Elm Lodge Surgery Patient Participation Report and Action Plan2013-14

Elm Lodge Surgery Patient Participation Report and Action Plan2013-14

Thank you to everyone who either filled in a survey or attended a group, virtual or physical!Thank you particularly to everyone who provided feedback either by emails or in person regarding the action plan and enabled us to improve and amend the original version.

The full results of the survey can be found by the link on the front page of our website (just below the link for this report – we thought this document would be too long with the results attached on the end). There are also paper copies in reception and larger print versions can be produced on request.

On the percentages on the survey we have used whole numbers – the software rounds down to the next number down so 2 or less replies to any question is shown as 0%, for which apologies. Next year we will show at least one decimal point in the percentages. Copies of the actual numbers for the survey and from peter.hall2at nhs.net (need to add@ in place of at!) or via reception.

The key survey results

There were some very positive results

• 93% would be happy to see the same doctor or nurse practitioner again.
• 68% of patients would “yes, definitely” recommend the surgery and another 14% “yes, probably”.
• The nurses’ results were excellent again – all those who responded would be happy to see them again.
• 37% described their experience of the surgery as excellent & 34% very good, 15.8% good.

The action plan is based around the following:

• 48% only could get to see a doctor urgently on the same day.
• 73% thought it was important to be able to book ahead but we are aware from patient comments (and the comments from our patient meetings) that this is difficult to do.
• 23% said it was “Not very easy” and 13% said “It was not at all easy” to get through on the telephone HOWEVER whilst 28% wanted an automated telephone answering system, 32% did not, with 26% having no strong feelings , not presenting a case for the fully automated system
• 16% were unhappy with the opening times but, whilst not a large proportion of responses, we are aware from patient comments that this is a very important issue for this group of patients and could affect their health care if not addressed.

As a separate point about the problems with telephone answering one patient commented:

“Having to sit for 20 mins for an appointment that is now 10 mins late (and counting) and listening to the endless ringing of a phone which no one answers is absolute torture”

It’s not only the stress of trying to get through but the ringing of busy phones when you’re waiting – and the stress for the reception team knowing there are so many people waiting.

Our action plan arising from the survey & patient group feedback

Rather than spread our efforts over a number of areas we wanted to focus in our action plan on the areas of key concerns identified, namely

• The appointment system , especially with reference to booking ahead
• Getting through on the telephone
• Access for those who find it difficult to attend the surgery with our current opening times

We are very limited in our options around extra staff and doctors due to funding limitations so the plan focuses on making bets use of the resources we currently have, providing more advice to patients and information about services and developing the online system further to reduce pressures on the telephone, looking at collaboration with local practices to give out of hours appointments, and seeing what technology is available to improve the telephone system without going for a fully automated system.

The specifics:

• Further training for our staff to ensure our the new software system is used to its full potential (so that the receptionists and doctors spend less time battling the software and more time seeing patients or answering the phone – we had to change at a busy time and need to fill the training gaps)

• More publicity in the surgery for the online system for booking and prescriptions

• Experimenting with an increase in appointments which can be booked ahead, and possibly different lengths of appointments

• A review of our workflow on reception and look for efficiencies so that staff are released to answer the phone

• To publicise the advice service and medication review provided by our local pharmacies

• A list of FAQs (frequently asked questions) on the website with further health – related information so that a telephone call may not be needed in the first place

• A review of how much more we can use telephone consultations (without increasing risk!)

• Research to see what telephone technology is available which will make our call answeringmore efficient (not an automated phone system as there was not strong support for this – only 28% in favour, with 32% against – but will look at something which perhaps will indicate how many calls there are ahead of you)

• Exploring partnership with local surgeries to jointly provide more appointments out of hours.

Progress from last year

The action points and plan from last year were discussed at the meeting on 9 May 2013 and subsequently during the year and we did make progress!

The plan was as follows:

• Extra appointments (to be provided by our new nurse practitionerwho starts on 8 April )
• Encouraging use of our new online booking and prescription service
• More appointments which can be booked ahead, especially through the online system
• The practice to review the options for an automated telephone system (if funding can be obtained) and bring proposals back to the patient group for further consideration
• A publicity programme reminding patients that appointments are only for 10 minutes, a “who does what” guide and providing guidance on how best to use the appointment time
• Providing more early and late appointments, initially with the nurse practitioner, but also to keep under review opening before 8 and after 6.30
• A review of electronic solutions to improve access and provide information, beginning with an email address to receive routine correspondence and investigating an option for providing results to patients by an e-solution

The nurse practitioner appointments proved very successful! Sadly Anne Sweeney, our first nurse practitioner, left us in December to return to Northern Ireland. Diane Singers has provided locum cover over February and March(and we hope to keep the connection) but Anne Dickson, our new permanent nurse practitioner joins us on 2 April – again providing extra 8 am appointments.

We now have approximately 9% of our patients registered on the online system, despite having a new system (not anticipated last March) and needing everyone previously registered to re-register! As can be seen from the current year’s plan, the

Task now is to get wider and more effective use.

We increased the number of appointments booked ahead, especially taking advantage of the online system as planned (special stress on earlier and later apppointments bookable online). We need to take this even further judging by the response in this year’s survey – and hence the further point in the action plan.

We did review the idea of an automated telephone system and had a very mixed response. We used the survey this year to ask a direct question and attempt to finally resolve the question. This year we are looking at technological alternatives which will improve things but which are not a fully-fledged automated system.

The publicity programme fell short of what was originally intended. The “who does what” guide didn’t materialise and this will be rectified this year. However, notices were put up around the surgery (and in clinical rooms) reminding patients that appointments are for 10 minutes only. When we discussed the idea further of a “how to use an appointment, what is your main problem” guide there was again mixed responses within our team and a feeling that for normal consultations this might affect care. If someone tells you as their third problem something serious the clinicians would not be happy to let the patient leave the room. At present only the diabetes recall system uses this type of approach. We have plans now to extend this to other chronic disease review processes if not the main surgery appointments

More early and late appointmentswith the nurse practitioner proved a success as also did those with Dr Kemp. We also usually added an additional late appointment on the clinicians’ rotas – not radical but having more 6 pm appointments did help a little!The new nurse practitioner will continue to provide 8 am appointments(which was not possible for our locum Diane)

Electronic solutionssaw progress during the year more than expected insome ways but not as much as hoped in other.

The biggest change was the practice adopting a new patient software system, which, as many of you will know, caused massive disruption, but we hope will provide benefits in both the online services but even more in the care we can provide to patients. After an initial difficult period (and note this year’s plan point regarding training)we are now beginning to see the benefits. We now are using email more routinely for both receiving clinical correspondence and letters from and to our patients.

We have not yet published on the website a practice email address and are unsure if we feel comfortable doing this yet for anti-spamming and security reasons, but make an address available to any patients who ask.

We will in all likelihood an e-results system when this is made available by our new software provider.

It hasn’t always been an easy year with staff sickness and unexpected leave, plus the new computer system, but we feel we are now almost back on an even keel!

And many thanks for your support and patience during the year!

How we agreed on the action plan

We reported the findings from the survey by a presentation to the patients’ meeting in the surgery on 27 March 2014 of the initial results, with action plan, for consideration review and approval.We sent the same to the virtual group on the same day.

After both physical and virtual exchanges (for reference we received 12 positive responses from the virtual group, qualifying comments but no negatives to the overall plan), the action plan wasagreed with some amendments, particularly to look further specifically at whether we could introduce a system where a caller knows how many patients are in front of them or similar technology. Also we agreed that the surgery would publicise the services of local pharmacies as an important resource to improve access. Some disquiet was expressed at the possibility of using a partnership with local surgeries to provide earlier and later appointments, but this is mainly a necessity due to limited resources.

The final version of the report was emailed to the virtual group on 31 March (and that will be today if you are in the virtual group and have opened the email immediately) and copies made available in our Reception area.

The action plan will also be brought to a patient meeting on 9 May for an update on progress, with similar to the virtual group on or around that date.

Nuts & bolts – when our groups met, surgery details

What are our groups and who are in them?

We have a physical PPG which met 4 times this year. 21 people attended over the year. The make- up of this group is mainly over 75 years old (14 of the people who attended – 6 between 65 and 75, 1 under 65), mainly female (19), predominantly White English. As 6% of our patients are 75 and over, who face increasing care needs, this is an important group for us.

Our virtual group provides a forum for patients in other age and ethnic categories.

The balance virtual group experiment with currently has 92 members, a significant increase from 42 last year due to a recruitment drive.

Emails are sent at periodic intervals to the virtual patient group and there are also individual exchanges of emails with Peter Hall, the practice manager, on an “ad-hoc” basis. We are also discussing whether we might begin a social media type chat room although we are unsure whether we have the capacity to administer this.

Emails this year have included advising progress on last year’s action plan, requesting feedback on the new online system, assessing the priorities for this year’s survey and various regarding the survey results and action plan with individual emails covering various subjects with emphasis on appointment system problems, including telephone, and the online system. One group member is providing invaluable advice regarding possible changes to the telephone system. Another patient very kindly provided us with training on Information Governance, one of her areas of expertise.

We feel the two groups, combined with the survey, are representative of our practice population.

With regard to ethnicity 3 % of survey respondents were Black or Black British and 3% were Asian or Asian British. In the virtual group 5% are Asian or Asian British, with 3% Black or Black British.

This is in accordance with the practice ethnic splitwhich is approximately as follows (on declared ethnicity):

Asian or Asian British4.2%

Black or Black British4.0%

The virtual group is 32% male, 68% female. The survey response is slightly worse (26% males) so it may be that this reflects users of practice services (we don’t currently have statistics of ageder appointment splits). As this was a similar split to last year, and we have again attempted to further recruit, we think this is the most realistic we can get.

With regard to the ages of the group members these are the figures for the virtual group and survey responders compared to the practice age profile.

Fig 1: Breakdown of age profile of virtual group compared to practice population

TOTAL PATS / VIRTUAL PRG
Age ranges / 7586 / 99
0-15 / 1750 / 23% / 0 / 0%
16-44 / 2845 / 38% / 28 / 28%
45-64 / 2085 / 27% / 42 / 42%
65-74 / 475 / 6% / 16 / 16%
75 & over / 431 / 6% / 13 / 13%

The age split of the survey respondents is 16& under 1%,16 – 44 31%, 45 to 64 44%, 65 to 74% 8% and 75 and over 11% (15% no response)

The virtual group roughly matches the age spread of the total patient group with higher and lower percentages in the older and younger age groups for obvious reasons.

We have no users under 16 in any groups and our conclusion is that we must rely on there views to be mediated through those of their parents.

We do not hold statistics for working/non-working/ retired people in our practice population but we do have a high proportion of fulltime working and retired.

As indicated above, the views of our housebound and frailer patients are strongly presented by our Chronic/Elderly care nurse, who acts as advocate for them, and Peter’s response to complaints/comments raised by patients and their families. The high proportion of over 75 year old patients in our face-to-face group also provides a voice for them.

How we recruited to the groups

Details of groups and meeting dates are advertised on the website.

The meetings of the face-to-facepatient Feedback Group were advertised in the waiting room.

When we circulated details of our new online booking system in February (approximately 600 - 800 patients – some problems with emails sending/receiving hence the uncertainty on numbers!) we also took the opportunity to advertise the virtual patient group.

We also advertise our patient groups via our new patient questionnaires.

How we decided on the survey questions, the numbers of surveys received, how we collated the results and how we reported the results to our patients

1. The survey questions

We took the following steps in preparing the survey:

• We discussed priorities for the survey in the December patient meeting in the surgery.
• We sent a survey monkey questionnaire round to the virtual groupin March (see below).
• We took into consideration complaints and informal comments from patients and also comments on NHS Choices

So that the survey was more effective we decided to focus on those areas which were of the highest priorities to our patients – clinical care, the difficulties getting through on the telephone, the appointments system and opening hours(the latter a smaller percentage but an important issue for that group of patients)

The physical patient group’s priorities were the telephone system and booking ahead.

The priorities for the survey from the virtual group (26 responders) were

Appointment system 31%

Clinical care14%

Telephone answering 20%

Opening times 16%

Services provided 12%

2. How we distributed the surveys