W HAT DO THE P ATIENTS W ANT ? Jacqueline Swan John Russell Susan Dovey

GP R ESEARCH R EGISTRAR RNZCGP Research Registrar Programme Mix of clinical and research work, plus academic study Alternative pathway to fellowship Sponsored by Comprehensive Care Ltd, Auckland Mentorship Susan Dovey

B ACKGROUND “Better, Sooner, More Convenient” Any changes to existing models of care should have patient participation and be responsive to what patients want

O BJECTIVES How do patients view current primary care services? What changes do patients want to improve those services?

M ETHODS Mixed Methods Focus Groups to inform questionnaire development GPs, nurses, Practice Managers, patients Survey of Patients Random selection of PHO patients, stratified by ethnicity NSH ECC, patients presenting without a GP referral Ethics approval

R ESULTS 485 responses 380 PHO patients (19.3%) 105 ECC patients (83%) Respondents were more likely to be female (63%), European (48%) and older in age

M AJOR C ONCLUSIONS AND R ECOMMENDATIONS

Patient’s presentation to the emergency department is more around the seriousness of the condition than poor access to GP services, although for one in five patients access and cost is a factor

W HAT INFLUENCED YOU TO COME TO THE ED TODAY ? 66% considered medical condition to be serious 50% did not think their medical condition could be managed by the GP 20% could not get an appt with their GP 22% could not afford to see the GP 17% GP was closed

Patients are satisfied with their general practice

A LL THINGS CONSIDERED, HOW SATISFIED ARE YOU WITH YOUR OWN GP CLINIC ?

The majority of patients feel cost is about right and not a barrier to them seeking GP services, although when asked about improving services lower cost is the top choice.

F OR THE SERVICE I RECEIVE I BELIEVE THE COST IS

Present costs are a barrier to my seeking general practitioner services True 36%False 64%

R ECOMMENDATION Efforts regarding subsidies should be concentrated towards those most deprived

Patients want secure internet access to their medical information and information on reliable medical internet sites, particularly those less than 50 years of age

R ECOMMENDATIONS The PHO and its practices should consider the use of a patient portal system The PHO and its practices should consider links via their websites to reliable medical internet sites for patient’s reference

Patients want longer appointments as an option when booking but not as routine

I WOULD LIKE LONGER APPOINTMENT TIMES 50% yes, as an option when I book 8% yes, as routine Rest no / neutral 91% of those who wanted longer appointments didn’t want to pay for them!

R ECOMMENDATION Practices should continue to offer longer appointments as an option, but alert patients that this will incur an additional cost

Relationship and choice of doctor are more important to patients than facilities or speed of access

P LEASE INDICATE WHICH IS OF MORE IMPORTANCE TO YOU 86% relationship with my doctor more important than practice facilities 53% choice of doctor more important than the speed at which they can get an appointment

While most patients agree it is important to know about quality standards and qualifications, only 9% have heard of cornerstone and 43% of FRNZCGP

9% of patients had heard of Cornerstone Of those, 59% indicated understanding 43% of patients had heard of FRNZCGP Of those, 72% indicated understanding

R ECOMMENDATION Practices, PHOs and the Royal New Zealand College of General Practitioners should embrace, educate patients and promote Cornerstone and Fellowship

Most patients would be happy to see the nurse for more minor conditions and for separate consultations

R ECOMMENDATION Looking into the future, changes to care models should make use of nursing consultations and should be careful not to erode the relationship factor of General Practice, this needs to be considered ahead of co-location and facilities

Patients would like a drop in clinic and weekend clinic times, however access seems satisfactory, with 67% of patients agreeing or strongly agreeing that they can easily get an appointment at their clinic within 24 hours.

R ECOMMENDATION Practices should offer some weekend and evening clinic times, and consider the use of drop-in clinics

For the majority of services additional to the GP clinic, location is not deemed important. However, over half of all respondents would like the chemist to be within a five minute walk or closer, and approximately 40% of respondents would like laboratory and x-ray services within a five minute walk or closer.

R ECOMMENDATION When considering location, practices should be close in proximity to laboratory, x-ray and pharmacy services

T HANK - YOU