To:Cornerways Patient Group

FILE NOTE

To:Cornerways Patient Group

From: Alison Rogers

Re: Our meeting 08 03 2012

Date:21 March 2012

Dear All,

Thank you so much to you all for attending the second Cornerways Patient Group meeting and we really did appreciate all your thoughts, questions and contributions.

We thought it would be a good idea to write some meeting notes so that anyone who didn’t attend could catch up with what we discussed. They can also serve as an aide memoire for where we got to ready for our next meeting.

Please don’t hesitate to suggest any amendments if you can see that I’ve forgotten anything, or got anything wrong.

Sincere thanks again from us all,

Dr Tim Knight, Partner with a special interest in Patient Involvement

Andy Lopez, Practice Manager

Alison Rogers, fellow patient

C:\Users\Alison Rogers\AFR Consulting Ltd\Clients\Cornerways\File note post meeting 9 August 2011.doc Page 1 of 1

Cornerways Patient Group

Second Meeting

8 March 2012

5:30pm – 7:15pm

Cornerways Medical Centre, Poulner

Meeting Report

Introduction

A second meeting of the Cornerways Patient Group met on 8 March at the Poulner surgery of Cornerways Medical Centre.

It was attended by patients and members of staff including GP Tim Knight, Partner with a special interest in patient involvement; Practice Manager, Andy Lopez, Jo Downer, IT specialist and Caroline Rickman, Reception Manager. Alison Rogers, a patient at the surgery, facilitated the meeting. It was also attended by Caroline Delaney, trustee of the newly formed Cornerways Beacon Trust.

The event had been advertised to patients through the recent launch of the Cornerways Feedback scheme, by posters in the surgery and information had been given by staff to patients. Patients who had expressed an interest in being kept updated had been notified of the meeting by email or phone call.

The meeting was well attended by approximately 30 patients with everyone taking part and many contributions from the floor.

Welcome, background and update
Dr Tim Knight opened the meeting and thanked everyone for attending. He summarized the previous inaugural meeting for all those not previously present. He thanked the initial group for their very useful feedback and suggestions relating to the issues that might be of particular interest to patients, and which had formed the basis of a patient survey which would be discussed during the meeting. He particularly welcomed one or two younger members of the group and emphasized that he was keen to get a good cross-section of Cornerways Patients at the Patient Group.
Press following the last meeting
Alison Rogers handed round copies of a full page spread in the Ringwood and Fordingbridge News (issue 1 – 14 Feb 2012) which had highlighted the activities of the group and contained a meeting report of its first meeting. She thanked everyone who had contributed to the Press Release and agreed to be pictured.
Cornerways Beacon Trust
Caroline Delaney, trustee and secretary of the newly formed Cornerways Beacon Trust (CBT) introduced herself. She explained that the CBT was taking over the activities of the old ‘Friends’ charity. The Trust is now actively seeking to listen and understand the needs and thoughts of patients, and a Trustee from the Trust will join the Patient Group meeting to better develop this understanding, and to support the work of the Patient Group where appropriate.
Recruitment of new members
Andy Lopez showed a poster which had been put up in the surgery which encouraged everyone to take part in the patient group.
Finding out what our fellow patients want - the survey and survey results
Alison Rogersintroduced this item and explained that it was the main part of the meeting. She explained that she would run through the background and analysis. She invited Patient Group Members first of all to have their say and explain why they had come to the meeting and what they wanted to see happen for patients at Cornerways.
There were many contributions from the floor, including questions or comments about:

1. Not being able to get appointments for blood tests – this was supported by many patients and, on a show of hands, by about half the room

1. The surgery being completely shut between 1pm and 2pm

1. How MRI and scan results and test results generally are processed and notified

1. Whether patients truly feel empowered to be critical of their Doctor or surgery, and whether some older patients might be concerned about leaving feedback

1. The issue of the ‘family GP’ and how news of retirements and reallocation of patients to new Doctors is handled.

1. The check in process and whether it was acceptable to be left sitting waiting for 1.5 hours without an update as to likely timing; the possibility of using the electronic screen to notify patients if a Doctor was running late, or to say how many patients were waiting for that Doctor.

1. The length of time allowed for emergency appointments

Alison explained that many of these points were also covered by the survey, and was pleased that the areas that had come up in discussion were also those areas of concern surveyed in more depth by the survey. She explained the background and results as follows:

Background

1. A survey of patients at Cornerways Medical Centre (Cornerways) was undertaken between 6 February and 29 February 2012.

1. The survey was intended to provide guidance to the PPG as to the issues considered important to patients at Cornerways and to gauge overall levels of satisfaction with the service provided by Cornerways.

1. The survey had built upon the qualitative feedback offered by the meeting of the PPG which had previously been held on 26th January 2012 and which had highlighted a number of issues which were explored within the survey.

1. The survey was designed with open and closed single and multipart questions. There was a section at the end for additional free form comments.

1. The survey was given out in the waiting rooms of both branches of Cornerways and also by GPs after a consultation with patients.

1. A copy of the survey is attached.

1. A total of 170 surveys were completed by patients and analysed.

Analysis

The results of the analysis were quantified and/ or analysed qualitatively as below.

Attendance

The sample represented a good cross section of patients who were more or less regular visitors to the surgery, visiting less than once a year to more than 6 visits a year.

Special Needs

17% (26 out of 152) patients identified themselves as having special needs. These were described by patients as being: blood pressure, hearing impairment, diabetes x 2, atrial fibrillation; arthritis x 2; heart failure; sarcoidosis; epilepsy; height adjustability needs post fall; cardiac; inability to walk far after fall; fibromyalgia; dementia; mental health needs; MS; rheumatoid arthritis; asthma; wheelchair user; on warfarin requiring regular blood tests x 2; starting a course of injections; knees and chest; asthma; a tendency to worry.

The self definition was particularly telling and suggests the wide cross section of conditions and tendencies with which the NHS and primarycare is faced.

Appointments

A generally encouraging 75% (127 out of 170) of patients were satisfied with their experience of getting appointments. They either rated appointments as ‘easy to get’ or ‘generally available when wanted’. Given that this has been widely flagged in the media as an issue for patients and an easy complaint to make, this response appears to suggest a relatively high level of satisfaction with appointment availability. 36 out of 170 (21%) either found it hard to get an appointment or didn’t understand the system (a possible surrogate marker for frustration or dissatisfaction). 7 (4%) did not respond.

Waiting room times

Patients were given 5 options on waiting room times.There was a very positive response to waiting time acceptability where an acceptable waiting time was deemed to be anyone who responded ‘yes’ (the first 3 options). 87% (148 out of 170) deemed waiting time to be acceptable. There were 12 ‘no’s and 10 who did not answer. Patients were invited, if they wished, to quantify the time spent waiting and this could be either acceptable or unacceptable – with interesting overlaps!

What is valued and should be maintained

This and the following question were open questions designed to elicit responses which might produce a thematic narrative for the positive and negative aspects of Cornerways. What came across very clearly as the number one theme was patients’ overwhelmingly positive attitude towards the people who work at Cornerways - both GPs and staff. Whilst other areas of approval or disapproval tended to mentioned only once or twice, or perhaps up to 6 times, the support for the personnel was mentioned specifically in 45 surveys out of 170 – 26% of respondents. Patients typically described staff as ‘friendly and helpful’, approachable, commented on the personal touch; commented ‘All so kind’ and touchingly ‘Good service even if you are very old – keep it up’. Other aspects that were valued were the convenience of the surgery / location (9 mentions), specifically the great GPs (7 mentions); the possibility of having blood tests done at the surgery (5 mentions); the good overall service (9 mentions) and between 1 and 3 mentions for good appointment handling, being accommodating, being children friendly, the automatic check in service, good urgent appointments, parking, the continuity of GP care, good communications. ‘The whole system in Cornerways is beyond compare’ was one of a number of superlative comments.

Areas for improvement

There was no overwhelming theme as there had been for the excellent quality of the staff in the question that reflected what patients were not so keen on. The largest areas of concern all scored 6 mentions or under and these were parking, better continuity with GPs, the lack of blood tests at the surgery and waiting times for forward non-urgent appointments. In addition, scoring 1 or 2 mentions each were: waiting times, the check in machine, option driven telephone system, reception triage, toilet cleanliness, some GPs’ attitudes towards Mums with children, prescription ordering, being ignored at reception, long waits on the phone, reception not being responsive or friendly enough, reception closed between 1pm and 2pm, understanding that patients can forget things, more immediate appointments, seating arrangements / dreary decor, lack of visible reception staff, the water machine being close to the children’s corner, over-heating, St Leonards not being open all day every day, communication, the weighing machine not being screened off, the cancellation of the well man clinic, the elderly being patronised and being called ‘Dear’ by receptionists, the time lag between asking for help and any real action.

About the NHS more widely...

There were mixed reactions, although many chose not to answer this question. Communications, hygiene and negative feelings / experiences at Bournemouth Hospital were modest themes. Some positive comments about the NHS overall.

Blood tests

Patients were asked specifically about blood tests as this was a theme that had arisen at the PPG, was a known area of concern based on patients feedback and had been considered by the PPG to warrant further investigation. Patients were asked whether blood tests should be provided as part of the standard service at Cornerways. Overall 65% of people (110 out of 170) felt blood tests should be standard service; 24 (14%) felt it should not; another 24 (14%) didn’t mind and 12 (7%) did not answer the question. That suggests a high level of support for blood tests being available at the surgery – 70% if we take out non-responders. In addition this issue did elicit a certain degree of qualitative comment as well as a formal letter from one patient who pointed out the impact on people’s time and particularly the impact on the elderly. This is a clear cause for concern.

Contacting patients with normal results

Like blood tests, this issue was highlighted in discussion with the PPG; some people feeling that all test results should be conveyed by Cornerways to patients, not just those that were abnormal and required further action. In this case there was also an overwhelmingly positive wish by patients to receive notification of all test results – with 148 out of 170 (87%) of patients – wishing for this to happen; 12 not wishing it and 10 not minding. This suggests a clear mandate to investigate whether this can be done in a time efficient manner.

Out of hours GP service

When invited to think about the GP out of hours service, which had been identified at the PPG as an area that was being consulted upon and which tends to give rise to strong feelings, patients were asked to rate on a 1 – 4 system what was most important to them. The results were not easily quantifiable as there was a fair degree of non-compliance with the rating system. What was clear and evident was that, in rating aspects of service up or down, the need for ‘familiarity with the person you are speaking to’, and the need for a face to face consultation tended to be rated lower than ‘the need to have confidence in the level of medical knowledge of the person you are speaking to’. This suggests perhaps that patients do understand the need for telephone consultations out of hours and the need for non-family / non-surgery GPs to undertake those consultations, but perhaps reflects worry about the competence and knowledge of those currently answering phones out of hours.

Other thoughts or comments

19 out of 170 respondents (11%) took the opportunity to provide further free form comment. 13 out of 19 (68%) wrote positive comments which were on a spectrum of satisfied or very pleased with the service provided, one commenting that, having lived in 3 countries, this was the best service their family had experienced. Other specific suggestions or gripes – some of which may have been included alongside positive comments - were: more preventative / well-being initiatives (2 mentions), wider parking bays, some receptionists being curt and lacking in people skills, NHS out of hours service, not being given an appointment when the patient thought it was necessary (described as being ‘borderline kidney failure’) repeat prescriptions and waiting times.

Summary and conclusions

The overall sense on reading the responses is that patients are happy or very happy with the service provided. The over-riding impression is that the people who work at Cornerways – GPs and staff - are considered to be the major asset of the surgery and they are valued by patients for being kind, helpful, approachable, sensitive, responsive to specific needs and friendly. There are one or two small gripes about reception issues which may warrant some thought and consideration. The feedback from patients on the desire for blood tests to be taken locally is significant, and given that blood tests in primary care are significantly cheaper than secondary care and considerably more convenient for patients, this should be an immediate action point to consider further.

The desire for feedback on all test results is also overwhelming. Whilst it is in the nature of such questions – being inherently ‘motherhood and apple pie’ in the likely response they elicit – there is a strength of feeling that suggests the cost benefit of instituting some sort of automated system via email or test should be at least investigated.

Discussion

There was discussion of the survey and many of these points were gone over in more depth. Broadly the survey was felt to be a good indication of the concerns of patients and the areas that they did and did not like.

Two students from Ringwood who had agreed at the previous Patient Group to survey the Ringwood Academy students also supplied the results of their survey and these are attached below.

The desire for blood tests to be taken locally and the nursing capacity to undertake them was a really burning issue which affected many in the group. A Mother of a 12 year old girl with a chronic condition explained how vital it was for her daughter to have them done locally so that she did not miss too much school and in order to be able to maintain as normal a life as possible.

Alison summarized some suggested action points that might be proposed to the surgery, and would circulate these to the members of the group for their further consideration.

Memorandum of Understanding

As the meeting had gone on for some time, this was not discussed, but would be made available on the website for people to review and comment upon.

What we can all do to help the group

Alison explained that it was very helpful if people would continue to attend and discuss what the patient group should be doing and trying to achieve.

She invited people to leave their emails so we could inform them of progress and notify them of subsequent meetings.

Frequency, types and location of meetings