state that the call is about a young child.

2) Speaking to a doctor on the phone (same range of options as above)
Haven't tried. Can't see a situation where I would, not having any long-term conditions (yet). If I want practical help, there's the pharmacist. If I want to be told that I can't be diagnosed on the phone, there's NHS Direct.

3) Speaking to a nurse on the phone
See above.

4) Getting test results on the phone
See above, though in contrast I would consider this a perfectly reasonable course of action.

Section C. Seeing a doctor
In the past 6 months, have you tried to see a doctor fairly quickly? (By 'fairly quickly' we mean on the same day or in the next 2 days the GP surgery or health centre was open. (Options are yes, no, or can't remember)
Yes.

Think about the last time you tried to see a doctor fairly quickly. Were you able to see a doctor on the same day or in the next 2 days the GP surgery or health centre was open? (same answering options)
Yes. But only because my wife, who can be quite robust with people, made the call when I was sick with a flu-induced chest infection and a temperature of 39.5 degrees. If I had been physically well enough to phone, my impression from previous experiences is that I would practically have had to beg to get seen. Pity there isn't a 'yes, but ...'category here.

In the past 6 months, have you tried to book ahead for an appointment with a doctor? By 'booking ahead' we mean booking an appointment more than 2 full days in advance. (same answering options)
Oh yes.

Last time you tried to, were you able to get an appointment with a doctor more than 2 full days in advance? (same answering options)
Yes I was. But they clearly thought it was a bit of an inconvenience.

When did you last see your doctor?
When did you last see a doctor at your GP surgery or health centre? (In the past 3 months; between 3 and 6 months ago; more than 6 months ago; or I have never been seen at my present GP surgery or health centre)
In the last three months.

D. Waiting time in the GP surgery or health centre. How long after your appointment time do you normally wait to be seen?
I don't normally have appointments at a particular time
I am normally seen at my appointment time
Less than 5 minutes
5 to 15 minutes
16 to 30 minutes
More than 30 minutes
Can't remember
Badly phrased question. Do they want an average? Last time, bad flu time, nearly 35 minutes - not a surprise, given the local prevalence of flu, and the GP did apologise. Usually? 5 to 15. I shall put 5 to 15.

How do you feel about how long you normally have to wait?
I don't normally have to wait too long
I have to wait a bit too long
I have to wait far too long
No opinion / doesn't apply
Oh joy. A 'how do I feel?' question. Not 'what do I think?'. When I am told I'll be seen at one time, and then have to wait longer, I don't 'feel' thrilled. This is obviously because I'm a very important person with a health policy website to edit, and my time is Euros.

However, if I stretch myself to have a little think, then I don't  necessarily want the person or people before me with the GP to get box-tick-kicked out at the end of their consultation if there is a real problem. This needs to be up to the GP's professional judgment.

It'll be a 'no opinion / doesn't apply' here, then.

E. Seeing the doctor you prefer. Is there a particular doctor you prefer to see at your GP surgery or health centre? (Yes, no, or 'there is usually only one doctor in my GP surgery or health centre'
No.

Did we mention the polyclinics?
F. Opening hours. In the next few questions, think about the times your GP surgery or health centre is open for you to see a doctor or a nurse. How satisfied are you with the hours that your GP surgery or health centre is open?

Very satisfied
Fairly satisfied
Neither satisfied nor dissatisfied
Fairly dissatisfied
Very dissatisfied
I'm not sure when my GP surgery or health centre is open
I'm self-employed, and often work from home, so will skew the response by saying 'fairly satisfied'. A better question might be 'if you want an appointment outside of traditional working hours (9-5), could you get one within 1-2 days or do you know of alternative local arrangements?'

Would you like your GP surgery or health centre to open at additional times? (Yes / No
Yes please. I would also like warm, sunny summers and lower mortgage payments. Oh, I've just got the latter. OK, I'd like warm, sunny summers and free food. Note the absence of a 'don't know' option.

Which one of the following additional times would you most like the GP surgery or health centre to be open?
Please select one answer showing the time you would most like it to be open.
Before 8am
At lunchtime
After 6.30pm
On a Saturday
On a Sunday
After 6.30 pm - and mine isn't even open till then every day.

G. Seeing a doctor in the GP surgery or health centre. Please answer these next questions about the last time you saw a doctor at your GP surgery or health centre. Last time you saw a doctor at your GP surgery or health centre, how good was the doctor at the following?
1) Giving you enough time (Very good, good, neither good nor poor, poor, very poor, doesn't apply)
Good
2) Asking about your symptoms (same options as above)
Good again
3) Listening to you (same options)
Very good
4) Explaining tests and treatments (same options)
Good
5) Involving you in decisions about your care (same options)
Good
6) Treating you with care and concern (same options)
Going to answer good to this, but I think this should again be two separate questions (see www.healthpolicyinsight.com/?q=node/236). I thought he treated me with good care, but a strictly professional concern with no attempt at unwarranted sympathy or empathy. I like that in a doctor, but others might not.
7) Taking your problems seriously
Very good. I mean, I got antibiotics. How could I say any less?

Did you have confidence and trust in the doctor you saw?
Yes, definitely
Yes, to some extent
No, not at all
Don't know / can't say
Yes, definitely. Though since I was feeling pretty horrible, I was not necessarily at a peak of discernment. I just wanted some drugs.

H. Seeing a practice nurse in the GP surgery or health centre. Have you seen a practice nurse at your GP surgery or health centre in the past 6 months? (Yes / No)
No. But why have they not left the 'don't know / can;t remember' option in here?

I. Your overall satisfaction. In general, how satisfied are you with the care you get at your GP surgery or health centre?
Very satisfied
Fairly satisfied
Neither satisfied nor dissatisfied
Fairly dissatisfied
Very dissatisfied
Fairly satisfied comes closest, all in all.

J. Planning your care. The next few questions are about a discussion you may have had with any doctor or nurse. Do you have any long-standing health problem, disability or infirmity? Please include anything that has troubled you over a period of time or that is likely to affect you over a period of time. (Yes, No or Don't know / can't say)
We'll we've got the 'don't know' option back. A grateful 'no' here.

K. Out of hours care. The next few questions are about contacting an out-of-hours GP service when your GP surgery or health centre is closed (for example, in the evening, at night or at the weekend). These questions are not about NHS Direct, NHS walk-in centres or Accident and Emergency (A&E) or Casualty services.
If you wanted to, would you know how to contact an out-of-hours GP service when the surgery or health centre is closed? (Yes / No)
Yes I would, but a good few people I know don't have a clue about this. Media reports have left them thinking GP out-of-hours cover no longer exists. Most would go to a walk-in if it was before 8 pm or to A&E. No option to add this info at this point.
In the past 6 months, have you tried to call an out-of-hours GP service when the surgery or health centre was closed? (Yes, for myself; yes, for someone else; no)
No

L. Some questions about yourself. The following questions will help us to see how experiences vary between different groups of the population.
These are just the obvious ones on age, sex, ethnicity, employment status, family, carer status and whether you're a deaf person who uses sign language.

The intersting one, suggesting that Paul Corrigan's obsession with communter-friendly dual registration lives on chez DH, is
In general, how long does your journey take from home to work (door to door)?
Up to 30 minutes
31 minutes to 1 hour
More than 1 hour
I live on site
I live on site, sometimes. The next question is also clearly linked to the 'let's justify polyclinics' agenda:
If you need to see a doctor at your GP surgery or health centre during your typical working hours, can you take time away from your work to do this? (Yes / No)
Yes, but again, why no 'don't know'? Younger and healthier people may not actually have needed to know about this one.

In general, would you say your health is...?
Excellent
Very good
Good
Fair
Poor
Very good, thanks for asking.

Do you have any of the following long-standing conditions? Please include problems which are due to old age. Please select all the options that apply to you
Deafness or severe hearing impairment
Blindness or severe visual impairment
A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, lifting or carrying
A learning difficulty
A long-standing psychological or emotional condition
Other, including any long-standing illness
No, I do not have a long-standing condition
No such condition

You have come to the end of the survey. Thank you for taking the time to answer these questions. This questionnaire has been developed in conjunction with the Peninsula Medical School and the National Primary Care Research and Development Centre at the University of Manchester.

Final thoughts: any the wiser, or just better-informed?
That felt quite long, at 47 questions, though blogging while answering bites into the time.

Do I think much will be learned? I am not sure. It was interesting that they didn't include the 'therapeutic rant' box for 'If you have any other comments about your local GP service, please write them here'. A sample of such would run the risk of eliciting some totally 'green ink', but also might throw up some interesting issues. The availability of the 'don;t know / no opinion / can;t remember' options felt random.

I'm not sure I'm a great believer in opinion surveys. They can be constructed to create a climate conducive to the answers you want to get.

Will the responses to this leave the DH much the wiser? I'm reminded of the great reposte by the eminent Victorian advocate Edward Marshall-Hall. Marshall-Hall had just taken the court through a lengthy technical point of detail. The judge responded, "Thank you Mr Marshall-Hall; I am no wiser".

"No, my Lord," Marshall-Hall replied, "but you are better-informed".