Very poor

Poor

Fair

Good

Excellent

0

1

5

23

71

1%

5%

23%

71%

Q2. Are the timings of appointments and clinics, generally convenient to you?

Yes

No

93

7

93%

7%

Q3. What additional hours would you like the Practice to offer for appointments?

Early morning

Lunchtime

Evening

Weekend

None, I am satisfied

2

4

13

33

53

2%

4%

13%

33%

53%

*These percentages do not add up to 100 because more than one choice could be selected.

Q4. Are you satisfied with the range of services provided by the Practice?

Yes

No

96

1

99%

1%

Q5. Are there any services provided by your practice that you would like to be provided differently?

Yes

No

5

91

6%

94%

Q6. In your experience, have you been able to secure a consultation on the day, or the day after contacting the Practice?

Yes

No

90%

10%

Q7. In your experience, have you been able to pre-book an appointment up to 2 weeks ahead, if wished, with any Doctor?

Yes

No

66

14

83%

17%

Q8. In your experience, have you been able to book an appointment with a specified named doctor of your choice within 4 weeks?

Yes

No

70

8

90%

10%

Q9. At present your telephone call is answered in turn, as one of four incoming lines. A change to a queuing system, which would play music would mean that you would start paying for the call whilst waiting in the queue. Would you prefer to continue with the present system?

Yes

77

No

6

A comment was made that this would be very expensive for mobile phone users and so was strongly in favour of continuing with the present system

Q10. When you have telephoned your Practice for an appointment, have you been asked to ring back the following day , before being offered a specific appointment?

Yes

No

19

59

24%

76%

a) Do you have any long- standing illness, disability or infirmity that has lasted, or is likely to last at least 12 months?

Yes

No

Prefer not to say

27

37

4

40%

54%

6%

b) Does this illness or disability limit your activities in any way

Yes

No

Prefer not to say

18

10

4

56%

31%

13%

c) Are there any changes which you think we could make to improve your ability to access our services?

Yes

No

1

31

3%

97%

Sex

Male

Female

32

47

40%

60%

Would you describe yourself as

British

Welsh

English

Prefer not to say

Non - British

21

46

12

1

2
1 Indian
1 Polish

25%

56%

15.5%

1%

2.5%

What is your preferred language?

English

Welsh

60

27

70%

30%

How would you describe your occupation?

Employed

Unemployed

Home responsibilities

Unable to work because of incapacity

At school or student

Retired

43

2

4

6

2

23

54%

2.5%

5%

7.5%

2.5%

28.5%

Discussion re survey technique
After the survey was completed we had a discussion amongst the staff as a learning exercise for the next survey.

The following points were noted

•  Several patients did not realise that there were 3 pages and only answered the first. This improved after PTO was written in at the bottom of each page.

•  Some of the questions were felt to be difficult to understand and so were answered inappropriately. Testing the questions on family or friends should be done next year.

•  One point noted by a couple of patients was that there was no box for self - employed.

•  100 patients represent a very small sample of the practice population (2.5%) but inputting the data from those took quite a while so a larger study would be very time consuming.

•  The survey was added to the website but no responses were obtained from this source. Posting some might have reached a greater cross-section but tight time scales for completion of the DES did not allow sufficient time for completed surveys to be returned.

Analysis  

Q1. What is your overall level of satisfaction with the service provided by the Practice?
To achieve 94% good or excellent overall satisfaction is a figure that is going to be hard to improve on. This reflects the general feedback that we, both receptionists and Doctors, receive from patients in our day to day dealings with them. In particular, we have been highly praised by patients moving into the area who have had poor service elsewhere.

Q2. Are the timings of appointments and clinics, generally convenient to you?
Again it is going to be very hard to improve on an overall satisfaction with timings of appointments of 93%. Changing times to suit the 7% who are not satisfied might then not suit those who were previously happy.

Q3. What additional hours would you like the Practice to offer for appointments?
53% did not want any change as they are satisfied. With the constant mention in the media about how Doctors should offer extra hours has, we feel, swayed public opinion. 33% would like weekend opening but on speaking to some patients they assumed that this would mean that we would be on call for the whole weekend, taking back the work of the Out Of Hours Service. We should have stated in the question “Saturday morning surgery for routine, booked appointments only”. We already run surgery until 6.30 in the evening so presumably the 13% who would like this option mean later than this.

Q4. Are you satisfied with the range of services provided by the Practice?
Only one person answered no and did not clarify it is unknown what else was required.

Q5. Are there any services provided by your practice that you would like to be provided differently?
94% responded that they are happy with the way we provide services.

Comments  

Six of the 20 comments were positive.

•  None, quite happy.

•  Satisfied with services as they are good

•  The service provided is good – no complains at all.

•  All very good.

•  I am quite happy with all the services I receive.

•  Excellent service. Very happy

Other comments were looked at individually

•  Blood samples to be taken at the surgery rather than having to go to hospital.

The phlebotomy sessions at Cardigan hospital are well organised and run smoothly. We feel that our patients receive a good service there. We have --- appointments each week, if our nurses were seeing these patients they would have less time for more complex intervention such as Diabetes, heart disease and asthma clinics If blood tests are urgent, the hospital slots are full or Tuesdays are inconvenient for the patient then our nurses or Health Care assistant will willingly do them.

•  Possible “Well Man clinic”?

Any nurse appointment can be booked for this with the nurse offering a Drs appointment if indicated. One nurse is available until 6pm every Thursday so late appointments after work can be booked for this.

•  Go back to the drop in service – appointments mean delays.

The overall consensus on speaking to patients has been definitively in favour of the new system. If a patient wants to be seen on the day we can offer them an appointment which is surely better than waiting up to 3 hours as with the old system.

•  Out of hours service with own GP.

This is now contracted to the LHB so is not a possibility.

•  The practice always runs late. I have to wait over an hour sometimes when my appointment was earlier.

We definitely do not always run late but it is inevitable on occasions when some consultations have been complex and lasted more than the allocated ten minutes. Also emergencies do occur during the course of a surgery so the Doctor can be called out. Sometimes a hospital Dr needs to speak to the GP urgently about an inpatient and this does delay appointments. The receptionists endeavour to keep patients informed if there is a delay giving them a chance to wait to rebook.

•  I would like for my Dr to be able to provide moderate dental advice/treatment e.g. painkillers, antibiotics etc.

Dental training is additional to Medical training and so it has to be understood that Drs are not trained to manage dental problems. We have produced a leaflet with some general advice about dental problems. This explains why antibiotics are not always appropriate for dental infections and so examination by a dentist is essential. Contact details for emergency treatment are included on this leaflet.

•  Being able to contact my own GP out of surgery hours.

The out of hours service is now run by the LHB and GPs are no longer contracted to do this work. A new system where the out of hours Doctor can access some parts of the patients GP records, with their permission, is to be introduced shortly. This should help to improve the service as the consulting Doctor will have access to the patients' current medication list and medical history.

•  I would like to have a room in my own surgery when I meet my CPN.

We do not have the space to allow other services to use our premises. Since having more nurses and a health care assistant the rooms are busy. They are also used by the Health Visitor and dietician.

•  Professional counsellors.

As above, we do not have the space to accommodate extra services.

Q6. In your experience, have you been able to secure a consultation on the day, or the day after contacting the Practice?

90% of patients answered yes. If patients ask for a specific Doctor then they might have encountered a problem. Having discussed this response with the receptionists they have confirmed that if a patient wants to be seen on the day then they will be given an appointment using as many “emergency” slots as necessary if the surgery is full. If it is an extremely busy day, for example the day after Bank holidays, the patient might be asked if it could wait until the following day.

Q7. In your experience, have you been able to pre-book an appointment up to 2 weeks ahead, if wished, with any Doctor?
83% of patients answered yes. We do not understand this response because reviewing our appointment book there are always free appointments with at least one of the Doctors within two weeks. It might be that we need to improve the way we explain the way the appointment system works. It is clearly explained on the website and in the Practice leaflet.

Q8. In your experience, have you been able to book an appointment with a specified named doctor of your choice within 4 weeks?  

90% responded positively. However we do not pre-book appointments more than 2 weeks ahead so, in retrospect, the question should probably have been phrased differently. The number of DNA's has been proven to increase significantly the further ahead that the appointment is booked. Even with two weeks pre-booking we do find that there are several wasted appointment slots with patients not turning up.

Q9. At present your telephone call is answered in turn, as one of four incoming lines. A change to a queuing system, which would play music, would mean that you would start paying for the call whilst waiting in the queue. Would you prefer to continue with the present system?  

93% would like to continue with the present system. Having discussed the possibility of call waiting systems with the staff, there was a general consensus of opinion that to listen to the same piece of music repeatedly is frustrating especially knowing that you are paying for the call. The receptionists aim to answer the four incoming lines as soon as possible but at peak times it is sometimes difficult. We have tried to reduce the number of calls by asking patients not to phone for repeat prescriptions - this has also improved the accuracy of prescribing. In the near future we should be able to introduce an on-line booking service for appointments but are dependent on release of the software which was promised last year.

We will continue to review staffing levels to ensure that enough are available to provide a good telephone service.  

Q10. When you have telephoned your Practice for an appointment, have you been asked to ring back the following day, before being offered a specific appointment?  

24% answered yes. If there are no pre-booked appointments free for the following day and that is when the patient wants to be seen then they will be told to ring back the following morning after 08.30 to book a “Book on the day” slot. We have not received any complaints about this system.

Q11. Access for the disabled  

a) Do you have any long- standing illness, disability or infirmity that has lasted, or is likely to last at least 12 months?  

40% of those who answered this question considered themselves to be disabled. This reflects the high prevalence of chronic disease that we have in our practice population.

b) Does this illness or disability limit your activities in any way?  

Of those who consider themselves disabled, 56% felt that their activities are limited in some way. This does not provide us with any particularly useful information - perhaps the question should have been more specific to find out what sort of disability they have such as mobility, hearing or visual problems.

c) Are there any changes which you think we could make to improve your ability to access our services?
Only one person answered this and the suggestion was weekend opening.

Being a modern surgery, the access is, in general, adequate for all patients. We are aware of a couple of people with specific problems and our staff all know to offer special arrangements such as using the staff car park. See Access DES on disability for more details.

Conclusions  

Overall satisfaction of 94% excellent or good is very hard to improve on. With 93% of patients surveyed also feeling that appointments are generally convenient to them, we do not feel that we need to make any major changes.

Initial changes planned are

•  to introduce an appointment system for the child health clinic.

•  on certain days the afternoon surgery will start later giving a few appointment slots after school.

•  one Dr will start their pre-booked surgery at 9.00 to give a few earlier appointments than at present.

•  priority for evening appointments will try to be given to those who are working.

•  a news letter will be distributed to patients explaining the changes, reinforcing how the appointment system works and a comment about the telephone system.

We will continue to listen to patients' comments and suggested either verbally, via email through the Practice website or via the suggestion box in the waiting room.

We are still waiting for details of next years Welsh access enhanced service so cannot look at opening for additional hours until we know the terms and conditions.