2 Patient experience of advance access
2.1 Introduction
Questions 4 and 5 of the survey measured the ability of GP Patients to book an appointment with a GP 3 or more days ahead (see the questionnaire in Annex A). The answers that people provided to these questions were coded into those who had obtained advance access and those who had not. Anyone who had not tried to book a GP Appointment more than 2 days in advance in the last year was excluded. The coding is more straightforward than for 48 hour access, and is shown in Annex B.
All results in this chapter are based on responses from 991 practices, as those practices which only offer "open access" 2 have been excluded from the analysis.
2.2 Advance access results for Scotland and NHS Board areas
Overall, the advance access results were lower than for 48 hour access, with an estimated 75% of patients in Scotland able to book an appointment with a GP 3 or more days ahead. The highest result for an NHS Board was for Orkney, with 96% and the lowest was for Tayside with 68%. (Note that these aggregate estimates have been weighted by practice size in order to reflect the population.)
Chart 9: Advance access results by NHS board
The target for NHS Scotland is that 90% of patients should report obtaining advance access by 2010/11. It can be seen that nearly all NHS boards (except Orkney) have yet to meet this target.
2.3 Advance Access results for GP Practices
It can be seen in chart 10 that the range of practice results for advance booking was wider than for 48 hour access. The minimum was 21% and the maximum 100%. 39% of practices (388 of 991) had more than 90% of respondents gaining advance access.
Chart 10: Distribution of practice results for advance access
GP practices will receive quality incentive ( QOF) payments if their result on advance access is higher than 60%. 139 practices (14%) had a result less than or equal to 60%, therefore the remaining 86% of practices will receive some reward for advance access. 39% of practices (389 of 991) had 90% or more respondents gaining advance access, and so will receive the full payment.
NHS Board area
Table 4 shows that the percentage of practices with more than 90% of patients obtaining advance access ranged from 22% in Ayrshire & Arran to 100% in Orkney. 14% of practices overall had a result of 60% or less. This ranged from no practices in Orkney, Shetland, Western Isles and Borders, to 21% of practices in Tayside.
Table 4: Practice results for advance access by NHS board
NHS Board | Practice results for advance access | Total number of practices
(100%) |
|---|
Up to 40% | Over 40%,
up to 50% | Over 50%,
up to 60% | Over 60%,
up to 70% | Over 70%,
up to 80% | Over 80%,
up to 90% | Over 90% |
|---|
Ayrshire & Arran | 3% | 2% | 12% | 12% | 26% | 22% | 22% | 58 |
|---|
Borders | 0% | 0% | 0% | 8% | 8% | 28% | 56% | 25 |
|---|
Dumfries & Galloway | 0% | 3% | 6% | 15% | 9% | 18% | 48% | 33 |
|---|
Fife | 2% | 7% | 9% | 14% | 18% | 16% | 35% | 57 |
|---|
Forth Valley | 4% | 7% | 11% | 9% | 12% | 16% | 42% | 57 |
|---|
Grampian | 5% | 1% | 4% | 12% | 17% | 26% | 35% | 81 |
|---|
Greater Glasgow & Clyde | 2% | 4% | 8% | 9% | 17% | 22% | 38% | 269 |
|---|
Highland | 0% | 1% | 3% | 4% | 9% | 19% | 64% | 91 |
|---|
Lanarkshire | 6% | 5% | 6% | 20% | 16% | 21% | 24% | 98 |
|---|
Lothian | 7% | 4% | 7% | 12% | 17% | 25% | 28% | 121 |
|---|
Orkney | 0% | 0% | 0% | 0% | 0% | 0% | 100% | 12 |
|---|
Shetland | 0% | 0% | 0% | 0% | 10% | 0% | 90% | 10 |
|---|
Tayside | 7% | 10% | 4% | 21% | 9% | 12% | 37% | 68 |
|---|
Western Isles | 0% | 0% | 0% | 0% | 9% | 9% | 82% | 11 |
|---|
Scotland | 3% | 4% | 7% | 12% | 15% | 20% | 39% | 991 |
|---|
Practice Size
Chart 11 illustrates that, as was seen with 48 hour access, on average smaller practices had higher proportions of patients who were able to obtain advance access than larger practices.
Chart 11: Average practice achievement for advance access by practice population
For small practices (fewer than 2,500 patients) 83% had a result of more than 90%, compared with 12% for large practices (more than 10,000 patients). Almost 97% of the 86 practices with fewer than 1,500 patients had a result of more than 90%.
Table 5: Practice results for advance access by practice population
Practice population | Practice advance access result | Total number of practices
(100%) |
|---|
Up to 30% | Over 30%,
up to 40% | Over 40%,
up to 50% | 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% | 0% | 1% | 0% | 4% | 12% | 83% | 200 |
|---|
2,500 - 4,999 | 0% | 1% | 2% | 5% | 7% | 13% | 21% | 50% | 303 |
|---|
5,000 - 7,499 | 1% | 6% | 6% | 7% | 21% | 20% | 21% | 17% | 232 |
|---|
7,500-9,999 | 3% | 3% | 8% | 13% | 18% | 20% | 24% | 11% | 153 |
|---|
10,000+ | 1% | 4% | 7% | 11% | 17% | 23% | 26% | 12% | 103 |
|---|
Urban rural classification
Practices located in rural areas had on average higher results than those in urban areas. 79% of practices in rural areas had over 90% of their patients obtaining advance access, compared with 29% in urban areas. Please see Annex C for details of the urban rural classification.
Chart 12: Distribution of advance 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 area, 31% had more than 90% of their patients obtaining advance access, compared with 40% for other areas.
Comparison of practice results for Advance and 48 Hour Access
Table 6 shows how the practice results on advance access relate to their results on 48 hour access. A generally positive relationship can be seen between practice results for advance access with their results on 48 hour access.
35% of practices had results of above 90% for both types of access measured in the survey.
A total of 840 practices (83%) had results that were both greater than 60% for advance access and greater than 70% for 48 hour access.
There were 73 practices (7%) with results of over 90% for 48 hour access but less than 60% for advance access, and one with over 90% for advance access and less than 70% for 48 hour access. These are the minimum thresholds for QOF payments.
Eight practices had results of less than 60% for advance access and less than 70% for 48 hour access.
Table 6: Practice advance access results by 48 hour access result
| Advance access results | All practices |
|---|
N/A | Up to 40% | 40% to 50% | 50% to 60% | 60% to 70% | 70% to 80% | 80% to 90% | Over 90% |
|---|
48 hour access results | 50% to 60% | 0 | 0 | 1 | 2 | 0 | 0 | 0 | 0 | 3 |
|---|
60% to 70% | 0 | 3 | 0 | 2 | 4 | 5 | 2 | 1 | 17 |
|---|
70% to 80% | 0 | 1 | 7 | 11 | 27 | 24 | 11 | 1 | 82 |
|---|
80% to 90% | 0 | 11 | 6 | 22 | 32 | 56 | 79 | 26 | 232 |
|---|
Over 90% | 24 | 19 | 26 | 28 | 51 | 64 | 109 | 360 | 681 |
|---|
All Practices | 24 | 34 | 40 | 65 | 114 | 149 | 201 | 388 | 1015 |
|---|
Note:
The categories of results shown in the table include the upper end of the range, e.g. "60%-70%" would contain a practice with a result of 70% but a practice with 60% would be in the category below.
2.4 Advance access by patient characteristics
Results in this section are shown by the characteristics of the patients responding to the survey.
The figures presented are based on the 122,393 responses that were eligible for inclusion in the calculations, as defined in the coding scheme outlined in section 2.1 and in Annex B. Figures are un-weighted, i.e. based directly on responses to the survey.
Overall, 80% of the survey respondents who had tried to obtain advance access (and whose responses were not excluded by the coding rules) had managed to obtain it.
Gender
Of 74,478 female patients who had tried to book an advance appointment, 79% had been able to do so. This compares with 82% of the 47,915 male patients who had tried to book 3 or more days in advance.
Age
As with 48 hour access, advance access was obtained more often for older patients - with 87% of over 70's reporting that they had been able to book an appointment more than 2 days ahead compared with 74% of those aged 16-29.
Chart 13: Percentage of patients obtaining advance access by age group
Urban Rural Classification
89% of patients who live in rural areas were able to obtain advance access compared with 77% of those in the other areas. Chart 14 shows the differences in access between the more detailed categories in the classification (see Annex F for definitions). Within the urban areas, people living in "other urban areas" were least likely to obtain advance access. These are towns with populations between 10,000 and 125,000.
Chart 14: Percentage of patients obtaining advance access by urban rural classification
Deprivation
76% of respondents who live in areas of high deprivation had been able to book in advance, compared with 81% of those living in other areas.
Ethnic group
85% of patients who identified themselves with the 'African, Caribbean or Black' ethnic group reported that they were able to obtain advance access. This compares with 77% for patients who reported their ethnic group as being 'Asian, Asian Scottish or Asian British', and 80% of 'white' respondents.
Chart 15: Percentage of patients obtaining advance access by ethnic group
* Asian, Asian Scottish or Asian British
Disability
81% of patients who indicated that their day-to-day activities were limited a lot because of a long term condition or disability had been able to obtain advance access.
Chart 16 shows that only 73% of patients who indicated they had a learning difficulty were able to obtain advance access. The compares with 80% for those patients indicating they had no health condition, and 84% with blindness or severe vision impairment.
Chart 16: Percentage of patients obtaining advance access by long term condition or disability3
