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Part 1: Survey results
1 Patient experience of 48 Hour Access
1.1 Introduction
Questions 1, 2 and 3 of the survey measured the ability of patients to obtain a consultation with an appropriate health professional within 2 working days at their GP practice (see the questionnaire in Annex A). The answers provided to these questions were coded into those who had obtained 48 hour access and those who had not. Anyone who had not tried to obtain 48 hour access in the last year was excluded.
The box below provides an outline of how the various responses to Question 1, 2 and 3 were coded for a completed patient questionnaire. There is also a summary of response coding in Annex B. All of the results shown have been derived using this set of rules.
Tried to obtain 48 hour access
If the patient answered "yes" to Q1 then their response was included in the calculation, as the person had tried to gain 48 hour access in the last year.
If the patient answered "no", both "yes" and "no" or missed out Q1, then their response was excluded from the calculation.
For those patients who had tried to obtain 48 hour access:
48 Hour Access was obtained…
If the patient answered "yes" in Q2 to either 'face-to-face' or 'telephone' consultation then 48 hour access was obtained.
Or
If the patient answered "no" to Q2, but went on to answer either "I was offered the chance but the time offered did not suit me" or "I was offered the chance but the person I wanted was not available" for Q3 then 48 hour access was obtained.
48 Hour Access was not obtained…
If the patient answered "no" to Q2 and "I was not offered the chance" for Question 3 then 48 hour access not obtained.
If the patient missed out or ticked more than one box in Q2, or if they answered 'no' to Q2 and any of the following to Q3: "Don't know/can't remember", "other reason", missed out or ticked more than one box, then their response was excluded from the calculation.
1.2 48 Hour Access results for Scotland and NHS Board areas
The survey showed that an estimated 90% of patients in Scotland were able to obtain a consultation with an appropriate health professional within 2 working days. The highest result for an NHS Board was for Orkney, with 99% and the lowest was for Forth Valley with 85%. (Note that these aggregate estimates have been weighted by practice size in order to reflect the population.)
Chart 1: 48 hour access results by NHS Board
The target for NHS Scotland is that 90% of patients should report obtaining 48 hour access by 2010/11. It can be seen that the majority of NHS boards have already met this target.
1.3 48 Hour Access results for GP practices
This section presents the survey results on 48 hour access for GP practices, i.e. based on the coding described in 1.1, the percentage of patients in each practice that obtained 48 hour access. Results for individual practices can be downloaded from the Scottish Government website: http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/GPAccessSurveyResults
The analysis looks at numbers and percentages of practices with results in different ranges, for example how many had over 90% of their patients obtaining 48 hour access. This is presented for Scotland and also by practice size and location.
Chart 2 shows how the practice results are spread - it can be seen that the majority have very high results. The minimum result for a practice was 54% and the maximum was 100%.
Chart 2: Distribution of practice results for 48 hour access
GP practices will receive quality incentive ( QOF) payments if their result is higher than 70%. 20 practices (2%) had a result less than or equal to 70%, therefore 98% of practices will receive some reward for these results. 684 of 1015 practices (67%), had results of 90% or more, that is at least 90% of their patients indicated that they were able to obtain 48 Hour Access. Practices with results of 90% or more will receive the maximum possible payment.
NHS Board area
Table 1 shows the percentage of practices with results in each range, by NHS board. It can be seen that the percentage of practices with more than 90% of patients obtaining 48 hour access ranged from 33% in Fife to 100% in Orkney.
Table 1: Practice results for 48 hour access by NHS Board
NHS Board | Practice result for 48 hour access | Total number of practices
(100%) |
|---|
Over 50%,
up to 60% | Over 60%,
up to 70% | Over 70%,
up to 80% | Over 80%,
up to 90% | Over 90% |
|---|
Ayrshire & Arran | 0% | 3% | 5% | 24% | 68% | 59 |
|---|
Borders | 0% | 0% | 4% | 24% | 72% | 25 |
|---|
Dumfries & Galloway | 0% | 0% | 3% | 11% | 86% | 35 |
|---|
Fife | 0% | 2% | 16% | 49% | 33% | 57 |
|---|
Forth Valley | 4% | 2% | 12% | 32% | 51% | 57 |
|---|
Grampian | 0% | 1% | 12% | 24% | 63% | 83 |
|---|
Greater Glasgow & Clyde | 0% | 2% | 9% | 20% | 69% | 271 |
|---|
Highland | 0% | 0% | 2% | 12% | 86% | 102 |
|---|
Lanarkshire | 0% | 6% | 10% | 35% | 49% | 98 |
|---|
Lothian | 0% | 1% | 11% | 26% | 62% | 124 |
|---|
Orkney | 0% | 0% | 0% | 0% | 100% | 14 |
|---|
Shetland | 0% | 0% | 0% | 10% | 90% | 10 |
|---|
Tayside | 0% | 0% | 0% | 12% | 88% | 68 |
|---|
Western Isles | 0% | 0% | 0% | 8% | 92% | 12 |
|---|
Scotland | 0% | 2% | 8% | 23% | 67% | 1,015 |
|---|
Practice Size
Chart 3 illustrates that, on average, smaller practices had higher results than larger practices. The average result for practices with fewer than 2,500 patients was 97.2%, compared with 87.6% in practices with over 10,000 patients.
Chart 3: Average practice 48 hour access result by practice population
For small practices (with fewer than 2,500 patients), 91% had more than 90% of patients who said they were successfully able to obtain 48 Hour Access. For the smallest practices (fewer than 1,500 patients) the figure was 99% out of 100 practices. This compares with 42% of large practices (with 10,000 or more patients).
Table 2: Practice results for 48 hour access by size of practice
Practice population | Practice result for 48 hour access | Total number of practices
(100%) |
|---|
Over 50%,
up to 60% | Over 60%,
up to 70% | Over 70%,
up to 80% | Over 80%,
up to 90% | Over 90% |
|---|
0 - 2,499 | 0% | 0% | 2% | 7% | 91% | 222 |
|---|
2,500 - 4,999 | 0% | 2% | 5% | 17% | 75% | 305 |
|---|
5,000 - 7,499 | 0% | 3% | 9% | 29% | 58% | 232 |
|---|
7,500 - 9,999 | 1% | 3% | 15% | 35% | 46% | 153 |
|---|
10,000+ | 1% | 0% | 17% | 41% | 42% | 103 |
|---|
Urban rural classification
Practices located in rural areas had on average higher results than those in urban areas. 92% of practices in rural areas had at least 90% of their patients obtaining 48 hour access, compared with 60% of urban practices. (Please refer to Annex C for definitions of urban and rural areas.)
Chart 4: Distribution of 48 hour access results for urban and rural practices
Deprivation
Practices were defined as serving a deprived population if more than half their patients live in a deprived area (in Scotland's 15% most deprived data zones). Of practices serving a deprived population, 71% had 90% or more of their patients obtaining 48 hour access, compared with 67% for "non-deprived" practices.
Table 3 provides a more detailed breakdown of the results by level of patient deprivation within practices. This shows that although the practices with the highest percentages of people living in deprived areas got better results than some of the practices serving more mixed areas, the practices with no patients living in areas of high multiple deprivation achieved the highest results. This may also be related to the fact that there are many smaller, rural practices in this category.
The comparison above between deprived and non-deprived practices is therefore to some extent an artefact of the definition of deprivation (more than 50% of patients living in a deprived area). For example, if 20% was selected as the threshold, then we would have 62% of "deprived" practices with results of over 90% for 48 hour access compared with 69% of "non-deprived" practices.
Table 3: Practice results for 48 hour access by deprivation
Percentage of patients in practice that live in a deprived area 1 | Practice result for 48 hour access | Total number of practices
(100%) |
|---|
Over 50%,
up to 60% | Over 60%,
up to 70% | Over 70%,
up to 80% | Over 80%,
up to 90% | Over 90% |
|---|
0% | 0% | 0% | 2% | 11% | 86% | 203 |
|---|
over 0, up to 10% | 0% | 1% | 8% | 25% | 66% | 355 |
|---|
over 10%, up to 20% | 1% | 3% | 12% | 31% | 53% | 149 |
|---|
over 20%, up to 30% | 0% | 3% | 6% | 34% | 57% | 110 |
|---|
over 30%, up to 40% | 0% | 5% | 17% | 23% | 55% | 60 |
|---|
over 40%, up to 50% | 4% | 6% | 9% | 15% | 67% | 54 |
|---|
over 50% | 0% | 0% | 11% | 18% | 71% | 84 |
|---|
1. Deprived Area is defined as Scotland 15% most deprived data zones SIMD 2006
1.4 48 Hour Access results by respondent characteristics
Results in this section are shown by the characteristics of the patients who responded to the survey, regardless of which GP practice they are registered with.
The results presented are based on the 198,420 responses that were eligible for inclusion in the calculations, as defined in the coding scheme outlined in section 1.1 and Annex B. Figures are un-weighted, i.e. based directly on responses to the survey.
In total, 92% of the survey respondents who had tried to obtain 48 hour access (and whose responses were not excluded by the coding rules) had managed to obtain it.
Gender
93% of 115,035 females reported that they had been able to access GP Services within 48 hours. This compared with 91% of 83,385 males.
Age
The percentage reporting a positive experience of obtaining 48 hour access increased with age. 96% of respondents aged 70 years and above reported that they were able to obtain 48 hour access. This compares with 89% of respondents aged 16-29 years.
Chart 5: Percentage of patients obtaining 48 hour access by age group
Urban Rural Classification
Overall, 96% of 58,949 patients living in rural areas reported that they were able to obtain 48 hour access. This compared with 91% of 139,471 patients for the rest of Scotland. (Please refer to Annex C for definitions of urban and rural areas.)
Chart 6 : Percentage of patients obtaining 48 hour access by urban rural classification
Deprivation
"Deprived areas" are the 15% of data zones in Scotland with the highest level of deprivation, according to the Scottish Index of Multiple Deprivation ( SIMD, 2006). There was no difference in experience of obtaining 48 hour access between respondents who live in a deprived area compared with the rest of Scotland, both with 92% being able to obtain advance access.
In the practice analysis, it was shown that the threshold for definition of a deprived practice, in terms of percentage of the population living in areas of multiple deprivation, influenced the comparison between deprived and other areas. The practices with the lowest results had between 10% and 40% of their patients living in Scotland's most deprived areas. Although the survey has shown no difference in individuals' experiences based on where they live, there may be some impact at the practice level of concentrations of deprivation.
Ethnic group
92% of patients who identified themselves as 'white' reported that they were able to obtain 48 hour access. This compares with 88% for patients who reported their ethnic group as being 'Asian, Asian Scottish or Asian British'. The chart below shows the results for the main categories.
Chart 7: Percentage of patients obtaining 48 hour access by ethnic group
* Asian, Asian Scottish or Asian British
Disability
93% of patients who indicated that their day-to-day activities were limited a lot because of a health problem or disability that has lasted, or was expected to last, at least 12 months had been able to obtain 48 hour access.
Chart 8 shows that 90% of patients who indicated they had a learning difficulty, and 91% of patients who indicated they had a mental health condition were able to obtain 48 hour access. The compares with 92% for those patients indicating they had no health condition, and 94% of those who were blind or with severe visual impairment.
Chart 8: Percentage of patients obtaining 48 hour access by long term condition or disability1
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