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The length of routine booked appointments with the doctors in the practice is not less than ten 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 eight minutes.
Practices that routinely operate a mixed economy of booked and open surgeries should report on both criteria.
The contract includes an incentive for practices to provide longer consultations. This has been included as a proxy for many of the things that are crucial parts of general practice, yet cannot easily be measured e.g. listening to patients, taking time, involving patients in decisions, explaining treatments, in addition to providing high quality care for the many conditions not specifically included in the QOF.
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.
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 six 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.
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 separate 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.
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. (Grade A)
If the practice operates 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.
The assessors may need to look at a number of sample days to confirm that 75 per cent 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.
The practice will have undertaken an approved patient survey each year.
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). It is possible 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. GPAQ is available with full instructions at www.gpaq.info
IPQ is available at www.cfep.co.uk/products_ipq_desc.html
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.
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.
The number of points allocated to this indicator has been decreased in recognition of the need to move towards the practice team actively addressing issues raised from a patient perspective.
A minimum of 25 completed questionnaires per 1000 Contractor Registered Population should be obtained in the survey. In order to obtain this return, practices may need to administer a considerably higher number.
Practices should provide evidence that the survey has been undertaken including the date and methodology. (Grade A)
The practice will have undertaken an approved patient survey each year and, having reflected on the results, will produce an action plan that:
1. sets priorities for the next two years
2. describes how the practice will report the findings to patients (for example, posters in the practice, a meeting with a patient practice group or a PCO approved patient representative)
3. describes the plans for achieving the priorities, including indicating the lead person in the practice
4. considers the case for collecting additional information on patient experience, for example through surveys of patients with specific illnesses, or consultation with a patient group.
Practices should have undertaken a recommended patient survey (see PE 2) and have discussed it as a team. The practice action plan will be informed by the analysis of the results of the survey. The action plan will report on activities the practice has chosen to undertake to address the patient issues raised by the survey results and will set priorities as above. A lead person for patient experience should be identified in each practice.
Some proposals for change may have resource consequences which need to be discussed with the PCO.
Subsequently the team should share the contents of the action plan with the most appropriate person or persons which may be a PCO approved patient representative. If the practice has a patient participation group then this group may be used.
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 e.g. mothers with young children, the elderly, patients whose first language is not English, patients with mental health problems etc, with which to share the results of the surveys and action plan.
Practices should submit a copy of their action plan, with evidence that some change has been achieved e.g. through patient report or by demonstrating a positive change in the patient survey. (Grade A)
The percentage of patients who, in the appropriate national survey, indicate that they were able to obtain a consultation with a GP (in England) or appropriate health care professional (in Scotland, Wales and NI) within 2 working days (in Wales this will be within 24 hours).
This indicator, alongside PE 8, is designed to encourage and incentivise practices to continue to improve quick and convenient access to consultations with GPs and/or health professionals for their patients. Achievement of this indicator will be dependent upon the results of the appropriate national survey as defined by each UK country. The arrangements for this are likely to differ in each of the four UK countries and separate guidance will be available as appropriate to support practices. Further information on the national survey for England is available below. Guidance for Scotland, NI and Wales will be available in due course when finalised.
Practices should note that the national surveys are in addition to the practice survey in PE 2.
This indicator reflects the previous 48-hour access target which featured in the Improved Access Directed Enhanced Services and which was subject to measurement through the national patient experience survey titled the GP patient survey. The same applies for PE 8.1 but relating to the advance booking of appointments.
Achievement of this indicator will continue to be measured through the national patient experience survey and a new GP patient survey is being established in 2008/09. The survey will continue to be conducted by a third party polling expert on behalf of the Department of Health The third party will administer the survey to registered patients and results will be collated for all GP practices.
Practices will want to encourage patients to respond to the survey by displaying the relevant communication materials when invited by the Department of Health/third party provider. Some patients may not want to take part in the survey and practices will need to facilitate such requests in accordance with notified arrangements for patient opt outs.
A sliding scale will apply to payments between 70% and 90% in the same fashion as other thresholds in the clinical domain. Exception reporting does not apply.
The results should be discussed and ways of improving patients’ experience of access in the future. The Improvement Foundation provides a general source of advice to practices and PCTs over improving patient access. www.improvementfoundation.org
It may be useful to note if patient participation is encouraged by display of the appropriate communication materials.
The appropriate national survey adopted in each UK country will deliver results to inform practices of their levels of achievement. The precise arrangements will vary in each UK country and again this will be notified in separate guidance.
(In England, this will initially be via a short report from the PCT. In the first year practices in England will not be required to enter their achievement values from this report on QMAS. PCTs will do this on practices behalf. This is because reports will not be available until following the last day of the financial year and PCTs will therefore need to use the adjustment facility to ensure correct achievement payments are made to practices).
The percentage of patients who, in the appropriate national survey, indicate that they were able to book an appointment with a GP more than 2 days ahead.
This indicator, alongside PE 7, is designed to encourage and incentivise practices to continue to improve quick and convenient access to GP consultations for their patients. Achievement of this indicator will be dependent upon the results of the appropriate national survey as defined by each UK country. The arrangements for this are likely to differ in each of the four UK countries and separate guidance will be available as appropriate to support practices. Further information on the national survey for England is available below. Guidance for Scotland, NI and Wales will be available in due course when finalised.
Practices should note that the national surveys are in addition to the practice survey in PE 2.
This indicator reflects the previous access target for advance booking of appointments which featured in the Improved Access Directed Enhanced Services and which were subject to measurement through the national patient experience survey titled the GP patient survey.
Achievement of this indicator will continue to be measured through the national patient experience survey and a new GP patient survey is being established in 2008/09. The survey will continue to be conducted by a third party polling expert on behalf of the Department of Health. The third party will administer the survey to registered patients and results will be collated for all GP practices.
Practices will want to encourage patients to respond to the survey by displaying the relevant communication materials when invited by the Department of Health/third party provider. Some patients may not want to take part in the survey and practices will need to facilitate such requests in accordance with notified arrangements for patient opt outs.
A sliding scale will apply to payments between 60% and 90%, in the same fashion as other thresholds in the clinical domain. Exception reporting does not apply.
The results should be discussed and ways of improving patients’ experience of access in the future. The Improvement Foundation provides a general source of advice to practices and PCTs over improving patient access. www.improvementfoundation.org
It may be useful to note if patient participation is encouraged by display of the appropriate communication materials.
The appropriate national survey adopted in each UK country will deliver results to inform practices of their levels of achievement. The precise arrangements will vary in each UK country and again this will be notified in separate guidance.
(In England, this will initially be via a short report from the PCT. In the first year practices in England will not be required to enter their achievement values from this report on QMAS. PCTs will do this on practices behalf. This is because reports will not be available until following the last day of the financial year and PCTs will therefore need to use the adjustment facility to ensure correct achievement payments are made to practices).
Prepared By Jean Keenan