HARROW ROAD HEALTH CENTRE

2012 LOCAL PATIENT PARTICIPATION REPORT

Developing Patient Participation

HRHC developed its current Patient Reference Group (PRG) in 2011. Prior to that, Harrow Road Health Centre had established both a Patient Participation Group and email based Virtual Patient Group. In 2011, in line with national guidelines for improving patient participation, these groups were merged into a constituted Patient Reference Group. The plans and priorities agreed through these groups where also collated into a single practice action plan.

The Patient Reference Group (PRG) operates mainly as an email based forum however there are also two patient meetings held annually in or around April and October to which all practice patients are also invited. Through these open meetings the practice is able to promote and stimulate engaging discussions with patients on proposed practice development plans and explore patient views, priorities and feedback in detail.

The practice initiatives to strengthen awareness of and recruitment to our PRG have been very successful with a growth rate of over 100% in active members over the last 12 months.

Ensuring our Patient Reference Group (PRG) is representative

Harrow Road Health Centre is based in West London in the North East part of the borough of Westminster. The Paddington and Westbourne Green area has a cosmopolitan population with people coming from all over the globe. Our practice patient profile mirrors that of the local wards and has a number of distinct characteristics:

  • The locality

*Compared with Westminster, there is a higher proportion of children aged 0-15.

*BME groups have a high level of morbidity. 61% of Westbourne residents come from BME groups and the area has one of the lowest proportions of White British ethnicity in Westminster.

*Some people in Westbourne only speak their native language. Health services need interpreters and tailored health promotion.

  • High burden of ill health

*Westbourne has the highest number of people on the Westminster Learning Disability Partnership (WLDP) caseload of all the wards in the Borough.

*The number of people with physical disabilities is very high in Westbourne compared with other wards in the Borough.

*Westbourne has the second worst life expectancy in Westminster, mainly due to premature CVD, cancer and respiratory disease.

*Deaths in Westbourne due to respiratory disease are two-fold and mental health/behavioural issues are three-fold higher than the Westminster average.

*Disability-free life expectancy is very low, as would be expected in an area with this level deprivation.

*There is a higher than average prevalence for respiratory conditions, mental health problems and most CVD diagnoses in Westbourne.

*Westbourne‟s admissions are above average for major disease chapters. “Other ethnic groups” have by far the highest hospital admission rates.

*Screening figures are low

*20% of Westbourne patients have 2 or more CVD risk factors such as obesity; smoking; high blood pressure; diabetes; and high cholesterol.

  • High health risk factors

*The Westminster Major Health Campaign showed that there were higher rates of smoking in the area compared to other parts of Westbourne and the rest of Westminster.

*Alcohol related conditions are a problem in Westbourne, with local GP practices showing above average levels of alcohol related inpatient admissions.

*Data from Westminster PCT‟s Major Health Campaign showed that there was a similarly low rate of physical activity in the area compared with other parts of Westbourne and Westminster as a whole

*The prevalence of overweight and obese children is 32% compared with the Westminster Schools average of 25%. Similarly for Year Six children we see 45% prevalence among residents versus 39% in Westminster.

  • High level of deprivation and need as indicated by the wider determinants of health

*Westbourne is one of the most deprived wards in Westminster and in the most deprived 10% nationally.

*The proportion of children under 16 living in low income households in Westbourne is far higher than Westminster and London averages.

*Maximum scores for air pollutants NOx and PM10 intensity and relatively high levels of SO2.

*There are a large proportion of residents who have no educational qualifications at all which is well above the Westminster and London averages.

*Westbourne ward falls within the highest 10 in London for claimants of incapacity benefits for mental health reasons. 5.5% of the total working aged population here claim this.

*Most casualties of RTAs were slightly injured, seven were seriously injured and nobody was killed.

*Crimes involving drugs, robbery and violence against individuals are higher than London averages.

  • Large numbers of refugees, asylum seekers and homeless people

Approximately 20% of the practice patient list are provided with enhanced care under the Westminster local enhanced Homeless scheme

  • High level of people with severe and enduring mental illness

The practice has one of the highest proportions of patients with serious mental health issues within Westminster; approx 2.5% of the practice population.

  • Many patients with drug and alcohol dependency

The practice has over 1% of patients accessing shared care services for substance misuse problems with a larger number engaged in care for alcohol related problems.

In addition the practice has:

  • A large number of patients with a learning disability (c 1%)
  • Approx 1.6% of patients who are identified carers (the practice continues to put in place systems to improve the accuracy of recording of carers)

Our Practice Capitation profiles for Age, Sex, Ethnicity and Language are detailed at the end of this report under Appendix 1.

Our PRG consists of only registered patients and members were, and continue to berecruited using the following methods:

  • Advertising and promoting within the practice – at Reception, in the waiting room and after consultations
  • Focus on high traffic areas for promotion such as labels on repeat prescriptions
  • Through our Email based “Contact your GP” Service
  • Including an open invitation in our Practice Leaflet and in our new patient registration pack
  • Targeted invites (both in person, text and by letter)
  • Promotion and recruitment via our website – focusing on high traffic areas such as online consultations and prescription requests
  • Through our new regular patient education, liaison and awareness sessions which include:

Quarterly GP Led health education sessions

Monthly Awareness Afternoons promoting all onsite services

Monthly “Meet the Manager” Coffee mornings

  • Recruitment via our onsite partner organisations some of whom are highlighted below

To ensure that our PRG is representative of our practice profile, the practice has taken the following approach:

The practice has and will continue to ensurethat its PRG promotions and invitations are targeted towards specific patient groups including those highlighted above. The Practice has referenced its targeted recruitment plans against the latest Health and Well being Assessment report as provided by the PCT and an up to date (December 2012)practice based Patient Profile Report to ensure that it remains up to date. ThePCT and Practice reportsinclude demographic and other profiles including age, sex, ethnicity and language (see Appendix 1).

The practice has sought assurance from the Local Neighbourhood Forum that its recruitment plans as set out in 2011 not only include all the relevant groups but that our targeting techniques build upon local experience of what works best. In addition, the practice has ensured that its PRG plans and activities are all compliant with the Equalities Act, including the amendments made in 2010.

Over a number of years, the practice has worked with local voluntary, community and allied health partners to develop a range of integrated extended onsite services to meet the very specific needs of our patients. The promotion of and recruitment to our PRG through these extended services has assisted significantly, indeed been the major driver in ensuring that our PRG is fully representative. The Practice worked with K&C Link to develop local awareness of our PRG and to also actively recruit patients.

Theservices, partnership organisations and target groups include:

  • Welfare and benefits rights advice service (CLCH Health Support Team); patients who are unemployed and / or requiring other economic support
  • HELP – support service for people in temporary accommodation (in Partnership with the City of Westminster); patients with housing and employment problems
  • Carers support service (Carers Network Westminster); Patients who are carers
  • signposting for Arabic speaking patients(internal); Arabic speaking patients
  • Health Trainers service (The Rain Trust); patients needing support with achieving a healthy lifestyle
  • Older People Champions Group; Older people including those socially excluded
  • Families support drop in service (The Children’s Centre); local young families
  • Injury Prevention for Carers Service (CLCH); Patients who are carers
  • Shared Care Substance Misuse service (Turning Point); patients with substance misuse problems
  • support for sex workers (Praed Street Project); patients working in the sex industry
  • Counselling (Westminster MIND); patients with low to medium level mental health issues

PRG Profile and capitation profile

A detailed demographic profile our Patient Reference Group is detailed in Appendix 2 at the end of this document.

Ongoing and 2013/14 ACTIONS:

Whist our PRG is relatively representative of the overall practice list and local community in terms of age, sex and ethnicity (see Appendix 1 and 2), it remains under representative in the following areas:

  • Arabic speaking patients
  • Particular vulnerable groups including:

Substance misuse

Mental health

As covered in detail above, the practice has employed a number of methods to recruit PRG members to ensure that it is fully representative. We will continue to focus on these over the next 12 months, and, in particular, to address the current under representation in the above areas we will:

Specific actions will include:

  • Arabic Speaking Patients

Improving awareness & promotion of the PRG through our Arabic speaking team members

Develop / provide interpreted PRG promotional material (in Arabic)

Engage with local community groups and champions to improve awareness (e.g. Westminster Refugee Consortium)

Work with key partners to improve awareness and to recruit members (e.g. Bensons Pharmacy)

  • Particular vulnerable groups including substance misuseand mental health

Develop a structured approach to the active promotion of the PRG by all clinicians and associated staff who deliver specialist services to patients from these groups. This will include:

-Including PRG recruitment on the agenda of the inhouse substance misuse & general clinical team meetings

-Integrate PRG promotion into the annual care plan review process

-Promote recruitment at the point of registration

Determining local priorities

Practice priorities were discussed and agreed after considering information from a number of sources including;

  1. Feedback from our 2010/11 patient survey
  2. Review of our Practice Outcome Standards

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  1. NHS Choices patient comments and performance indicators (including 2011 National Patient Survey)
  1. A review of patient complaints and suggestions
  2. Consideration of learning points from significant events and their subsequent analysis
  3. Known or expected local developments (including proposals for the ongoing regeneration of the Westbourne Green and Harrow Road wards) and demographic changes
  4. Known or expected changes to local and national primary care and wider guidelines and regulations including GP Commissioning and CQC registration and compliance.
  5. Practice and patient priorities and issues

The practice engaged in a number of measures to enable wide discussion and debate with patients on what areas that should form the focus of our 2012/13 practice survey about determining local priorities, and ultimately to gain patient consensus agreement. This process included the agreement of the questions to be included in the survey.

The practice -

  • Installed a public display outlining the proposed practice / patient priorities as agreed with the PRG inviting open feedback, comments and other suggestions
  • A virtual display was also created on our practice website, with open feedback similarly invited
  • Emailedthe proposed practice / patient priorities to all members of the PRG for review and feedback
  • The final priorities and survey questions and format were then agreed through an open meeting held with patients and PRG members. This meeting had been promoted to the PRG and all practice patients through the above activities.

2012/13 Practice priorities

* Ensuring goals set in 2011/12 are achieved

* Improve patient access to services and information

* Establish group health education and awareness sessions

* Improve Reception and Administration services and standards

* Involving patients in national developments including GP Commissioning and CQC (Care Quality Commission)

The Patient Survey

The form and content of the Patient Survey was agreed through a detailed process that was carried out in partnership with the practices patients and PRG members. This has been explained in detail above.

Historically, the response rate to local postal surveys has been very low. With that in mind and building upon the success of previous practice surveys, the survey was conducted both by post and in person, with survey forms available within the waiting room and from Reception.

To ensure that feedback was as representative as possible, all patients during a four week period were invited to complete the patient survey, including all patients accessing specialist clinics such as our learning disability clinic and our associated services / clinics (detailed in an earlier section).

A total of 150 survey were returned and completed accurately. The data from the completed forms was collated internally using standard spreadsheets and the results summarised into a short word based report.

2012/13 PATIENT SURVEY – SUMMARY OF RESULTS

  1. Do you feel you have been given adequate information as to how our appointment system works?

92% of patients said yes

2. How do you feel we could best raise awareness about the benefits of our Appointment System?

Leaflets at Reception – 51%

Discussion with Reception – 29%

Open patient meetings – 13%

Meet the Manager – 1%

Other – 5%

3. Do you think we could make any changes to our Appointment system to improve access for patients, including for more vulnerable of our Patients?

62% of patients felt access could not be improved upon.

4. Do you feel there is easy access to the doctor for your children, both on the phone and for appointments?

90% of patients felt that there was easy access

  1. Would you attend open patient education sessions run by our doctors if they were relevant to you?

62% of patients said they would attend

  1. Do you feel that our Reception Service is supportive, informative and helpful?

98% of patients said yes

7. Would you like more information on national developments within the NHS?

55% said yes with leaflets being the preferred way to communicate

them

8. Are you aware of : YES

Our patient information leaflets? 82%

Our online service? 69%

That callbacks are not meant to replace face to face appointments? 91%

That interpreters can be arranged for callbacks? 73%

Our extended range of onsite services? 71%

Summary of key themes from comments and suggestions:

  • The majority of patients who participated in the survey indicated that they were satisfied with the level of access provided and standards of services delivered by our team
  • Suggestions for improvements / developments included:

Increased use and functionality of Email communications

Enhance / promote awareness of services and operations by the use of various tools including information leaflets, patient notices, direct one to one communication (both by Reception and the GP) and through the use of email

Ensure that emergency needs are accommodated; especially for children

Note: The results of the survey are based on a total of 150 completed questionnaires

2012/13PRACTICE ACTION PLAN

  • Improving patient awareness

To implement a comprehensive plan to improve general patient and local awareness of practice services and operations and our approach to providing healthcare. This will be delivered through the following:

Availability of easy to read, widely available promotional leaflets

A core of 4 high quality and easy to read information leaflets will be provided both at the practice reception desk and at local pharmacies. There will be an information leaflet for each of the following:

Appointment information

Services and Waiting Times

Your Usual GP

Local services and Information

These leaflets will be supported by the provision of promotional and educational material through our practice waiting room screens, notice boards and website.

Establishing regular health promotion, education and general awareness sessions

A regular monthly “Awareness Afternoon” will be held in the health centre main waiting room to promote services that are available to local people. Different services will be promoted each month. This will be held on the first Tuesday of every month and be open to all local people.

A schedule of events will be promoted in new display units that will be erected on the front of the health centre. The schedule will also be available on the practice noticeboard and website and will be periodically cascaded to all local partners and PRG members.

Newquarterly GP health education and awareness sessions

The practice has started quarterly health education and awareness sessions in our main waiting room. These are lead by the GPs, who give a talk and facilitate discussion and questions. These are held on Thursday afternoons between 1pm and 2pm and are open to all local people. We will be asking the PRG and patients at large for suggestions as to which topics they would like covered in future events.