Patient Participation at Central Surgery

Patient Participation at Central Surgery

March 2014

Practice Details

Central Surgery

Surbiton Health Centre

Ewell Road

Surbiton

KT6 6EZ

Telephone

General enquiries:020 8399 6622

Appointments:020 8399 1343

GP Partners – Dr P Moore, Dr J Edwards, Dr N Mansour, Dr S Suriar

Opening hours:

Monday / 7:30am – 8:30pm
Tuesday / 7:30am – 8:30pm
Wednesday / 7:30am – 8:30pm
Thursday / 7:30am – 8:30pm
Friday / 7:30am – 6:30pm
Saturday / CLOSED
Sunday / CLOSED

Out of hour’s provider: NHS111/Harmoni

Background

Central Surgery was an early implementer of a patient participation group, launching it in the late 1990’s; around the time the practice took a PMS contract. The practice worked with a group of patients who were very keen to organise and promote the work of the group. A group engaged with patients through educational sessions, input to the content of the PMS contract, regular committee meetings and the publication of a bimonthly newssheet. There was also a move to set up a patient information point. These activities continued for over 5 years but the group then found difficulty in recruiting new patients to work with them and, as a result, the PPG ended. The practice’s ambition to restart the group was galvanised by the new DES.

On 1/04/2011 the Department of Health launched the Patient Participation Directed Enhanced Service (DES). A programme, which aims to encourage practices to ensure that patients are involved in decisions about the range and quality of services provided and, over time, commissioned by their practice. It aims to encourage and reward practices for routinely asking for and acting on the views of their patients. This includes patients being involved in decisions that lead to changes to the services their practice provides or commissions, either directly or in its capacity as gatekeeper to other services. The DES aims to promote the proactive engagement of patients through the use of effective Patient Reference Groups (PRGs) and to seek views from practice patients through the use of a local practice survey. The outcomes of the engagement and the views of patients are to be published on the practice website.

Gaining a representative View

The DES guidance makes it clear that practices should endeavour to ensure that its PRG is representative of its registered patients. With this in mind the practice analysed its practice demographic data and found that;

Males – 49.2%Females – 50.8%

Age breakdown (%)

Employment Status

Note: Practice data has shown that, at the time of extraction, only 3672 patients had an employment status listed on their notes which represents just 30% of the registered population and therefore should not be viewed as an accurate representation of the entire practice population.

Ethnicity

In 2011 when the DES was launched Central Surgery employed a range of strategies to recruit a representative PRG. At this time the group of 22 was made up of 12 females and 10 males, ranging in age from 43 years old to 88years old. In terms of ethnicity, the group included representation from the following ethnic categories;

o White British

o Other White

o African American

It was felt that the initial membership of the PRG was as representative of our practice population as we were able to achieve. Whilst it is recognised that there are certain demographic groups were not represented, such as the younger members of our practice population and a broader spectrum of ethnic groups, membership of the PRG was established on a voluntary basis and it was felt that we had done everything we could to make the PRG as well publicised and open to all as possible.

Engaging with patients and agreeing our focus area.

In March 2013 Central Surgery moved into new, purpose built premises. Whilst providing an excellent facility, the move itself provided some anticipated and some unexpected challenges. Considerable difficulties were experienced with;

• The phone system
• The IT system
• The appointments system

Both staff and patients endured a period of sustained stress and a number of steps have since been taken to resolve the IT and Phone system problems. In addition, extra receptionstaff have been appointed.

Ongoing feedback from patients and staff continues to suggest that our appointment system is currently not meeting the needs of patients and a number of patients are still commenting that they are experiencing difficulties getting through on the telephone.

With this in mind and given limited diversity of the established PRG a ‘mini survey’ was run to agree the focus area for our main practice survey. Patients were asked which of the following topics they would like us to focus on and the responses were as follows;

Focus area / Responses
The appointment system / 21
Our reception team and customer service / 15
The services we offer / 11
Practice Information / 0

The demographic information of the 47 respondents were as follows;

Male: 24

Female:23

Ages

0-180

19-3914

40-5912

60-7911

80+3

Ethnicity:

British27

Irish2

Any other white background5

White/black Caribbean2

White/Asian1

Other mixed1

Indian3

Pakistani1

Bangladeshi3

Korean1

Other ethnic group1

From this survey it was agreed that Central Surgery would run a wider, specific survey focussing on the appointment system (Appendix 1).

Patient Survey

The Practice made every effort to ensure that as many patients as possible were given the opportunity to complete an anonymous survey. It was made available in paper format in the waiting room as well as an online version using the tool ‘Survey Monkey’ to collate response. The online survey was added to the home page of the Practice website.The survey was run over a 4 week period during February 2014. In all 274 questionnaires were completed,

Survey result attached – Appendix 2

Discussion of findings with the PRG

Following completion of the survey and analysis of results, a meeting was arranged with the PRG on 18/03/2014 to share the survey results and work with the group to collaboratively develop an action plan for implementation. The meeting was attended by 10 patients. The following document (overleaf) was shared with the PRG and the proposed Action plan agreed by all as a way forward.

Next steps:

The practice will launch the pilot appointment system on 6/5/14 and review in 3 months. A further survey will be carried out at this time.

Central Appointments System review – March 2014

Patient meeting 18/3/14 7pm-8pm

We need your help?

Since moving into our new premises we have faced many challenges not only with the telephone system but also in meeting the needs of patients with regard to appointment provision.

We have worked hard to make improvements with the telephony infrastructure as well as appointing additional reception staff and we are starting to see real improvements in call handling performance. We are also delighted to have appointed a full time Patient Services Coordinator who will ensure the smooth running of the front of house services, starting 7/4/14

We do however recognise, having taken on board the feedback of both staff and patients that our appointment system requires significant review. We are sure that some of the following statements will sound familiar;

• I am asked to ring ‘on the day’ for appointments only to find that by the time I get through all the appointments have gone. I’m then asked to repeat this process the following day. It’s very frustrating!
  
• I find it frustrating that I can only book up to 2 weeks in advance for a GP
  
• The online appointments have limited availability and only bookable a short time ahead
  
• The only way to secure an ‘on the day’ appointment is to come in at 7:30am on the day, before the phone lines go over

We have over the past few weeks conducted a patient survey to try and better understand the ongoing concerns. We have collated 274 responses. We are delighted that it isn’t all doom and gloom!

Our plan for this evening is to;

• review the survey findings
• propose some changes which we hope will improve access to appointments and gain your views on these
• and with your help pilot a revised appointment system which we hope will improve matters for the benefit of all of our patients.

Thank you for attending, your time is very much appreciated.

Proposal / Benefits / Status
Increase clinical time
Appoint additional part time GP, 2 days/week
Appoint an additional Nurse Practitioner / Extra appointment availability / Appointed Mid January
Post currently at advertisement stage
Allow patients to book a GP appointment up to 4 weeks ahead / Greater flexibility for patients / Launch pilot 6/5/2104
Make a greater proportion of appointments available online
Online also available up to 4 weeks in advance / With over 3000 patients signed up for online services those patients who would prefer to book online can do and so avoid the need to telephone in, reducing call pressures.
24/7 access / Launch pilot 6/5/2104
Remove all ‘book on the day appointments and replace with a ‘clinician call back service’.
Any patient who does not wish to wait for the next pre-bookable appointment will be called back within 2 hours for a telephone consultation and invited in to be seen if needed
Service delivered by 3-4 GPs and Nurse Practitioner / Avoid the mad rush at 8am with a first come first served basis.
The call back service will enable us to deal with more patients in a time efficient manner.
When used in the past – positive patient feedback / Launch pilot 6/5/2104
Bookable telephone consults for all clinicians, currently only available for some / Patients find these invaluable and so this would improve patient choice and flexibility / Launch pilot 6/5/2104
Any other suggestions?

Communicating change to Patients

Once we have agreed the pilot scheme we would like to launch it early May so that we have at least a month to communicate these changes to our patients.

Our plan is to:

• Put up a waiting room display
• Provide a short leaflet to all patients visiting the practice
• Attached a short leaflet to prescriptions awaiting collection
• Put an announcement on our website
• Ensure our staff are adequately trained to communicate these changes verbally to patients who either attend in person or telephone the practice

The pilot

We hope to pilot a new system for a minimum of 3 - 6 months and it is our intention to repeat the same survey towards the end of this period. We realise that the model may need a few tweaks, or if we have very negative feedback via our staff, reviewed completely

We are happy to try a new approach and whilst it involves a lot of work, if it provides an improved service for patients it will be very worthwhile.

Some statistics!

GPs / Jan / Feb / March / April / May / June / July / August / Sept / Oct / Totals
Pre-bookable / 931 / 883 / 789 / 863 / 879 / 833 / 897 / 656 / 784 / 858 / 8373
Book-On-Day / 1326 / 955 / 1154 / 1237 / 1287 / 1158 / 1415 / 1140 / 1341 / 1428 / 12441
Emergencies / 373 / 286 / 491 / 580 / 364 / 294 / 327 / 391 / 521 / 522 / 4149
Total / 2630 / 2124 / 2434 / 2680 / 2530 / 2285 / 2639 / 2187 / 2646 / 2808 / 24,963
Tel Consults / 311 / 282 / 256 / 315 / 289 / 276 / 334 / 262 / 310 / 296 / 2931
Visits / 100 / 83 / 81 / 100 / 61 / 75 / 75 / 74 / 89 / 104 / 842

Telephone calls 10-14/3/14

Incoming – 1538 86.9% answered Average time to answer – 1min 39sec

Patient Survey February 2014Appointments

1. Last time you wanted to see or speak to a GP, what did you want to do?

See a GP at the surgery
Speak to a GP on the phone
Have someone visit me at home
I didn’t mind / wasn’t sure what I wanted

2. And when did you want to see or speak to them?

On the same day
On the next working day
A few days later
A week or more
I didn’t have a specific date in mind
Can’t remember

3. Were you able to get an appointment to see or speak to someone?

Yes
Yes, but I had to call back closer to or ‘on the day’ I wanted the appointment
No
Can’t remember

4. How convenient was the appointment you were able to get?

Very convenient
Fairly convenient
Not very convenient
Not at all convenient

5. If you weren’t able to get an appointment or the appointment wasn’t convenient, why was that?

There weren’t any appointments for the day I wanted
There weren’t any appointments for the time I wanted
I couldn’t see my preferred GP
I couldn’t book far enough ahead to see a Doctor
Another reason

6. What did you do on that occasion?

Went to the appointment I was offered
Got an appointment for a different day
Had a consultation over the phone
Went to A&E / a walk in centre
Saw a pharmacist
Decided to contact the surgery another time
Didn’t see or speak to anyone

7. Which of the following methods would you prefer to use to book an appointment with a GP?

In person
By telephone
Online

8. If you wished to be ‘seen’ by a GP and the next available appointment was too far in the future, would you be happy to speak with a GP by telephone on the same day in the first instance?

Yes
No

9. Overall how would you describe your experience of making an appointment?

Very good
Fairly good
Neither good nor poor
Fairly poor
Very poor

PATIENT INFORMATION

Are you male or female?

Male / O
Female / O

How old are you?

Under 18 / O / 55 - 64 / O
18 – 24 / O / 65 - 74 / O
25 – 34 / O / 75 - 84 / O
35 – 44 / O / 85 and over / O
45 – 54 / O

Which of these best describes what you are doing at present? tick one ONLY

Full-time paid work (30 hrs or more per week) / O
Part-time paid work (under 30 hrs per week) / O
Full-time education (school, college, university) / O
Unemployed / O
Permanently sick or disabled / O
Fully retired from work / O
Looking after the home / O
Doing something else / O

What is your ethnic group?

British / O
Irish / O
Any other white background / O
White & Black Caribbean / O
White & Black African / O
White & Asian / O
Any other Mixed background / O
Indian / O
Pakistani / O
Bangladeshi / O
Any other Asian background / O
Caribbean / O
African / O
Any other Black background / O
Chinese / O
Korean / O
Any other ethnic group / O

Thank you for taking the time to complete this survey.

Appendix 2