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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.
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. Practices should submit a statement to this effect. (Grade A)
For other practices, claiming against this indicator, 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 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, encourages and incentivises practices to improve quick and convenient access to appointments with GPs and/or health professionals for their patients. Achievement of the indicator is dependent on the results of the national survey in each UK country. The arrangements for these differ in each country and further information is available below.
Achievement of the indicator is measured through the national patient experience survey titled the GP patient survey. The survey is conducted by a third party polling expert, Ipsos MORI, on behalf of the Department of Health. Ipsos MORI administer the GP patient survey to contractor’s registered patients’ and results are collated for each contractor.
The survey is administered each quarter through out the financial year. The assessment of achievement of the indicator is based on annual results. This is determined by aggregating the results data (numerators and denominators) for the questions relating to the indicator from each of the four quarterly surveys undertaken during the financial year.
Practices will want to encourage patients to respond to the survey by displaying the relevant communication materials provided by the Department of Health/Ipsos MORI. 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 precise arrangements are published on the GP patient survey pages of the Department of Health website:
www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/GPpatient survey2007/index.htm
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, encourages and incentivises practices to improve quick and convenient access to appointments with GPs and/or health professionals for their patients. Achievement of the indicator is dependent on the results of the national survey in each UK country. The arrangements for these differ in each country and further information is available below.
Achievement of the indicator is measured through the national patient experience survey titled the GP patient survey. The survey is conducted by a third party polling expert, Ipsos MORI, on behalf of the Department of Health. Ipsos MORI administer the GP patient survey to contractor’s registered patients’ and results are collated for each contractor.
The survey is administered each quarter through out the financial year. The assessment of achievement of the indicator is based on annual results. This is determined by aggregating the results data (numerators and denominators) for the questions relating to the indicator from each of the four quarterly surveys undertaken during the financial year.
Practices will want to encourage patients to respond to the survey by displaying the relevant communication materials provided by the Department of Health/Ipsos MORI. 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 be a short report from the PCT. 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 precise arrangements are published on the GP patient survey pages of the Department of Health website:
www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/GPpatient survey2007/index.htm
Prepared By Jean Keenan