Local Patient Participation Report – 2012-13

St Katherines Surgery has had a Patient Participation Group for more than 11 years. Over the last 12 months there have been efforts to increase the size and diversity of the Group and to recruit new members to replace those who have decided to retire. The Surgery regularly advertises the PPG in the quarterly newsletter, on the electronic screen in the waiting room, on the surgery website, the PPG notice board in the waiting room and in local publications such as Ledbury Focus. The PPG also have a good presence at local events such as the annual flu clinics and attendance at the annual national NAPP (National Association for Patient Participation) conference.

The Group is currently made up of 7 registered patients who have an interest in the provision of healthcare in the local area. All Group members give their time freely to attend bi-monthly lunch time meetings and to support specific events such as the annual flu clinics and Patient Education Events.

Each Member has signed a confidentiality agreement and will have agreed to abide by the following rules:

GROUND RULES

  • We advocate open and honest communication and challenges between individuals
  • We will be flexible, listen, ask for help and support each other
  • As a group we will demonstrate a commitment to delivering results
  • Silence indicates agreement: speak up, but always go through the Chair
  • All views are valid and will be listened to
  • No phones or other disruptions
  • We will start and finish on time and stick to the agenda
  • The meeting is not a forum for individual complaints and single issues

TERMS OF REFERENCE

Purpose

To promote and support improvements of all kinds as approved by St KatherinesSurgery in the health and wellbeing of St Katherines Surgery patients

Objectives

To be established as an important and well recognised link between patients andthe practice

To complement the Practice and other elements of the NHS in ensuring patients are kept informed about issues affecting their primary care.

To ensure that issues common to groups of, or all, patients are brought to the attention of the Practice.

Means

Develop effective methods of communication with patients.

Communicate patient experiences, views and suggestions to healthcare professionals

Contribute to Practice publicity efforts

Sponsor or assist in health promotion events

Establish links with other organisations as appropriate

Membership is open to anyone registered at St Katherines. The Practice has ensured its advertising of the Group is available to all but has found recruitment difficult, particularly in attracting younger members. In order to make participation more accessible to a wider practice population, there has been a drive over the last twelve months to recruit members to a “virtual” PPG Forum. There are currently more than 40 members of this group and advertising this form of participation is on-going in order to establish a more representative group of patients. This Group is still in its infancy, but the hope is to use this Group to gain wider opinion and to encourage constructive comments and suggestions on various topics throughout the year.

PPG work during 2012

The Group have also been canvassing for members of the “Virtual” PPG Forum and will continue this project at all events as well as through the website, electronic screen and in the quarterly newsletters. The PPG and Virtual Forum is also advertised on the back of any letters sent out to patients from the surgery, such as appointment letters for nursing appointments, vaccinations etc.

Privacy at Reception

Last year’s survey highlighted that patients were not happy with the lack of privacy at the main reception desk, and were concerned that conversations can be over heard. PPG members visited several other surgeries in the County to see how they combated this issue. The majority of other surgeries reported similar problems, some were lucky enough to have a separate waiting area, but patients queuing at the desk could still overhear the patient in front. The Practice has the benefit of a hatch away from the waiting area, but it was agreed signage for this option was poor, and so has now been improved, and the music in the waiting room has been turned up a little to distract patients from conversations.

Patient Education Event

Members wished to get their teeth into something for the direct benefit of the patients and so at the PPG meeting in May 2012 it was suggested the PPG arrange a patient education event, suggested topics were diabetes and COPD. Due to the number of patients potentially involved COPD was agreed.

PPG members arranged a venue, speakers and refreshments and the Practice secured some funding from pharmaceutical companies and put together an information pack for patients. 95 patients were invited and 33 attended, which was an excellent response. A speaker from the British Lung Foundation and a specialist GP from Hereford gave presentations and were joined by St Katherines Surgery respiratory nurses for a Q&A session at the end followed by tea and cakes. Feedback forms were available for attendees to comment on the evening, a summary of the results is attached (Appendix A). This was an excellent event, valued by the patients and St Katherines doctors and nurses, and members of the PPG were quite rightly very proud of their efforts. It is hoped a similar event will be organised for next year.

Flu Clinics

In November the Group supported the Practice at three flu vaccination sessions at the local Community Hall, providing tea and coffee to patients and staff, and also giving out information about the PPG and encouraging others to get involved.

Annual Survey

At the July 2012 meeting it was agreed that surveying opinion about the reception/phones/appointments system had been done several times over the last few years, and following results of these surveys, tweaks and changes had been made to increase effectiveness and efficiency, and now it was time to look at a different area of the Practice.

The Practice Nursing Team has asked if they could be included in this year’s survey, as their role within the practice had expanded greatly over recent years. In conjunction with the nursing team, PPG members created two surveys, one based on experiences of patients who attended chronic disease clinics and one based on patient experiences who attended nurse appointments for a procedure.

Members of the PPG spent time in the surgery over a two week period in December and handed questionnaires to patients following their appointments with the nursing team. The results were collated and reported upon. See Appendix B.

Access to Services

The Practice is open from 8am until 6pm Monday to Friday (excluding public holidays), with GP surgeries typically running between 9am - 11am and 4pm – 6pm and nursing clinics running from 8.30am -1pm and 2pm – 6pm. Patients can access services by telephone or in person. Additional services include coil and implant fitting, minor surgery, dermatology, rheumatology and paediatric clinics. Prescriptions can also be ordered in person, via repeat prescription slip, online via the website or by fax. All our services are clearly detailed on the website and in the practice leaflet, copies of which are available in reception.

Julie Knights

Practice Manager

APPENDIX A

Patient Participation Group

Respiratory Information Evening 18th September 2012

Following attending the Respiratory Information Evening, patients were asked to score the following areas, with a rating of 1 – 5 (1 being poor and 5 being excellent). 18 forms from 33 attendees were returned and the scores converted to percentages.

Location/Venue
99%
Organisation of the event
99%
The speakers
98%
The opportunity to ask questions
100%
Do you think you will be able to manage your condition better now than before?
98% of patients felt more able to manage their condition.
2% of patients didn’t answer this question
Would you recommend a similar event to friends or family?
100% of patients would recommend a similar event
Comments and Recommendations:
  • New things learned, helpful and informative evening
  • Well worth attending
  • Very worthwhile, learnt from it, kept to the timetable
  • Excellent gathering
  • Well attended, information well described and available
  • Thank you, an excellent idea

Conclusion

Returned questionnaires showed great satisfaction with the event. I would recommend the PPG give serious consideration to organising a similar event next year.

APPENDIX B

St Katherines Surgery Patient Participation Group

Patient Survey 2012

Introduction

  1. A key role of the St Katherine Patient Participation Group (PPG) is to reflect the views of the patient community to the surgery. The most effective method used recently is to carry out a patient survey from time to time, focussing on a particular area of the practice’s work. In summer 2011 in a major questionnaire-based exercise, the views of 646 patients about the appointments system were canvassed, and the results analysed and reported. In early 2012, a smaller sample of patients’ views were obtained in a less formally structured way by means of interviews in the waiting room.
  1. Discussion within the staff led to the suggestion from nurses that it would be good to find out how their work was thought of by patients. Significantly, nursing services are not generally covered by other surveys such as the annual national GPAQ survey, so a survey of patients’ views on the nursing clinics would fill a known gap.
  1. There are two distinct topic areas for the survey. These are: general nursing clinics, including blood tests, dressings, suture removal, ear syringing, vaccinations etc; and chronic disease clinics, for conditions such as asthma, diabetes, and heart disease. The issues that could arise in the two cases are different, though overlapping, and it was therefore decided that two different questionnaires would be appropriate. These are reproduced as Appendices C and D. The form for the general clinics asks the patient to describe, using a 4 point scale, their degree of satisfaction with key aspects of the way the nurse carried out the consultation. In the case of the chronic clinics, there a different set of questions on the consultation itself, and a further set of questions, with a different 4 point scale, covering patients’ confidence about understanding and dealing with their condition following the consultation. A space was provided on both forms for patient comments. Also included on both forms was an extra open-ended question, asking for suggestions for additional nursing services that the surgery might provide.
  1. The bulk of the survey was conducted in both morning and afternoon sessions on four days over the period 3-10 December 2012. The general nursing form was completed by 120 patients and the chronic clinic form by a further 41. 28 of these were in fact collected after the main survey period, as we recognised that the number of responses from this category of patients that we had been able to collect in the time available was too low. In case it was relevant we recorded the age and sex of patients, and the results for individual nurses were recorded separately. In total 62 patients from the total of 161 contributed written comments.

Measurement scales

  1. The possible patient responses that we included on the questionnaires were intended to match what were judged to be the most likely responses. In the case of the two sets of questions about the consultation itself, the scale comprised: “Very satisfied”; “Satisfied”; “Slightly dissatisfied”; and “Dissatisfied”. This scale is clearly not symmetric; as such, it recognises both that it is possible to feel slightly less than fully satisfied, and that “satisfied” is an absolute that cannot be qualified by a term such as “slightly”.
  1. For the set of questions about patients’ feelings about their understanding of their condition and their ability to cope with it after the chronic disease clinic consultation, we allowed for a neutral answer that indicated that these factors had not been affected either positively or negatively. The four possible responses were therefore: “much more able”; ”more able”; “just as able”; and “less able”. These four are clearly not directly equivalent to the 4 response options for the other sets of questions described above.

Result and Analysis

  1. The data collected from patients shows a very high degree of satisfaction with the experience of their consultations with the nurses, in both the general and chronic disease clinics.

General clinics

  1. The following Table shows the aggregate response to the four questions about the general nursing clinics. The questions concern respectively

1)The nurse’s thoroughness in explaining the procedure

2)How well the nurse explained the need for the procedure

3)Whether it was made clear how to obtain results from tests

4)The nurses caring and concern for the patient

Note 1: Question 3 was considered to be not applicable by 3 patients.

  1. The results are overwhelmingly positive, and when responses from all 4 questions are aggregated, assessments of “satisfied” or “very satisfied” were given in 99.1% of instances. The “slightly dissatisfied” markings came from 3 patients, but neither made any written comment.
  1. Because of the nature of the results, there is nothing to be gained from comparing responses from male and female patients or looking in the data for any age-related factor in the responses. Similarly, it is not considered that there is any evidence of variation in patients’ assessments between nurses.

Chronic disease clinics

  1. The description of the results for the chronic disease clinic patients is split into two parts to reflect the two distinctly different sets of questions. The following Table shows the aggregate response to the six questions about the patient’s experience when attending the clinic. The questions concern respectively

1)The nurse’s thoroughness in asking about symptoms

2)Care in listening to the patient

3)Patient involvement in their own care decisions

4)The explanation of the treatment that the patient was on

5)The nurse’s patience with questions and worries

6)The nurse’s caring and concern for the patient

  1. As in the case of the general nursing clinics, these results show a very high approval rating for the nursing team. Aggregating over all questions, assessments of “satisfied” or “very satisfied” were given in 99.6% of instances. In the one instance of slight dissatisfaction, concerning thoroughness in asking about symptoms, no supporting comment was provided by the patient.
  1. The following table show the aggregated patients’ view of how well they were able, after the consultation at the chronic disease clinic,

1)To understand their problem or illness

2)To cope with the problem or illness

3)To keep healthy

Note 1: A small number of patients recorded no view about some or all of the aspects of the ability to cope with his/her condition.

  1. The results indicate clearly that the consultations in general either maintained or enhanced patients’ ability to deal with their condition.
  1. In the single instance in which a patient responded that after the consultation he/she was less able to understand their illness, no supporting comment was given.

Patients written remarks

  1. A representative selection of written comments provided by patients (some 35% of the total) is reproduced in Appendix E.
  1. None of the comments are in any way critical of the service that was provided by the nursing team at their consultation. Indeed, they are typically very appreciative and at times enthusiastic in their praise.
  1. There were two comments in which patients pointed out that they had difficulty in getting to appointments because of the pattern of their working day.

New Nursing Services

  1. None of the patients answered the question that asked for suggestions for additional nursing services

Discussion

  1. Very strong patient approval of nurses. The survey clearly shows, both from the markings and the written comments from patients, that all the nurses in the St Katherines team are thought of as being of high quality and that the service provided is very good indeed. It is particularly significant that so many patients chose to use the “Very satisfied” marking in their assessments – aggregated over all questions, almost 84% of assessments were in this category.
  1. Coping with chronic conditions. A normal expectation would be that a patient who has been attending the chronic disease clinics for some time would after the consultation be at least as able as before to understand and cope with his or her condition. However, it would be unlikely that they would emerge from the consultation much more able to do this. By comparison, patients recently diagnosed might be more likely to get this additional benefit from the consultation. The expectation therefore might be that the responses would be distributed between “just as able” and “much more able”, with a small number giving a mark of “much more able”. Unless the proportion of newly diagnosed patients was high over the period of data collection, the large proportion of markings indicating that patients were now much more able to deal with their condition suggests that some respondents may have read the text less carefully than others. Unfortunately we did not record whether any patient was a recent first attendee of a chronic disease clinic or an attendee of long standing.
  1. Additional nursing services. A reasonable explanation for the complete lack of a response to the question that asked for suggestions for additional services is in the way the question was posed. It could well be that if a number of examples of possible new services had been givena useful response would have been forthcoming. In the event the question relied on the respondent already having given some thought to this issue. Out of the small proportion who may have thought about it, a large proportion quite possibly didn’t notice the question or didn’t realise that it was actually a question. The question was actually pointed out to many patients as they completed filling out the questionnaire, but none of them were able to contribute anything.

Action Plan