The Castle Practice

The Castle Practice

Patient Feedback 2014/2015

Introduction

The Practice has reviewed feedback from patients throughout the year and conducts a collaborative review annually. Feedback has been received in a variety of ways including:

Written complaints and suggestions made direct to the Practice via email, post and website, to NHS England and NHS Choice
Verbal complaints and suggestions made direct to the Practice
Family and Friends Test
External health and social agencies, e.g. Wiltshire CCG, Salisbury Hospital

There were three key priorities identifiedfrom the review; appointments availability, prescribing and customer service.

Review of feedback

The review is detailed in four sections:

Summary of feedback received
Priority areas to address
Appointment availability
Prescribing
Customer Service

Section 1: Summary of feedback

Complaints and suggestions made direct to the Practice via face to face, email, post, telephone and website, to NHS England and NHS Choice have been received throughout the year and have been categorised according to area of concern:

Table 1. Summary of complaints and suggestions received according to area of concern

Area of concern / Route of communication
Direct to Practice / NHS England / NHS Choices / Total (%)
Appointment availability / 5 / 0 / 0 / 28%
Prescriptions / 4 / 0 / 0 / 24%
Administration / 2 / 0 / 0 / 12%
Clinical care / 2 / 0 / 0 / 12%
Customer service / 4 / 0 / 0 / 24%

Each complaint was acknowledged within three working days by the Business Mgr (Lead for complaints) or Practice Mgr in his absence. and responded to by senior management, usually the Business/Practice Manager or the patient’s GP. Complaints and suggestions are taken very seriously, they are investigated thoroughly and feedback/reports taken by all involved in the complaint. Patients receive a reply with actions to be taken and are invited in for a face to face discussion if they prefer. Learning is taken from all complaints and suggestions and they are discussed at weekly Practice Meetings and Quarterly Clinical Governance Meetings.

The review also included results from the Family and Friends Test (FFT) which was launched on the 1st December 2014. It is a national survey used by healthcare services to ask patients to provide feedback on the service they received.

Patients can provide feedback using the FFT form placed at reception or following a link on the practice website. The test asks patients how likely they are to recommend The Castle Practice to family and friends who needed similar care or treatment. The ratings ranged from extremely likely to extremely unlikely. The reason for the rating was also asked for to give guidance to the Practice on how to address any concerns and improve services. The results were as follows:

Table 2. Ratings made by patients

Rating / Month / Total for 3 months (%)
December / January / February
Extremely likely / 11 / 33 / 55 / 70%
Likely / 8 / 17 / 10 / 25%
Neither likely or unlikely / 0 / 3 / 1 / 2%
Unlikely / 1 / 0 / 0 / 1%
Extremely unlikely / 1 / 0 / 0 / 1%
Don’t know / 0 / 1 / 0 / 1%

Collectively, patient feedback identified the following areas to be further investigated in priority order:

Area of concern / Total (%)
Appointment availability / 28%
Prescribing / 24%
Customer service / 24%
Administration / 12%
Clinical care / 12%

The key three areas identified were appointment availability, prescribing and customer service. However, given that the majority of comments about customer service also related to appointment and ability to see desired clinician, these have been combined. Therefore, the key priorities addressed were:

Appointments
Prescribing
Customer Service

Section 2: Priority areas to address

Appointments

Acceptable waiting time for a routine appointment with a GP

Information from our 2013/14 Patient Survey showed that the majority, 73%, of respondents, considered that it was acceptable to wait one to five working days for a routine appointment. This is in line with the group results (Plain Talking – group of 6 Practices within the locality working as a virtual group for the past 3 years. The constituent practices being Avon Valley Practice, Barcroft Medical Centre, Bourne Valley Medical Practice and Cross Plains Practice which have since merged and become Salisbury Plain Health Partnership, and St Melor Surgery) (see table 1.)

However, all the Practices operate an appointment system that allows patients to book appointments from on the day through to six weeks in advance. These results suggest that the Practices should reduce the length of advance booking for GPs to two weeks, only allowing clinicians to instigate appointments that are booked further in advance.

Table 1. Acceptable waiting time for a routine appointment with a GP

Level / 1 working day / 1 – 5 working days / 5-10 working days / 10-15 working days / 15-20 working days
The Castle Practice / 10% / 67% / 18% / 3% / 1%
Group / 12% / 70% / 16% / 2% / 1%

For 2014/15 we therefore amended the session structure for GPs in line with patient’s wishes to see a GP ideally within 1 – working days, releasing half of the routine appointments along with the rota release (up to six weeks in advance). The remainder of the appointments generally are split 25% release 48 working hours in advance, and ether seven working days in advance or may also comprise of specialist chronic disease clinics.

This has improved GP availability in the immediate future although we are still refining the system as we get more GP session availability. This has also allowed GPs to have the flexibility to book in those patients they need to review and who clinically need to be followed up. DNAs improved initially as people were not able to book as far in advance, however these are on the increase and a new strategy will need to be looked at to tackle these wasted appointments.

Amending appointment systems according to the time of year

Patients were asked what they thought about changing our appointment system according to the time of year. This was asked because we have noticed seasonal changes such as a decreased demand for on the day appointments during the school summer holidays alongside an increased demand to book appointments ahead, e.g. in 2-5 weeks’ time. At other times of the year, there appears to be an increased demand for same day appointments and less to book ahead.

The majority of patients explained that such changes would be too confusing and that the system should be suitable all year round. Those who considered that such changes may be beneficial if supported by evidence and must be accompanied with comprehensive announcements and instruction.

On review for 2014/15 this was still considered the same, however, we have made changes to improve urgent on the day availability at our Tidworth surgery on a daily basis and also on days prior to and after Bank Holidays when demand is high.

Reasons for requesting an emergency or urgent appointment

Evidence suggests that the reasons patients request an emergency or urgent appointment vary substantial and are usually different to the assumptions made by GPs and Practices. Therefore, the patients were asked why they would request an emergency or urgent appointment to promote greater understanding by Practices and therefore improved insight.

The majority of respondents considered that they wanted to see a clinician urgently due to sudden onset of health concern, pain and/or anxiety surrounding the problem they were experiencing or that the wait for a routine appointment was too long. Urgent appointments should be provided as soon as possible and on the day.

6% of respondents considered that children should be given emergency or urgent appointments

Reducing the quantity of missed appointments

The number of appointments that are missed increases year on year and now amounts to the loss of several months’ worth of appointments in a year. This is despite text reminders, and notices in our surgeries and on our websites. Patients were asked for suggestions on how to deal with this.

Suggestions included the use of additional reminders to patients, such as telephone calls. This would be particularly useful for patients who do not have mobile phones and therefore cannot use the text messaging service. However, the majority of respondents considered that patients, who frequently miss appointments, e.g. three within a given period, should be fined and/or asked to leave the practice.

The new way of phasing the rotas for 2014/15 showed DNAs improved initially as people were not able to book as far in advance, however these are on the increase and a new strategy will need to be looked at to tackle these wasted appointments. The practice will also be reviewing the way that calls are taken at point of contact and a new format of questioning by our reception team will be introduced during 2015/16 to try to get the most appropriate appointment for our patients. This will involve both consultation and training to enable a smooth transition.

Other suggestions to improve the appointment system

Most of the respondents were happy with current appointment system as it is and therefore did not suggest any changes. However, telephoning the Practice to make an appointment was difficult and needed urgent attention. Indeed, a new telephone system has since been implemented to increase the capacity; this has increased the number of lines available into both Ludgershall and Tidworth and has thus addressed this problem.

Telephone consultations have been introduced in 2014/15 and have received very positive feedback. These are 5 minute consultations and are for patients who feel they need tod discuss something with their GP but do not feel that it is necessary to either come into the surgery or take a full 10 minute appointment. This has increased availability by additional 6-10 appointments a day and patients comments have been that they like to convenience and that they like the fact that if they are working they do not restrict their working day. The have also ben useful for GP follow-ups.

Prescriptions

The Electronic Prescription Service (EPS)

EPS means that GPs will be able to send prescriptions electronically to the dispensary/pharmacy of your choice, without the need for paper in most cases. EPS is reliable, secure and confidential. The Castle Practice is piloted this service in a basic format during 2013/14. This pilot has since been extended and released in its initial format nationally. As we had piloted the scheme we were able to launch in the early stages.

This service is of particular benefit to those patients on regular repeat medications and means that, once approved by the GP, the dispensary/pharmacy will be able to dispense medication at monthly intervals until the next medication review is due, without the need for patients or dispensaries/pharmacies to order prescriptions from the Practice every month. This should make the prescription and dispensing process more efficient and convenient for both you and GP Practices.

Advertising this service was essential and therefore patients were asked how to promote it. Suggestions included

Newsletter
Posters in the Practice
Website
B side of prescriptions
During medication reviews
Emailing
Text messaging
Letter in the post
Announcements on radio

Ordering prescriptions

Repeat prescriptions should be easily ordered and therefore patients were asked their preference to ensure this method was available (see table 3).

Table 3. Preferred method of ordering repeat medication

Level / In person / Online / Telephone / Fax / Post / Other
Email / Direct from chemist
The Castle Practice / 43% / 34% / 19% / 0% / 1% / 3%
Group / 45% / 36% / 35% / 0.2% / 1% / 6%

The Practice currently enables patients to order prescriptions in person, online (using a secure system) and by fax or post. We continue to operate an e-mail, fax and postal service along with System On-line; however we have continued to promote the on-line system as a secure system provided by the Practice clinical computer system.

The introduction of EPS has enabled patients to order frequent, stable repeat prescriptions from their pharmacy of choice, taking advantage of pharmacies who offer a delivery service should they prefer.

Customer Service

This was prioritised as a third area for review as several complaints had featured issues with communication and customer service.

The standard complaints procedure has been revisited and complaints forms are available for patients to complete should they prefer to writing a letter.

The issues raised by such complaints are investigated thoroughly and a report written with the facts collated from all the individuals concerned. These are discussed with the team members and a plan developed and learning has taken place following any such complaints.

This has resulted in a greater awareness of the importance of good communication with patients from clinicians, reception team members and all within the administration function. We hope that this has engendered a feeling by patients that they have been looked after in a safe environment by caring staff with effective and responsive medical care and that they feel valued and included. The results of our FFT surveys on the whole have reflected this although we aim to make continuous improvement in this area.

The website has been re-designed to be more interactive and provide a wider range of information.

Any complaints are discussed at weekly Practice Meetings and also at Quarterly Clinical Governance Meetings.

Recommendations

Following discussion with the practice team on 2nd March 2015, the following recommendations were emailed to the PPG on the24th March 2015. The report has been posted onto the website for those patients without an e-mail address.

Appointments

To continue to advocate SMS services to patients
To continue to promote and widen the use of on-line appointment booking
To continue to review and improve the appointment system to ensure the correct appointment is booked for patient first time. This means appointments need to be booked with most appropriate clinician, within the correct time frame and using the most appropriate method, e.g. telephone or face to face.
To display the number and impact of missed appointments in the waiting room and in newsletters, alongside positive statements about how many patients attended their appointment as a different slant on the same message.

Prescribing

To continue to promotethe electronic transfer of prescriptions
To continue to promote and widen the use of on-line prescription requests

Customer Service

To provide quarterly reports to patient via the website about complaints and suggestions received by the Practice.
To provide a log of what patients have said and consequently what the Practice did. ‘You Said…. We did!’ for Friends and Family Test

Other

To use electronic noticeboards in the waiting rooms to improve communication with patients, providing information about the Practice and local health and social events
To continue to refine the use of the website as a communication tool

Suggested plan of action

Action / By who / By when / Progress
To share findings and suggested recommendations with all patients who have provided an email address for receiving information about the Practice. / CW / 25th March 2015
To inform patients about accessing their medical records, including test results, online from 1st April 2015 / CW / 1st April 2015
To continue to offer the electronic transfer of prescriptions / CW/Team / Ongoing
To continue to advocate SMS services to patients / CW/Team / Ongoing
To continue to advocate System On-line services to patients for booking of appointments, ordering prescriptions and accessing their medical records / CW/Team / Ongoing
To continue to review and improve the appointment system to ensure the correct appointment is booked for patient first time. This means appointments need to be booked with most appropriate clinician, within the correct time frame and using the most appropriate method, e.g. telephone or face to face. / CW / Ongoing
To display the number and impact of missed appointments in the waiting room / CW / Ongoing
To provide quarterly reports to patient via the website about complaints and suggestions received by the Practice. / CW/NS / 16h July 2015
To provide a log of what patients have said and consequently what the Practice did. ‘You Said…. We did!’ / CW/NS / 16th July 2015
To use electronic noticeboards in the waiting rooms to improve communication with patients, providing information about the Practice and local health and social events / CW/WA’L / Ongoing

Written 20th March 2015