4. Patient feedback

NASGP AppraisalAidYou must undertake a patient feedback survey once in every 5-year revalidation cycle, usually needing to collect at least 34 responses.

Which questionnaire to use

Neither the GMC or RCGP now specify which questionnaire to use. Many questionnaires are provided by the various toolkit providers and locum chambers.

The GMC has developed their own questionnaire and instructions on how to administer it. Whilst these instructions are specific to their own survey, there are key features that all questionnaire providers have to note:

  • Questionnaires should be based on GMC principles of Good Medical Practice, follow GMC principles of good questionnaire design and have been piloted and validated.
  • They should be completed anonymously by consecutive patients from the full scope of your work. For locums, this may mean carrying out your survey in different practices and clinical settings.
  • The response should be handled and collated independently of the doctor, appraiser or RMO.

The RCGP suggest checking with your Responsible Officer (RO) whether they recommend any specific feedback questionnaires. Given the key role of your appraiser and RO in your revalidation, it might make your life easier to use a tool that is not too alien. However, if you have used a questionnaire that has been designed and administered in accordance with GMC guidance, then you should be able to justify your choice.

Tips for a smooth patient feedback survey

Engage with the practice staff

  • You are going to need some level of cooperation from the practice staff in distributing your patient questionnaires and collecting completed responses.
  • Make it part of your Terms and Conditions that practices offer you the same support as a fellow healthcare professional that they would give to their own practice team.
  • Consider politely forewarning the practice manager that you are carrying out a survey and seek their advice on how this would work best in their practice.
  • Arrive early for your “survey” sessions. Check that the staff on duty understand the survey process. Lots of charm, gratitude and perhaps making a cup of tea might help!

Make it easier for the patient to complete the survey

  • Willing patients may be deterred from completing the survey if they have no pen, nowhere to sit and then have to join a queue at reception to hand it in. Likewise, if they take the survey away to post themselves, you may see a drop in response rate.
  • Overcome these obstacles by investing in some clipboards with pens attached; ask the practice staff if a chair can be placed in a quiet corner; make a clearly labelled postbox for completed responses which can be placed in reception.
  • Wear a professional name badge, use removable doorplates with your name on and even carry mini patient-friendly personal profiles to hand out to patients so they can identify you when giving feedback.
  • Some locum chambers have developed their own GMC-approved patient feedback, and have invested in several plastic post boxes, pens and clipboards to share amongst them, and there’s no reason why other groups couldn’t do the same.

Pitfalls in interpreting patient feedback for locums

The GMC feedback surveys were piloted and researched by Professor John Campbell of Peninsular college of medicine in 2012. Appraisers should be familiar with his guidance on interpreting feedback surveys. Some of the key findings that pertain to locums:

  • Locums tend to receive less favourable feedback than doctors in permanent positions.
  • Doctors who obtained their primary medical degree in a non-European country tend to receive less favourable feedback than those who qualified within Europe.
  • Beware benchmarking. Interestingly the GMC does not currently see comparison with other colleagues as an essential feature of the feedback process. Nonetheless, many survey providers do include benchmarking but it is very rarely locum-specific. So for your own sanity and in preparation for your appraisal, it is good to be aware of the rating bias against locums.

The NASGP, with our experience of locum work, think that below the surface of these GMC findings there are probably many granular factors at play which affect how locums are perceived. Read on for some examples which could serve as reminders and talking points with your appraiser when reflecting on your feedback. Unless your appraiser is also a locum, they may not fully appreciate the context in which you work, so be ready to tell them!

Patient variables

Your session was booked weeks ago.

  • So you’re expected at least. The absent GP will be on holiday, educational or maternity leave, so likely to be at least a well run practice. Indeed, if it’s to cover an appraiser, educational lead or for educational events this suggests it may be an above average practice.
  • Patients may be generally healthier, so will present with less ‘pathology’ and because of good contemporaneous notes you will be less stressed and will get better feedback…
  • Oh…but remember too that they’ll have much higher expectations, and likely that there will be more worried well – so be prepared for some critical comments too.
  • If the practice doesn’t often use locums, be prepared to see more than your usual dose of chronic and untreatable conditions, and probably every heartsink in the district. The longer you stay, the faster word will get round that there’s a new GP in town. Drug addicts usually come out when you’ve been there over 3 days, with heartsinks after a week.
  • Feedback will be affected either way. Some will see you as their second opinion, valuing your different approach to their problems. You don’t necessarily have to do anything differently, but just offering a different opinion, reinforcing previous advice, or simply speaking in a different tone can all have a new effect on your patient. But similarly, having had high expectations of you as their fresh new GP who may not have heard it all before, their hopes of a different therapy or a radical cure, may be dashed.

Booked within the last 24 hours?

  • It’s unlikely that your patients will have been told that they’re seeing ‘just a locum’ before they arrive at the surgery. Obviously this may delight them, but equally they could be very disappointed.
  • They may have waited weeks to see their usual GP – and now they’re seeing you. If the receptionist isn’t up to speed, and you’re presented as ‘the locum’, they may not even know that you’re a GP.
  • In these days of electronic check-in, the first they know that it’s not their GP will be as they enter the room which can lead to an uphill battle to establish rapport....

Practice variables that may affect how a GP locum is perceived

  • What sort of practice are you locuming in, and what is the reason? Sometimes a practice may require your services because all is not well within the practice.
  • Practice unable to recruit a partner or salaried GP?  Perhaps there’s a good reason they can’t find a suitable candidate.
  • Usual GP off sick – was it stress related due to the practice, and were they practicing at their best prior to their absence?
  • Holiday – usually a good sign, showing that the practice plans their GP cover. But if the patients have worked out that their usual GP is off for a few weeks, they may be turning up in force for a second opinion, or for an easier ride. You may be that ticket to that referral they’re desperate for, or a new GP to hoodwink into prescribing the medication that their usual GP refuses to prescribe. You may have to dash their expectations, and that never goes down well in a feedback form.
  • Last-minute ‘desperate’ booking? Practices who have to call in a locum last-minute are usually running at peak capacity anyway, with little or no slack in the system. Why have they been unable to organise some internal cover if it’s that important? Is there a wider organisational issue that suggests other more fundamental issues in that practice? ‘Siege Mentality’ is the scourge of many a practice, and bodes ill for a smooth surgery.
  • Maternity cover. This sounds straight forward, but realise that the normal incumbent’s usual clientele are devotees of the absent female GP and may be disappointed by middle-aged male GPs! And for some reason, maternity locums are often subject to mission creep.
  • Suspended GP. This speaks for itself; if a practice has reached the point where one of its usual GPs – and this could of course include a previous locum – is suspended from work, that practice is likely to have major ongoing issues for some time whether they recognise them or not.
  • Practice rarely use a locum? These can vary – either you’ll have the red carpet treatment and treat you like royalty, or you’ll be something the cat brought in and they won’t have a clue what to do with you. So feedback from these practices can vary enormously, from “she was a pleasure and we’re extremely grateful for the high level of care she showed”, to “Who?”.

AppraisalAid patient logbookSomething that you have with you all the time, is password-protected, and secure. Your smartphone!

We've developed an electronic logbook using Google Forms that can be installed as a form on your smartphone, where you can then access the information back home on your computer. You will also need a free Gmail account.

  1. On your PC/Mac, access the read-only NASGP AppraisalAid | Patient logbook.
  2. You'll see an ugly spreadsheet - yeugh - but ignore that for now. Instead, click on |sign-in| in the top right hand corner. This is where you'll need to either sign in with your Gmail account, or sign up for a free one.
  3. Once you're signed in, go to |File| >Make a copy...
  4. This copy is now in your personal secure Google Drive.
  5. Still in the spreadsheet, go to |Form| >Go to live form

This form is an easy smartphone-friendly way to securely record patients of interest. Add them to this form on-the-go, and then back home, from your Mac/PC, click on |Edit this form| >View responses.

Smartphone? Make sure you're viewing the live form, then copy the url/weblink and email it to your smartphone. Open the link on your smartphone, then find a teenager who'll then create a shortcut to it for you.

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