Patient Participation Report 2013-14
How the Patient Participation Group (PPG) has been developed
Jubilee Surgery has a current patient population of 9325. The age/sex breakdown is shown below. (Fig1)
Total practice population Fig 1
Our Patient Participation Group (PPG) is made up of a small core group of 14 individuals who meet with one of the doctors and the practice manager every three months, and a “virtual” group of 450 patients who can be contacted by email, text, phone or post (Fig 2) As you can see from the graph we have a higher percentage of female patients in most age groups, they are more likely to visit the surgery for routine screening and therefore be more aware of the issues.
We invite other members to the core group as required or when patients express an interest.
Two of our core group members are also on the Fareham & Gosport Patient Representative Locality Group which includes members from all local practices.
PPG population Fig 2
All new patients, over the age of 16, are asked if they would like to join the virtual group, we also have posters and leaflets in the surgery advertising the group, and information and a form on our website for patients who may wish to take part. In addition we have mentioned the group on a recent article in the Titchfield Parish Magazine along with other information about the surgery.
Ethnicity
Jubilee Surgery does not have a high minority ethnic (Fig 3) but we have virtual PPG members from this group as shown in Fig 4.
Total Ethnic Population Fig 3
Virtual PPG Ethnic Population Fig 4
At a meeting on 17th March 2014 the core group considered that we had good representation from all areas, and that the current strategy for recruiting to the PPG was working.
PPG meetings were held at Jubilee Surgery on the following dates:
6th March 2013
14th May 2013
6th Aug 2013
12th Nov 2013
14th Feb 2014
With an additional meeting to discuss the findings for the report on 17th March 2014.
In August 2012 the practice had the sad loss of their practice manager Jan Bell, This role was not filled until March 2013 and so there was no published survey or PPG report for 2012-13. However the results of survey for 2012-13 were collated and discussed at the PPG meeting on 14th May 2013, and a poster summarising the results displayed in the waiting room.
At this time the virtual groups had not been set up although we had received over 350 applications forms. These were collated into 4 groups all covering a range of age and sex. The resulting groups now form our virtual PPG. As we get more applicants they are added to the groups up to a total of 100 per group, we anticipate that we will exceed 500 virtual members over the next year.
Patient Surveys
We are required to carry out at least one patient survey each year, this helps to shape and improve our services to patients, and gives our patients the opportunity to share ideas and comments. In 2012-13 the survey was developed by the small PPG group and the practice manager. Responses were received from 90 patients, results from this were collated in 2013 and the following actions taken. The information below was displayed in the surgery.
Jubilee Surgery – Patient Survey 2012-13
From the 2012-13 survey we have made the following changes;
Updated telephone system / We had our existing phone system updated in the summer 2013 to help direct your calls to the best person to deal with your query.PA System / There is a new PA system for the doctors to call you in, and we have a hearing loop in reception for those who have hearing aids.
Appointment changes / We have made new slots available that can be booked one week, or two weeks ahead for routine appointments – these become available at 8:00am and 2:00pm each day. We have also added telephone follow up slots, 24 hour appointments, and increased the number of slots available to book on-line.
Toys and magazines / We have reinstated the children’s play table and try to keep a regular supply of clean magazines for you to read – if you have magazines you no longer need we are always glad to have them to replace any which are getting worn.
Text alerts / We are using texts to remind patients about appointments, or when flu vaccinations or Blood Pressure checks are due. Please make sure you keep us updated with changes to your mobile phone number.
Jubilee Surgery – Patient Survey 2013-14
The practice undertakes an annual Patient Survey to monitor and improve our services. This is developed with input from our PPG group, who decide on the areas to audit. We try not to repeat questions used in the previous year, and include questions on both the staff and services.
The core PPG group discussed the possible questions to include at our quarterly meeting on 12th November 2013. We had around 20 questions which had not been used in the past 2 years from which they chose 9 questions which looked at the appointments system and how it was used, the clinicians and whether the patients felt that they were involved in their care, prescribing and the ease in obtaining repeat medication and the overall experience when attending the practice.
The survey was offered to patients attending the surgery for 4 weeks, some members of the PPG spent time in the waiting room handing out survey forms and answering questions about it. There was also a notice in the waiting room and a box for the return of completed questionnaires. We received 222 paper survey forms from patients.
In addition the survey was posted on the internet through Survey Monkey, and the link sent to all our virtual PPG patients and any other patients who had consented to receive emails from us. We also put the link in our newsletter and on posters. At this time we had not completed development of our new website so were unable to add a link to it. We received a further 187 responses to the on-line survey.
All responses for the questions were collated and discussed at the PPG meeting on 11th February. The results are as follows:
Questions and answers
Q1. 411 patients responded
Q2. 411 patients responded
Q3. 356 patients responded
Q4. 409 patients responded
Q5. 405 patients responded
Q6. 406 patients responded
Q7. 407 patients responded
Q8. 397 patients responded
Q9. 407 patients responded
Additional comments
In addition to the results of the questions, Dr Karen Postle one of the PPG members collated all the comments from the survey for a qualitative analysis. We have used these to formulate an action plan for the coming year. A core group from the PPG met on Monday 17th March to discuss the actions, and comment where it may not be possible to implement change at present. Where possible we have discussed and included expected time frames.
Once compiled the report was sent to all members of the main PPG group for review before publishing and sending out to 100 members from the virtual group to request further comments.
The qualitative analysis is based on grouping “like with like” responses.
103 respondents did not make any comments at all.
Comments from the practice giving further information are shown in italics.
Comments about staff / 33 patients commented positively about staff saying they were pleased with the service.There were 21 positive comments about GPs
5 positive comments about nurses,
6 positive comments about receptionists.
Action – priority for all staff:
There were 24 negative comments which dealt with specific incidents or individuals, usually about abruptness or unhelpfulness, which have highlighted a further need for training in customer service for all staff.
The staff have regular training meetings and customer service is always part of the session. All staff are reminded that patients are often worried or feeling ill and need to be treated with compassion and empathy. We are going to undertake further training by July2014 with external trainers to raise awareness of this very important issue.
Appointment System / There were a number of comments about the appointment system (number of patients with this comment are in brackets):
· Lack of future appointments (11)
· Future appointments too far ahead (22)
· Difficult to get appointments when you work (32)
· Hard to get an urgent appointment (4)
· Online booking too hard to use/fails (4)
· Too many different methods to book appointments (1)
· Want online booking (1)
· Unaware of extended hours (1)
· Didn’t like triage system (1)
· Didn’t like telling the receptionist what was wrong (1)
This is a priority action.
From April 2014 a new system will be introduced, each day the duty GP and a nurse will triage all requests for appointments. It is hoped that this will help relieve the pressure on the system, and that some patients will have their problems dealt with by a telephone consultation. A similar system is used successfully at other local practices.
The comments also highlighted the need to further publicise the new appointment system, on-line booking and extended hours and this will be done by April 2014, using newsletter, website, posters, emails, texts and another Parish Magazine article.
Receptionists do ask for some idea of the problem for patients needing treatment urgently, or for nurse appointments, this is to assist us in giving the patient the correct type of appointment. Patients can decline this information, and will then be put through to the clinician doing triage who will be able to give them an appropriate appointment.
Waiting times / 22 patients commented on the length of time they were waiting for booked appointments. - GPs will where ever possible give patients the time they need to resolve their problem and investigate issues fully, this can lead to delays.
2 patients felt their wait was longer while the doctor had a chat and a coffee – Doctors will sometimes take a comfort break during their 3 1/2 hour surgery and catch up with colleagues to discuss patients they have seen.
There were useful comments about how we could advise patients on the likely length of wait including using the check in screen.
Action:
The practice used to add comments to the electronic check in screen, but this had stopped working. As we now have a new screen we will endeavour to set this up again before the end of March 2013.
Telephone System / 6 patients reported problems getting through
4 complained that they were kept waiting on the phone for a long time – The receptionist dealing with your call will often have to get further information which can delay her completing one call and answering the next.
2 patients would like to see more receptionist answering the phone and on the desk. –We currently only have 4 phone lines. In the morning and other peak times we have three receptionists answering the phone and one on the front desk, at present we don’t have space to increase this – although this is something we are considering to change in the future.
1 patient wanted a text phone system for those who are deaf or have a speech impediment – We offer on-line booking of appointments for those who struggle to use the telephone. We can send text messages as reminders but do not currently have capacity to monitor incoming text messages although this may be available in the future.
Action:
We are still aware that the current phone system may not coping with demand, nor meeting our requirements. We are looking at changing to a new supplier who may be able to offer us a better system, we expect that this will be changed during the summer 2014.
Issues with GPs / 6 patients always want to see the same GP – where possible we will give the patient a routine appointment with the GP of their choice, however, if it is an urgent problem we will always offer an appointment with one of the triage nurses or GPs on the same day. We hope that our new appointment system will make it easier to be able to offer patients the GP of choice.
3 patients would like to have more female GPs available. – Dr Naylor is currently our only lady GP, although Dr Nicola Wood will re-join the practice at the beginning of August for a year. When we have to book locum doctors we try to use females to give patients more choice.
Action:
We will be reviewing our GP hours in 2015 and may consider increasing our female GP sessions then.
1 patient wants to be able to see the doctor about more than one problem. – At present most of our GP slots are 10 minutes, in some cases they can deal with more than one acute problem, but many chronic problems can take a long time. If the doctor feels it necessary they will arrange for the patient to have longer appointments.
Ordering prescriptions / A number of comments related to repeat prescriptions; we have included explanations for each one.
Some patients wanted to:
1. Order and collect on the same day – We are contracted to do repeat prescriptions in 48 hours. This is to allow time for the prescription to be issued, checked and signed by the GP, and to allow for any queries that may arise to be dealt with. As we receive requests for around 200 prescriptions each day, working through the whole process on the same day would be impossible.
2. Order medication for 6 months at a time – the only medication issued for 6 months at a time is the contraceptive pill. All other medication can require monitoring, give side effects and needs to be reviewed to ensure that it is not being over or under used. If medication regimes are changed issuing large quantities can lead to costly wastage and it is everyone’s responsibility to try to reduce waste and keep costs under control in the NHS.