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Patient questionnaires: in the contract
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Under the new community pharmacy
contract, all pharmacies will have to
carry out a patient satisfaction survey. The survey will form one of
the clinical governance requirements. Clinical governance is an essential
service in the new contract and it is covered in this week’s Contract
2005 (p519).
Clinical governance is something that all health professionals are having
to get to grips with. Patient satisfaction surveys are not just a requirement
for community pharmacy; GPs faced the same demand in their new contract,
implemented in April this year. Many GPs have chosen to use the services
of a specialist organisation for this function.
The Department of Health has accredited two organisations’ questionnaires
for the job. One is the “Improving practice questionnaire” produced
by the Client-Focused Evaluations Programme, based at the University
of Exeter (further information at www.cfep.net). Its executive director,
Michael Greco, is currently talking to the DoH about the possibility
of offering a similar service for pharmacists. The other is the General
Practice Assessment Questionnaire developed by the National Primary Care
Research and Development Centre in Manchester.
The CFEP already has experience of pharmacy-based patient satisfaction
questionnaires. At the request of the Healthcare Commission, it designed
a pharmacy questionnaire. At the same time, primary care trusts that
had been using the organisation’s GP questionnaire started requesting
something similar for pharmacies.
The result is an “Improving practice questionnaire” for pharmacy
consisting of 27 questions about the pharmacy, the pharmacist and the
services the pharmacy provides. So far, it has been used at 25 pharmacies
across six PCTs in England and 28 pharmacies in eight local health groups
in Wales. A total of 936 questionnaires have been analysed, equating
to about 25 forms per pharmacy.
Questionnaire results
The headline result from the 936 questionnaires is that patients are
positive about pharmacists, but less positive about pharmacy premises. “What
it comes down to is that
patients like the product — the pharmacist — but it is getting
to it and its surroundings that needs tinkering with,” says Dr
Greco.
“The lowest scoring items were about
access to the pharmacy, availability of privacy, and the comfort and
surroundings in the pharmacy,” he explains. Patient comments about
access included: “Should be open from early morning until 10pm”, “Make
the door easier to use” and “Improve parking facilities”.
Regarding privacy, patients said: “Address the lack of privacy
for consultation”, “Consultation area needs to be a little
more private” and “Information on the availability of privacy
should be made known to patients”. A number of patients wanted
more chairs in the pharmacy — “Provide three to four seats
for customers getting prescriptions who do not feel well” — and
some wanted the pharmacy to be bigger.
Dr Greco comments that issues around seating and privacy could probably
be addressed relatively easily. “If pharmacists explain to patients
where they can talk privately it would help,” he suggests.
Another area in which pharmacies scored relatively poorly was in providing
information about preventing disease and public health. “Waiting
times were a bit of an issue too. But it was more about people wanting
to know how long they had to wait rather than the wait itself,” he
adds.
On the positive side, patients rated pharmacists highly. The highest
scoring question was about the respect patients felt pharmacists showed
them. This was followed by patients’ confidence in pharmacists’ knowledge,
overall satisfaction and trust in the pharmacist. “All these areas
were rated at over 90 per cent compared with 60 to 70 per cent for the
lower scoring questions,” says Dr Greco. Scoring was based on a
percentage of excellence, so for a score of 100 per cent all patients
would have rated the pharmacy as excellent.
Patient comments included: “The pharmacist and his assistant are
always hospitable, willing to help and very approachable”, “I
have always received excellent services and this has involved some very
serious illnesses” and “An asset to the community”.
When CFEP analyses a pharmacy’s patient questionnaires, it not
only provides the results but also benchmarks them against other pharmacies. “This
allows pharmacists to compare how they are doing with other pharmacies,” says
Dr Greco. At the moment, the benchmark is the average of all the other
pharmacies that have taken part but he plans to provide more precise
benchmarking in future with categories such as similar-sized pharmacies
or pharmacies in one geographical area.
The CFEP also plans to provide workshops to allow pharmacists to explore
how they can act on the questionnaire results. The workshops will cover
how to bring a small group of patient together to help advise the pharmacy
on taking the results forward and how to think about clinical governance
plans. What happens next
“Seeking patients’ views is an essential service in the
new pharmacy contract and our survey could be a model for [all] pharmacists,” says
Dr Greco. He adds that the CFEP has been commissioned to carry out surveys
by nearly 5,000 GP practices in over 200 PCTs. “We could do the
same for pharmacists. The DoH is currently looking at this and I would
recommend that a choice of questionnaires is made available as it has
been for GPs.”
Dr Greco comments that one of the reasons the CFEP approach has been
popular with GPs is that it is an independent organisation, based at
the Innovations Centre, University of Exeter, and not part of the NHS. “GPs
feel confident that our results are confidential. We do not have to release
the
results to anyone else,” he says.
The question is how much would it cost? Dr Greco says it would be quite
cheap. “For a one-pharmacist pharmacy it would be around about £100.
The cost would be increased for more than one pharmacist but it would
not get above £200 for pharmacy-level results,” he explains.
“Pharmacists have done this type of work before on an ad hoc basis.
This is about doing it systematically, providing a benchmark and helping
the
pharmacy to move forward,” says Dr Greco. “Although pharmacists
are used to getting customer feedback it is usually complaints-driven,
not a systematic approach.”
Perhaps it is worth noting that in the surveys carried out so far, patients
said that they had little opportunity to make complaints or comments
about pharmacies. If pharmacy is to move forward to a new quality-based
contract, finding out what patients think about and want from pharmacy
will be key. Carrying out a patient satisfaction survey and having a
complaints procedure are both essential services in the new contract.
But it is not just about carrying out these functions because the contract
dictates it, it is about gaining information from them and using it to
improve the quality of services. |
The
Pharmaceutical Journal