CHAPTER TEN. CONCLUSIONS
10.1 With the substantial changes to NHS services in Scotland since Our National Health: A Plan for Action, a Plan for Change set out the Scottish Executive's agenda for modernisation, further developed by subsequent publications such as Partnership for Care, this survey aimed to assess progress on increasing access, choice, public involvement and responsiveness.
10.2 The role of Practice Nurses has been extended in Primary Care with more than a third of the overall sample having seen a nurse at their local surgery in the last year. There was a higher level of contact with nurses in Primary Care than was the case four years earlier. Importantly, satisfaction with this contact is higher than for any other category examined in the survey. This is encouraging in the context of changing professional boundaries and will facilitate more appropriate use of GP time with patients with nurses undertaking routine tasks such as giving flu jabs or measurement of blood pressure.
10.3 Awareness of choice in the NHS remains low with only a minority of people discussing possible choices of location, waiting times and appointment times for outpatient appointments. There is, therefore, more that could be done to give patients information about the extended choice in the health service, and also increasing the involvement of patients in decision making about their own treatment while in contact with Primary Care. The increased use of Patient Focussed Booking could have a positive impact in this respect.
10.4 There is clear evidence of a link between satisfaction and two factors - choice and waiting times. By offering greater choice it may also be possible to reduce waiting times leading to higher levels of satisfaction with the health service in Scotland however there are constraints on this including geographical location.
10.5 The data confirms that shorter waiting times for contact, treatment and admission correlate with higher levels of satisfaction, with both the individual service and overall use of the NHS. Rapid access to Primary Care is also important as those who saw or spoke to someone inside two days were more satisfied with the service than those who waited longer to consult a health professional. There have been improvements in access to health professionals since the 2000 survey and further progress could lead to increases in satisfaction.
10.6 The data shows that patients identified a greater need for improvements with aspects of the service when they saw a GP other than their own doctor. Initiatives to reduce waiting times and speed up access to Primary Care services may reduce choice to some extent which affects people's perceptions of the service they receive. This is not necessarily reflected in their satisfaction with primary care services or the NHS overall, however.
10.7 Satisfaction scores are generally very high with regard to individual service contact but are rather lower with regard to use of the NHS overall. This balance is also reflected in data on public attitudes to other public services. Where comparable, there is no evidence of any drop in satisfaction with individual services since the 2000 survey - indeed, over the last four years, there has been an increase in those very satisfied with their experience of Primary Care consultation and inpatient services.
10.8 As in the 2000 survey, younger people were less satisfied with some individual services (e.g. outpatients) and also with their overall use of the NHS in the last year. Longer term trend data will be able to determine if this group remain less satisfied as they move into the older age bands.
10.9 People most often identified a need to improve access to NHS services, notably for more convenient appointment times and car parking. Other areas where a need for improvement was identified included child friendly facilities, communication between health professionals and patients and the speed of receiving test results outside Primary Care.
10.10 In terms of people's perceptions of the level of public involvement in the design and delivery of services, the gap between perceived involvement and the public's desire for influence is considerable, and is larger than was the case in 2000. Overall, there is no evidence in the survey that people are more likely to make a complaint than four years ago. However, quite a number of people wanted to make a complaint about aspects of NHS services but did not do so, often believing that there was no point or because they were unsure about how to complain. Waiting times were the main reason for actual and potential complaints. Current initiatives being developed on patient focus and public involvement may address the responsiveness issues raised by the survey.
10.11 This survey has shown high and increasing levels of public satisfaction with NHS services and has identified some important areas where further progress could be made. The survey provides a baseline against which progress with modernisation can be assessed in the future. The intention is to repeat the survey every two years which should provide an indication of the impact of the wide range of initiatives being introduced to increase access, choice, public involvement and responsiveness.