Dr Farmer Dr Lacey Dr Healey Dr Joshi Dr Parsons Dr Notley Dr Caruana

Charnwood Surgery

DR FARMER DR LACEY DR HEALEY DR JOSHI DR PARSONS DR NOTLEY DR CARUANA

Main Surgery: Branch Surgery:

5 BURTON ROAD 5 TUFNELLGARDENS

DERBY DE1 1TH MACKWORTH

TEL: 01332 242004 DERBY DE22 4DY

FAX: (01332) 291830 TEL: 01332 204234

FAX: (01332) 385712

Patient Participation Directed Enhanced Service Report 2012 / 2013

Profile of the PRG and its membership

Charnwood Surgery has had a Patient Participation Group since 2008 but had struggled to get the members engaged and proactively working together. With the introduction of the Patient Participation enhanced service in 2011 / 2012 we had a recruitment drive and had an influx of new members early last year and a few more this year. The group has become more focussed and at the moment there are 14 core members of our PRG with the potential of a further 11. It is felt however that a core group of 25 members may be unwieldyand discussions are happening with regards to structure to enable all to have input but not necessarily attend all meetings

Representation

The practice capitation is as follows:

C/S is the main site Charnwood Surgery at 5 Burton RoadDerby (block colours)

M/W is the branch site Mackworth surgery at 5 Tufnell Gardens Mackworth (patterned colours)

Ethnicity of both members and potential members is 100% White British.

Ethnicity of patients who have consented to have this recorded

White British / Asian / Black African / Easter European / Others
9283 / 1197 / 636 / 280 / 516
78% / 10% / 5% / 2% / 4%

Although our PRG is not representative of capitation, age and ethnicity, every effort has been made to recruit other members to the group as was done last year. Posters are prominently displayed in the waiting areas, the newsletter contains details of the group and a newsletter is placed in every new patient registration pack. Patients are opportunistically asked and a request for members was included in the practice questionnaire. PPG members help other patients with the patient questionnaire and try to recruit members of different age groups and ethnicities. Patients whose first language is not English werealso approached by members of the PRG to fill out the questionnaire but there were only a handful who did so and these were mainly patients with a good working knowledge of English. Please note translators would be available over the telephone.

Being a representative cross section of the whole surgery population has again been discussed this year at several meetings and members are aware that they must endeavour to be representative of all ages, genders and ethnicities regardless of their own. We looked at setting up a virtual PRG also, but have had no one interested but we hope that we will be able to recruit a wider range of members.

The PRG meets on a monthly basis in the surgery and members continue to attend Patient and Public involvement meetings and bring back to the group the knowledge obtained at these meetings. They have also invited guest speakers from the new NHS initiatives to attend PRG meetings and to update members and answer questions. These areas are regularly included in the practice newsletter.

This year the PPG decided to form smaller groups to work on specific areas of interest which would then be brought back to the main group meeting. These areas are:

• New telephone system

Please see questionnaire report and action plan

• Car parking

This group met but no conclusions were drawn, will continue in the next year to find ways to alleviate the parking problem

• DNA letters

Please see questionnaire report and action plan

• Fundraising

Two of the PRG members staged a ‘Gold Rush’ to raise money for the practice to buy a defibrillator. Many of the gifts for this raffle were provided by members of the PRG and especially the Vice Chairman and the practice thank them for doing this.

• Questionnaire

Members of the PRG met and discussed what the content of this year’s questionnaire should be

• Developing the web site

This group is ongoing

• Newsletter

The PRG have a ‘slot’ in the newsletter for any interesting information to be communicated to the patients

Priority Areas

The PRG regularly discuss the priority areas on which they would focus to obtain the views of the practice population and after lengthy discussion the following areas were chosen to be included.

• Access
• Choice of clinicians
• Web site
• DNA’s
• A&E attendances
• Consultations
• Other comments

A discussion was held regarding the method of obtaining registered patients opinion and it was decided that a questionnaire in both paper form and on line on the surgery website would be used as last year.

Views of registered patients

This year, the smaller working party of members discussed questions which they would like to be in the questionnaire. A questionnaire was then put together, sent to all PRG members, and discussed at the next full meeting of the PRG where it was amended and agreed. A timetable was drawn up of PRG members who would be present in surgery to assist patients filling in the questionnaires and to raise awareness of the PRG and hopefully recruit additional members especially those not represented with the original membership.

567 questionnaires were completed at the main Surgery on Burton Road ~ 5%

120 questionnaires were completed at the branch surgery in Mackworth ~ 5%

The paper questionnaires were kindly entered on computer by the Vice chairperson.

PRG discussion

At the February meeting, the PRG looked at the results of the questionnaire and discussedthe results of the survey.From this meeting, the actions were then taken to the Practice Meeting to discuss with the GP partners and the action plan is detailed in theamalgamated questionnaire results below.

It was agreed that all areas of the action plan would be actively addressed and attempts made to improve any highlighted areas

Top of Form

Charnwood Surgery Patient Questionnaire 2012 / 2013

Please note that all results are in percentages of the total questionnaires answered

Q 1Have you in the last 12 months been able to get an appointment when you needed one?

The PRG members thought that the C/S result was encouraging as a high percentage of patients indicated that they were able to book appointments when needed. However 30% of M/W patients indicated that they were not.

Q 2If you werenot able to book an appointment when you needed one, what was the reason?

Answers were provided separately.

In the main, the reasons revolved around appointment availability in terms of numbers and times, specific GP availability, especially at the branch surgery as there are only 2 GP’s per day on duty there, and access via the telephone system.

We have set up a system whereby patients requesting an appointment when there are no longer any available are given the option of a telephone consultation with a GP of their choice or to be put on the on call GP’s list and s/he will triage them and offer an appointment if s/he feels the patient needs to be seen, either on that day or with their own GP on another day. This ensures that all patients can have contact with a GP when requesting an appointment.

With regards to GP availability at the branch site we were looking at a fixed session per week for each GP to provide continuity but this will not be possible during annual leave or absence. Since September last year we have been recruiting new GP partners and the idea of a fixed sessions was put on hold. We are now going to trial a system called Doctor First at the end of March. During the trial, when a patient rings or comes in to the surgery to ask for an appointment, they will be placed on the computer in a telephone consultation appointment and the GP on that day will ring them to discuss their needs and concerns. The GP will then decide if a face to face consultation is necessary and if so will book them into a suitable appointment. Each GP will spend a whole day at Mackworth during the trial and there will be some pre-bookable appointments each day in the afternoon.

The existing telephone system was originally chosen because patients complained that the lines were always engaged and therefore they requested a queuing system. However this means a longer time waiting on the phone. We also have an 0844 number which costs the same as a standard call from a landline but the use of mobiles has increased tremendously since we had the system fitted and suppliers charge inflated prices for calls. We havetherefore, with the PRG telephone group, actively looked at changing the telephone system and this will happen on the 19th to 21st march this year. The telephone numbers will be changing to geographical ones (please see numbers on letterhead) and we will, no longer have a queuing system. At busy times, patients MAY experience the engaged tones so we will monitor any concerns and act on them.

Q 3Do you know you can pre-book a GP or nurse practitioner appointment in advance?

At the moment, we operate a system whereby patients can pre-book appointments up to one week in advance for GP’sand Nurse Practitioners, or ring on the day for an appointment. From the results, 28% of responses indicated that patients were unaware of the ability to pre-book appointments. This response is somewhat surprising as the pre-booking system has been in place for a considerable time and has been included in newsletters and on line. Patients are also now able to pre-book appointments on line. To do so they must ask at reception for a user name and password and in order for them to be given this, they must bring in proof of identity.

4. Are you aware that we have some early morning, late evening and Saturday morning

surgeries?

Derby City PCT implemented a local enhanced service (LES) for extended hours access in April 2008 in order to ensure that local patients had improved access to services outside of normal core working hours according to the patient survey. Extended hours appointments should occur before 8:00 or after 18:30 Monday to Friday or anytime at a weekend. Charnwood Surgery was expected to provide half an hour of extended hours per 1000 patients and therefore we provide 6.5 hours per week:

• From 07.00 to 08.00 on Wednesdays at both main and branch sites (2 x 1 hours);
• From 18.30 to 20.00 on Thursdays at the main site (1.5 hours);
• From 08.00 to 11.00 on Saturdays at the main site (3 hours).

Extended hours offers the opportunity for patients to have a pre-booked clinical consultation with a GP, who is supported by an administration team that can book appointments and support the collection of prescriptions and other patient information needs.

Information about extended hours has been in the newsletter and the surgery opening hours are on the website. Again the responses to this question were surprising as we have been doing ‘extended hours’ for several years. We will endeavour to advertise this more widely.

5a. Do you know we have our own web page?

The responses to this question were again surprising as we ‘advertise’ our website extensively and include the website address on all our correspondence. We will again put an article in the newsletter which refers to the website.

5b. Do you use the web site to get information about the services offered by the surgery?

6a. Would you like to be reminded about your appointment by text?

The practice and PRG felt that SMS messaging would be beneficial as a reminder to patients of their appointments and times however the responses indicated again this year that half of the patients did not want to be reminded by text. This could be a security issue. We have this year targeted certain disease areas and have requested that we be able to message patients

6b. Patients were asked to fill out a consent form for text messaging and ensure we have correct mobile phone details.

The next question was included to try to assess why patients do not attend (DNA) for their appointments and do not inform the surgery of the need to cancel.

7. Appointments that are not needed but not cancelled are wasted. Do you know you can

leave a message to cancel an unwanted appointment even when the surgery is closed?

This question was included so the practice could have some indication about missing appointments as the DNA rate is quite high and wastes many appointments which could have been given to other patients. We monitor DNA’s very closely and write to patients who have DNA’d to inform them of wasted time. The PRG have a working party to look at the letters which are sent to patients to see if a change of wording will encourage patients to contact us if they are unable to keep an appointment. Posters are also prominently displayed indicating appointment numbers and time lost to non-cancelled appointments. There is a facility on the telephone system which allows patients to cancel but this is infrequently used and therefore we need to publicise this better.

8a.In the last 12 months have you attended A+E or the walk in centre during surgery hours?

35% of Charnwood patients and 27% of Mackworth patients indicated that they had been to A&E during surgery hours. The reasons for this were ascertained in the following question

8b. If so, can you explain why?

Only a small percentage of patients were referred directly by their GP to A&E. 26% C/S and 32% M/W referred themselves because they had been involved in an accident or had injured themselves which required specialist hospital treatment e.g. X-Ray, plaster cast or suturing. 26% C/S and 9% M/W patient referred themselves into A&E because of other health issues, some of which were an exacerbation of a chronic disease, pregnancy problems, collapse or severe pain. However several of the reasons given could have been dealt with in the surgery – e.g. emergency contraception, implant, in growing toenails. 24% C/S and 32% M/W patients indicated that they went to A&E because they were either unable to get an appointment or were unable to see their GP of choice. 18% C/S and 23% M/W gave other reasons which included their need being out of surgery hours and their being closer to A&E and therefore deciding to go there rather than attending surgery! A few patients also stated that they felt that they got a faster service at A&E.

The practice will put notices up to inform patients where is appropriate to attend during or after surgery hours.

9a. This surgery has a Patient Participation Group (PPG), would you like to become a

member?

The PRG thought that the answers were encouraging however not all the patients who indicated they would like to be part of the PRG filled out the ‘application’ forms (Q 9b). However the ones who did were contacted and invited to the next full PRG meeting.

10. Do you know you do not always need to see a GP? You can also see a Nurse

Practitioner(NP) / Practice Nurse (PN) / Health Care Assistant (HCA)

It was interesting to note that 15% C/S and 25% M/W patients were unaware that there were other clinicians in the practice who they could see. At present there are not any regular Nurse Practitioner sessions at M/W which could explain the results there but patients should be aware of the different clinical staff in the practice and their abilities. An article to be put into the next newsletter explaining the expertise of the different clinical staff.

The following questions were included to ascertain which clinicians were seen and how patients felt they were treated and cared for.

11.At your last appointment at the surgery did you see a GP, Nurse Practitioner (NP),

Practice Nurse (PN) or Health Care Assistant (HCA)

11a.Did the above clinician treat you with courtesy and respect?

11b Did you feel able to ask questions?

11 c Did the clinician understand enough about your condition and treatment?

11 d Did you understand any explanation or advice that the clinician gave you?

11 e Did you feel involved with decisions about your care?

On the whole, question 11 and its sub parts were answered very favourably which is encouraging.

12. What is your gender?

13. Which age group do you fit into?

14. Which Surgery do you use?

If you have any comments please write them in this section

Answers were provided separately

Again, the problems with telephone access were a main concern but thishas been dealt with as is mentioned above in Q 2 and hopefully concerns will cease when the new geographical number is in use and patients no longer have to wait in a queuing system.

Clinician /appointment availability was also a concern and it is obvious that not all patients know how to obtain appointments e.g. on line and by telephone. More notices will be put up and the information put in the newsletter again, but the difficulty is as always, how to ensure ALL of our 13500 registered patients are given information about the practice. We are proactively looking at more prescriptive GP availability at both main and branch surgeries as part of the recruitment of new GP’s.

Encouragingly, a large proportion of responses were very favourable to the surgery, clinicians and staff and we thank our patients for their compliments and understanding.

Results of the questionnaire will be published on our website and on our notice boards at both the main and branch surgeries

Opening hours

Charnwood Surgery (main site) / Mackworth Surgery (branch site)
Core Hours / Extended Hours / Core Hours / Extended Hours
From / To / From / To / From / To / From / To
Monday / 07.45 / 18.30 / Monday / 07.45 / 18.30
Tuesday / 08.00 / 18.30 / Tuesday / 08.00 / 18.30
Wednesday / 08.00 / 18.30 / 07.00 / 08.00 / Wednesday / 08.00 / 18.30 / 07.00 / 08.00
Thursday / 08.00 / 18.30 / 18.30 / 20.00 / Thursday / 08.00 / 18.30
Friday / 08.00 / 18.30 / Friday / 08.00 / 18.30
Saturday / 08.00 / 11.00 / Saturday / Closed
Sunday / Closed / Sunday / Closed

GP’s, Nurse Practitioners, Practice Nurses and Health Care Assistants are available during core hours. At present only GP’s are available during extended hours but skill mix of clinicians is under consideration. Access to services is available over the telephone, on the internet and face to face in reception during core hours.