Background

The GP Out of Hours (GPOOH) service in NHS Greater Glasgow and Clyde (NHSGGC) provides medical assistance to patients out with normal GP surgery hours. Patients can access the GPOOH service in the evenings, overnight and across the whole weekend by contacting NHS 24 or by direct referral from other service providers. Following initial triage by NHS 24 and dependent on outcome, patients will be offered a face-to-face consultation at a GPOOH centre, home visit or virtual consultations by telephone.

The GPOOH service model has been through significant redesign driven by key factors outlined in a paper presented to NHS Greater Glasgow and Clyde’s Board in February 2020. The Board approved the business continuity arrangements, which included immediate changes to the GPOOH service model. These were based on recommendations by Professor Sir Lewis Ritchie to ensure ongoing resilience, safety and quality of the service. The transformation of the GPOOH service model included moving to an ‘appointment only’ system from June 2020. This was in line with other NHS boards and utilising NHS Near Me to provide video consultations to reduce the need for patients having to travel.

Engagement - what we did

NHS Greater Glasgow and Clyde’s Patient Experience and Public Involvement (PEPI) Team conducted the programme of engagement during 2020 and 2021 and received feedback from 639 people on their experiences of the GP Out Of Hours service.

The scope for the engagement was to target patients from across all six Health and Social Care Partnerships (HSCPs) who have accessed the GPOOH service via any route.

The focus of the engagement was to:

• Measure if the care we are providing is of high quality and person centred.
• Understand how it felt and what was important to patients and carers when accessing GPOOH services.
• Find out what people think about the ‘appointment only’ system and if this has made a difference to the patient experience including any perceived benefits.
• Identify what aspects of the service works well and where improvements are required to enhance the patient and carer experience.

We used an online survey to gather people’s feedback.

Engagement opportunities were promoted in a variety of ways as detailed below:

• People who had recently used the service were sent a text message to invite them to take part. Those who responded were sent a link to the survey, enabling them to share their views. Of those contacted by text, 14% completed the survey.
• We developed a social media campaign. This was the first time NHSGGC used Instagram and Twitter polls to encourage two-way interaction and capture people’s views and experiences. The campaign ran for two weeks with 26 posts shared across NHSGGC’s Facebook, Twitter and Instagram. We also linked in with relevant accounts and organisations online across the six HSCPs to encourage them to share and retweet the GPOOH content. This included Local Authorities, HSCPs and community groups. Examples of online networks included: Inverclyde’s HSCP engagement ‘Your Voice’ network, Vale of Leven Hospital Watch, Glasgow Live and the Community Voluntary Services across the six geographical areas. This promotion resulted in 72 people completing the online survey. Our Twitter and Instagram story polls captured engagement feedback and tested the public’s wider understanding of how to access the service. The results can be used to inform future communication campaigns and messaging.
• The survey link was also shared with NHSGGC’s Involving People Network (IPN), an electronic mailing list with a reach of approximately 100,000 people. The press release and circulation to the IPN generated most of the online survey responses with 179 people taking part.

We also conducted targeted engagement with individuals with protected characteristics. This involved eight telephone interviews with people identified by the GPOOH service who needed communication support; ten interviews with Black and Minority Ethnic (BME) community members, and two discussion groups with eleven participants from the ‘The Life I Want Health Group’ who all have lived experience of being individuals with a learning disability.

We also offered telephone interviews and a link to Care Opinion as an independent means to give feedback. There was no uptake of these methods.

On the whole, patients and carers reported positive experiences of accessing the GPOOH service, with 80% of patients complimenting our staff and service. It was evident that most people found the care to be person centred with high praise for how professional and caring staff were.

The feedback captured on what is important to people has remained consistent throughout the programme of engagement over 2020 and 2021. The top four themes were:

• Promptness,
• accessibility, 
• care and treatment, and
• active listening.

Feedback received in 2021 highlights a significant proportion of people who are now accessing virtual consultations: 50% of respondents attended for an appointment at a GPOOH centre, with 45% of respondents receiving a consultation either by telephone or through NHS Near Me.

Patients were asked to reflect on their overall experience and rate the care they received from the GPOOH service. The majority of respondents had a positive experience.

When reflecting on their GPOOH experience and the quality of care received, the top three statements that respondents agreed the most with were:

• I understood the information that I was given.
• I was listened to.
• I was treated with compassion and understanding.

The negative experiences included:

• Concerns over attitude and behaviour of some staff.
• Care and treatment – perception among some that their individual needs were not met and didn’t receive right care or treatment. For example, one patient was referred back to their own GP.
• Frustration over delays experienced contacting NHS 24 initially and the triage process in general.
• Impact of COVID restrictions and not being able to have a relative or partner accompany them when attending GPOOH centre.

Responding to feedback

The above factors and the wider feedback will be used to inform opportunities for future service improvements. Reflecting on feedback received in 2020 where people indicated the importance of having a local and accessible GPOOH service, steps were taken to provide more local access where possible. In 2021, additional changes included increasing the Lomond Centre’s opening times (based at the Vale of Leven Hospital) and implementing local service provision in Inverclyde with the GPOOH centre operating on Saturday mornings and Public Holidays from May 2021.

What worked well

• The engagement has captured the lived experience of 639 people who have accessed the service and provided us with valuable insight into what truly matters to them.
• It has informed what is working well with the service as well as potential opportunities to continue to improve for the people who use it.
• The wide range of methods proved effective in capturing feedback and demonstrated a pro-active approach to engagement.
• We found that using Twitter or Instagram enabled us to capture high level perceptions of the service as well as the views of service users. It provided an opportunity to show that NHSGGC is a listening and learning culture, by transforming communication channels into two-way dialogue. For example, if people are asking for more information on a topic, this can inform our future communications strategy. Social media provided a quick and effective way to hear from a high number of people, for example, over 100 people participated from one story through the use of polls and quizzes.
• Through our use of social media we found that it is important people clearly understand what service you are asking them about and what you would like to know.

Key learning

• Reflecting on our first use of Twitter and Instagram polls our learning would be to seek views on ‘high level’ public perceptions from this method. We received helpful feedback but also people’s perception of the service rather than their direct experience.
• We have tailored subsequent social media campaigns to better capture the feedback from those that have recently used the service, or more towards the ‘high level’ perceptions and understanding where this was something we sought feedback on.

We found that some of the challenges of engaging with people using social media, and possible solutions, are:

• Social media behaviours – a risk of online ‘troll’ culture where people are negative for the sake of it or just for the ‘fun of it’. It is important to word questions in such a way as to encourage constructive feedback; and check whether your online results reflect other engagement approaches e.g. surveys to see how they correspond.
• Resource - We post our Twitter polls and Instagram stories manually. This means we can only post them during our hours of work, which may not be when our users are most active. This may contribute to less people responding to our online engagement. Consider how we can post Twitter polls at a time when our followers are most active and therefore more likely to see the poll and vote on it. 
• User demographics – some social media channels have followers from specific demographics. This could limit our ability to engage with all our communities and relies on stakeholder mapping of online groups to target particular voices.
• Encourage more people to participate with the use of particular stickers on Instagram stories, for example poll and quiz stickers get a higher quantity of users participating, but the question box sticker gives you more specific qualitative feedback.
• Increase reach and engage with other communities online by mentioning accounts in the Twitter polls and ask them to retweet/quote tweet our content.

Image credit: NHS Greater Glasgow and Clyde