Case Studies

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Surrey Heartlands Integrated Care System and East Surrey Clinical Commissioning Group (CCG)

Background

Following the presentation of the 2018 GP Patient Survey data received at the NHS England sustainability and transformation partnership (STP) away day (March 2019) it was agreed that the new data presented a compelling evidence base for carer commissioners to review current provision for both young and young adult carers.

Action

  • - The slides from the presentation have been shared to update Surrey Carers and Young Carers Joint Strategic Needs Assessment (JSNA). This is a process by which local authorities and CCGs assess current and future health, care and wellbeing needs of the local community to inform local commissioning.

  • - Commissioners held a discussion of the results at a recent Surrey Carers Commissioning Group. This is likely to reflect in the refresh of both our Surrey Adult Carers and Surrey Young Carers Strategies.

  • - It is hoped that the data can be used to help populate our carers tableaux (Hackathon) to provide a more detailed analysis at both GP practice and Primary Care Network (PCN) level.

  • - To help improve identification of young and young adult carers Surrey has a focus on increased GP young carers registration. To this purpose we are working with the Surrey Yong Carers Forum to launch a new ‘Child’ friendly GP Young Carers Registration Form.

  • - We are working with the School Nursing Service and The Dioceses of Guildford to run a pilot for school nurses to register young carers using read code 918h identified in Church of England schools directly on to their electronic patient records system.

  • - We will be adapting all our GP Carer training materials to include the data.

Outcome

This is all work in progress. Commissioners felt the evidence provided a strong evidence base to improve provision for the identification and support of young and young adult carers across our system.


NHS Gloucestershire Clinical Commissioning Group

Background

As a CCG, the GP Patient Survey (GPPS) data is reviewed to monitor performance of practices within our area to help make commissioning decisions. The Gloucestershire Patient Participation Group (PPG) Network was established to provide a regular forum for PPGs to come together to receive information, to share learning and to network, all with the purpose of improving patients’ experience of primary medical services in Gloucestershire. The network is made up of 75 GP practices.

Action

For the past two years, since the PPG Network was established, members have received an annual presentation on the GPPS. The first year’s presentation, made by the CCG’s lead for engagement and experience, focussed on the CCG’s overall performance and encouragement for PPGs to go back to their individual practices to discuss their local results with the practice team to identify areas for improvement focus.

The second year’s presentation, made by members of the NHS national GPPS team, again looked at the CCG’s overall results, but also provided a live demonstration of the GPPS analytical tool. The presentation focussed in particular on the changes to GPPS in 2018 and the rationale for the changes. PPG members were encouraged to take part in a lively Q&A session and provide feedback to the national team about potential improvements to the GPPS next year.

Outcome

The network has been a great way for the CCG to engage PPGs in using survey data. PPGs took away an increased understanding of how to best use the survey data, as well as about the running of the survey. The national team received constructive and practical feedback from the PPGs, which will be used to inform future developments of the GPPS. For example, suggesting ways the GPPS practice comparison tool could be improved to make it more helpful to PPGs.

University of Exeter Collaboration for Academic Primary Care (APEx)

Background

Do difficulties in accessing in-hours primary care predict higher use of out-of-hours GP services? Evidence from an English National Patient Survey.

Some patients are more likely to use out-of-hours primary care services because of difficulties in accessing in-hours care. This study aimed to review whether evidence supports this.

Action

We analysed data from 567,049 respondents to the 2011/2012 English General Practice Patient Survey who reported at least one in-hours primary care consultation in the preceding 6 months. Of those respondents, 7% also reported using out-of-hours primary care.

Outcome

Out of hours visits are more commonly reported in practices where patients also report more difficulty in getting appointments during normal working hours. The convenience of opening hours was the strongest single predictor of use of out of hours care. However, this relationship was strongest for people not in work, suggesting that it may be more important to improve access during normal hours than to provide extended opening hours in GP practices.

You can see further information about this research including the full citation here.

Gloucestershire PPG (Patient Participation Group)

Background

When looking at the results of the GP Patient Survey I noticed that only 4% of our patients had a copy of their treatment plan even though 75% of patients said they had an agreed plan and 71% of patients felt it was helpful. This was in contrast to our sister surgery where 43% of patients said they had a copy of their plan.

Action

We decided to add this to the Action Plan for this year, recommending that the surgery adopt the procedure that the sister surgery uses to make sure that all patients have a copy of their treatment plan, and that the PPG would support this.

Outcome

If I hadn’t noticed this in the practice’s survey results it would never have been known that patients weren’t being given copies of their treatment plans. The PPG had never had any feedback on this, probably because most patients don’t know that they can have a copy of their treatment plans. It was solely because of the GP Patient Survey that the PPG found out about this and was able to recommend to the practice that they change how they communicate the treatment plans with their patients.

NHS England – Older people workstream ‘Ageing Well’

Background

Frailty is a long-term health condition which is a priority for the NHS, due to the associated increased risks of acute hospital admission, care home admission and death. While typically associated with ageing, not all older people are frail, and not all frail people are old. Twenty percent of people aged 90 and over are estimated to be fit and ageing normally. This is important because as the population ages, most people are living longer with the older population growing at about three percent annually. However, healthy life expectancy (the number of years lived in good health) has not kept pace and is now only 63 years for males and 64 years for females. This generates a need for increased focus on ensuring that people are encouraged and supported to age well. The NHS Long Term Plan sets out world-leading new ambitions for population health management of frailty including systematic and timely identification of people living with frailty and helping people to live in their communities with proactive, targeted, co-ordinated and person-centred care.

To do this well we need to understand how people living with frailty are experiencing services now and to measure experiences as services are developed and policy is implemented.

Action

The data available in the GP Patient Survey is used as a proxy measure of frailty (classed in the survey as respondents self-reporting two out of three of the following: i. difficulties with physical mobility, ii. two or more falls, iii. feeling isolated from others). This provides important information for the older people workstream on prevalence of frailty, providing key population statistics. Importantly it has been used to highlight national geographical variation in prevalence of frailty and associations with deprivation and age (both older populations and also some younger people).

This data has been used in presentations and on social media to highlight areas of inequality, for example, the data shows the north of England, midlands, south west peninsula, south east coast, urban areas and deprived areas have a greater proportion of people living with frailty. It has also provided evidence that many young people also live with a cluster of problems associated with frailty.

Increasing awareness of the issues for people living with frailty and their experiences of care is essential for planning and making service changes. It is crucial that, as a programme of work, patient experience is built into measuring the impact of changes that will be made implementing the Long Term Plan.

Outcome

The data will continue to be used to highlight experiences of people living with frailty. NHS England will continue to develop plans for proactive services which support people at risk of and living with frailty. At the same time they will look at ways to embed patient experience data into system metrics and commissioning tools such as Rightcare, to ensure that changes are improving people’s experiences of services and are meeting their needs.


NHS England

Background

Public satisfaction with general practice remains high, but in recent years patients have increasingly reported, through the GP Patient Survey, more difficulty in accessing services including a decline in good overall experience of making an appointment in general practice. In 2016/17, 11%, (1 in 10) reported not being able to get appointment and the likelihood of getting a convenient appointment was lower if you are in work or young.

Action

NHS England introduced the Prime Ministers Challenge Fund, later the GP Access Fund, to test out new ways to improve access to general practice, including offering evening and weekend appointments and other more innovative ways to access services. 57 schemes across England piloted new ways of working during 14/15 and 15/16 and implementing improved access to general practice subsequently became a requirement for all CCGs in the NHS Operational Planning and Contracting Guidance 2017-19 and refreshed planning guidance issued in February 2018.

Outcome

Everyone across the country now has more timely and convenient access to general practice services, including in the evenings and weekends. CCGs are now focused on ensuring that the new services are advertised to patients and integrated with services such as NHS111 and urgent care. For more information about this programme please go to: www.england.nhs.uk/improving-access


Nuffield Trust/NHS England

Background

In 2018, NHS England commissioned the Nuffield Trust to conduct a project to investigate the impact of improved access upon continuity of care.

Action

Nuffield Trust conducted analysis of data from the GP Patient Survey along with a rapid literature review, interviews with providers and commissioners, site visits to services seeking to combine access and continuity, meetings with clinicians, managers, academics and policy-makers.

Outcome

A report “Improving access and continuity in general practice” including an evidence review and summary have been produced with findings and recommendations for commissioners and policy makers. The report sets out a number of strategies that can be adopted to promote continuity of care, while improving access. You can find the full report here.


NHS England

Background

Ensuring everyone can access services on an equal footing is a key priority for the NHS. One of the seven core requirements for implementing improved access, as set out in the NHS Operational Planning and Contracting Guidance 2017-19, is to address issues of inequalities in patients’ experience of accessing general practice, identified by local evidence including GPPS data, and put actions in place to resolve this.

Action

To support commissioners and providers of general practice services to address inequalities, NHS England has produced a practical resource – Improving Access for all: reducing inequalities in access to general practice services – which aims to promote understanding of groups in the community who are experiencing barriers in accessing services and help to address those barriers as improvements in access to general practice services are implemented. The narrative uses evidence from GPPS data and provides links to case studies and resources to support CCGs in addressing inequalities in access to general practice.

Outcome

The resource is available for providers and commissioners to support them conducting equality and health impact assessments locally and develop an action plan to address inequalities. An animation is available here to support use of the resource.


Wessex Local Medical Committees (LMC)

Background

Wessex LMCs run a series of training sessions for GP practice managers. One session is called ‘How are we doing?’ and looks to support practice managers in benchmarking, interpreting and understanding performance data about their practice and also how others, such as commissioners and the public, view and use this data.

Many practice managers can find the sheer volume of data available overwhelming and are not sure where or how to start. Others are looking for the session to update them on the sources available and how to use them in context.

This session includes a section on the use of patient data and in particular the GPPS.

Action

With regards to GPPS, the website was shared with the delegates and three examples of results from the GPPS were viewed (print offs of anonymised practices) and the delegates were asked to review the data and make judgements on what the information told them about each practice. This was then discussed as a group.

The pros, cons and limitations of the data set were discussed and how this information can be put into context with other datasets. In particular, using the patient survey as a tool to identify issues (such as difficulties getting through on the telephone or access to a GP) and using it as evidence for a need to change in the development of business cases.

The discussions also included how commissioners and the public use this data to benchmark the practice against others.

Outcome

The practice managers taking part became more aware of the content of the GPPS and how the data could be used for positive change. They became more aware of the limitations of the data and how others view it.

Have you used GP Patient Survey data?

We would love to hear from you. Email the Ipsos MORI GP Patient Survey team on the email below to share.

GPPatientSurvey@ipsos.com