NHS admin: how does it affect patient experience?

Are all your interactions with NHS services as good as you would like? My guess is that, at one time or another, most of us have experienced feeling frustrated by bureaucratic processes, outdated IT systems or unsatisfactory interactions with administrative staff.

I recently received a letter about an appointment just 12 hours before it was due to take place (and after I had changed it over the phone anyway). I’m often left on hold when calling my GP surgery to make an appointment, and I almost always have to chase them for test results. On one occasion, when I finally did receive my results, they turned out to relate to a different test done the previous year.

Of course, I have experienced good NHS administration too. But I only need to talk to my friends and family, or read stories in the media, to know that the examples described above aren’t unusual. Issues such as difficulty booking a GP appointment and lost test results are captured frequently in reports produced by local Healthwatch organisations.

As in many other parts of our lives, when the administrative aspects of a service seem poor (and when they seem good) it can have a significant impact on how we feel about our experience of using it overall. In the case of healthcare, this often comes at a time when we are already feeling anxious. In some cases, administration can also have an impact on the care we receive – for example, if an appointment is delayed. For these reasons alone (though there are many others) NHS administration is important.

Despite this, there has been very little research into NHS administration and its impact on service users, and it is not routinely captured in NHS data. Most patient experience surveys don’t ask about administration specifically, although it’s likely this influences responses across a range of other questions. The Cancer Patient Experience Survey is an exception here, with a question asking participants to ‘rate the administration of [their] care (getting letters at the right time, doctors having the right notes/test results, etc)¹’. Data on written complaints in the NHS, which is broken down by ‘subject area of complaint’, also provides some insight. For complaints relating to GP services, areas include issues such as ‘loss of/failure to send sample’ and ‘inaccurate/incorrect records’. However, the quality of administration is harder to pull out from complaints about acute services as this is reported on under broader headings such as ‘communication’.

At The King’s Fund, we’re kicking off a project to explore patients’ experiences of NHS administration in more detail. We’re interested in the routine, non-clinical processes that almost everyone experiences, like booking appointments and corresponding with NHS services. This represents a huge volume of activity – just think about, for example, the processes involved in booking 120 million outpatient appointments in 2017/18. We want to understand why NHS administration can be poor, and how poor administration affects patients. We hope that our work will also identify ways in which NHS administration might be improved in future.

As a first step, we reviewed a random sample of over 300 comments written on the Care Opinion website between 2016 and 2018. Anyone can use the website to comment on an NHS service, although some Trusts encourage their patients to do this more than others (and of course, some people are more likely than others to share their views in this way).

Our review highlighted some interesting points. Firstly, it confirmed that people care about their experience of the administrative aspects of NHS services. Of the comments in our sample, we recorded 42 per cent (131) as referring to administrative processes and/or administrative and reception staff. Most of these were about experiences of GP services – in fact, we found that of all comments about primary care within our sample, over two thirds mentioned administration or administrative staff.

The data also confirmed that while experiences of NHS administration can be good, they are often poor. Of the comments that referred to administration or administrative staff, just over half were negative. The issues most frequently cited in negative comments were difficulties booking GP appointments and problems with prescriptions, while positive comments tended to focus on helpful administrative and reception staff.

This last point is linked to a broader finding about the importance of interactions with staff – over two thirds of all admin-related comments referred to administrative and reception staff. While Care Opinion reflects the views of patients, we should remember that many NHS staff are affected by poor administration too. Some comments acknowledged that inefficient systems and processes were often to blame and that mistakes occurred despite efforts made by staff, some of whom went to great lengths to overcome them. However, there were also references to unhelpful or rude reception and administrative staff, mentioned in 52 per cent of negative comments.

A final insight from our analysis was that the quality of NHS administration can affect people in different ways. Comments referred to practical consequences, and time lost in particular, for example by waiting on the phone or having to attend another appointment. The comments in our sample also highlighted the impact NHS administration can have on how people feel, with several people referring to feeling stressed or let down when mistakes were made – or positive and cared for when the quality of administration was good.

This analysis is just the beginning, and there is lots more for us to explore. Over the next few months we will speak to patients and NHS staff to understand the issues around NHS administration in more detail. For more information, check out our project page.