ST JAMES SURGERY
2013
PATIENT REFERENCE GROUP REPORT AND ACTION PLAN
2013 – 2014
INTRODUCTION
In 2011 St James Surgery opened a Patient Reference Group which is available to all patients. It is run virtually via internet contact and at the last count had over 100 members. This group gives those patients who do not regularly attend the surgery or those who find it hard to get to the surgery the opportunity of having an input into the running of their practice.
Three groups we had previously found difficult to engage with, were mothers with children, single parents and the house bound. This medium gives these groups an opportunity to take part. The list is permanently open and can be accessed through our website and information is available in our practice leaflet and in the surgery.
PRACTICE POPULATION AND METHOD OF ENGAGEMENT
The practice has 6639 patients which are made up of inhabitants in Devizes and the local villages within a 7 mile radius. Our records show that our patient population is predominantly white British with less than 1% who consider themselves of an ethnic minority. Our own carers’ register of 95 demonstrates the number of patients that have either a terminal or long term condition that requires further support.
The patient population at December 2013 was 6639. The practice profile is as follows:
1760 patients aged 61 or over
3347 patients aged between 21 and 60 years
1532 patients under the age of 20
The practice population is split 3372 female and 3267 male patients.
In order to gain the widest response possible it was decided:
- To send the survey to everyone on the Patient Reference Group register
- To email those patients who had given us an email contact address
- To have the survey available in the waiting area and at reception for all patients who attended the practice
- To have the survey available on our website
- All members of staff (where appropriate) to mention the survey to the patients so they could collect a survey
- To actively engage with the Patient Liaison Group and to enlist their support and advice to attract as many people as possible
- To put an invitation on repeat prescriptions to take part in the survey
CONSULTATION PROCESS FOR THE 2013SURVEY
Dealing with the demands on appointments for all the clinicians has been a challenge and considerable worry to the practice since 2011. It was felt that a radical new approach has to be found to deal with the increased demand and to offer as wide a choice as was possible to our patient list. This subject has been a top priority for the Patient Reference Group (PRG) and,together with the surveyresults from March 2012, had been instrumental in instigating a new approach by the practiceto the appointments system.
Many changes were made to the system and therefore it was decided to audit these changes to validate the success was important.
Below is an extract of the letter sent to the PRG members and to all our patients who have supplied us with an email address.
It has now been nearly two years since we first asked your opinion about our appointments system by conducting a survey in March 2012. The contents of this survey were then professionally analysed by a company called “Survey Monkey” and the results published in a report which is still available to view on our website. We made changes to our system then and in October 2012 we carried out a further survey to see how well the changes had been accepted.
We have, since then, made further changes and improvements to the appointments system. So we are asking once again if you would be willing to express your views by taking part online in our 2013 Appointments Survey, This will enable us to audit the results of the changes we have implemented since our last appointments survey, and look at whether any further amendments should be made to the system.
A decision was also taken to include one question to raise awareness of the problem of patients who do not attend their appointments and who do not cancel in advance. On average, over 120 appointments are lost each month, the equivalent of 7 clinical sessions. This amounts to over 3½ days of doctor consultation time.
By raising awareness it was hoped that more patients would cancel their appointments in advance and also understand that one of the reasons we are short of appointments is because so many are wasted annually.
PROCESS FOR THE QUESTIONNAIRE AND CREDIBILITY FOR THE SURVEY
A number of decisions were taken:
- To keep the survey short and simple as possible but to add a question regarding patients who do not attend their appointments, or cancel.
- To have the survey available for completion for at least 6 weeks.
- To use an independent systempowered by Survey Monkey, a recognised survey tool, that could also collect the data and provide a valid computerised analysis.
- To make the survey available on the website for anyone visiting the site with a link straight through to Survey Monkey
- To make it available to patients attending the practice who were invited to complete the survey during their visit to the practice.
THE SURVEY WITH RESPONSES
PATIENT SURVEY 2013 -14 APPOINTMENTS SYSTEM
- How often have you visited the surgery in the last 3 months?
85.5% of responders had visited the practice at least once.
14.5% had not made an appointment or visited the practice.
- Were you able to see the doctor of your choice??
93% were either able to see the doctor of their choice or they did not mind who they saw.
7% were unable to see the doctor of their choice.
3As the doctors’ appointments are open 4 weeks in advance, were you prepared to wait to see the doctor of your choice?
38% of the responders were prepared to wait to see the doctor of their choice and another 42% did not mind who they saw if they could be seen quickly.
10% were not prepared to wait and 4.5% were unaware that appointments were open 4 weeks in advance.
(editor note: this could have been because they had had no reason to use the practice appointments system).
4Were you offered an appointment with one of the doctors within 3 days?
YES29%NO65%
5If you were offered an appointment in over 3 days, was it…
4 – 7 days ahead - 58%
More than 7 days ahead - 39%
2% did not know
6If you asked for an appointment on the day, was this because ….
44% responders felt their problem was urgent for that day.
24% of responders felt their problem could not wait 4 days for a routine appointment.
32% stated this is was not applicable.
7The practice has appointments from 8:30 am – 6:30 pm. There are also some appointments available between 6:30 and 7:45 pm every week. Would you like to see these later appointments reserved for those who work?
YES 79% NO21%
8Over 120 patients do not attend their routine appointments every month. This puts a huge strain on the appointments system and is a waste of both NHS resources and our doctors’ consultation time. We are looking at ways of reducing this number but always welcome any suggestions.
RESPONSE
The survey was initially sent out in November by email to all our patients in the PRG as well as all patients who have registered an email address with us.
A reminder to complete the survey was sent out in the middle of December.
Questionnaires were also available in the practice and patients were encouraged to partake. Those that were completed in the practice and elsewhere were uploaded directly on to the websitebringing the total number to 258 patients who responded and completed the survey. This response rate was slightly less than the one in 2012.
RESULTS OF THE SURVEY
The full results of this survey can be viewed as an addendum to this report or on the practice website.
3.9% of our total patient numbers completed the survey. It was felt this was a reasonable response. As the survey was anonymous, unless the patient identified themselves, it was not possible to analyse the patient demographic.
The survey was designed to look at the results of the changes that had been implemented during the year and to take into account the changes that have been made over the last 2 years. The questions were put together by the surgery working party that is responsible for investigating, devising and improving the system.
PRIMARY RESULTS
- 93% of the patients were able to see the doctor of their choice.
- If they were unable to see the doctor of their choice they were happy to see another doctor.
- Over 60% of patients are offered a routine appointment within 7 days.
- 44% of the people asked requested an appointment on the day because they felt it was urgent.
- 79% of the patients felt the evening appointments should be for working people.
- 3/5 ths of the patients wanted to make a comment about the ‘no shows’.
Some Views/Remarks regarding the patients who do not attend their appointment and do not cancel:
- They should be fined
- After 3 DNAs they should be asked to leave the practice
Other views
- Send text message to remind them
- Send emails to remind them
- Ring and ask them why they did not show up.
- Offer a cancelation line
All the above (3 – 6) have already been implemented; text message reminders have been used for 2 years.
REFERENCE GROUP
The reference group were informed of the results of the survey by email and were invited to attend a meeting in the practice on February 4th 2014 to discuss the findings.
Reference Group Meeting
The meeting was held on February 4that St James Surgery. There were 3 Doctors, the Practice Manager and 1 Receptionist/Admin Staff, plus
12 Members of the Patient Reference Group in attendance.
The agenda items covered the results of survey and as a separate item the comments on the DNA problem.
Results
283 patients responded to the survey. A synopsis of the results :-
- 85% had visited the practice within the last 3 months
- 93% had seen the Doctor of their choice or did not mind who they saw.
- 38% were happy to wait to be seen by the Doctor of their choice
D.42% didn’t mind who they saw if they were able to be seen quickly
E.29% of patients were able to be seen within 3 days
F. 60% were able to be seen within 7 days
G.Of those patients who had requested to be seen by a Doctor that same day, 44% considered their problem urgent.
H.79% felt that evening appointments should be reserved for those patients who work during the day.
Comments Arising
Joss Green Armytage & Dr Downey mentioned that in general the appointment system is working well and a considerable improvement in patient access within a week has been achieved. St James Surgery access achievements are very favourable when compared to (or are equal to)national statistics. The new system was explained with the emphasis that the number of available-to-book appointments had been increased about 6 months ago, with the introduction of 10 bookable appointments within the Emergency On Call Doctors daily schedule.
Also, it was explained that it was not possible to offer evening appointments solely to working patients sincethis would discriminate against other patients seeking such appointment times.
Comments –DNA
It was explained that St James Surgery does have a policy to write to those patients who DNA 3 times within a 12 month period and if appropriate, after review by the clinical team, patients could be removed from the Surgery list, which means that the patient has to find an alternative surgery.
That the surgery uses its best efforts to ensure that patient records are up to date with mobile telephone numbers and e-mail addresses; however the success of text messaging is reliant on patients keeping the practice informed of any changes.
The Surgery text messaging system allows patients to receive both confirmation of their appointment and reminders of appointments by text. It also generates text messages to advise patients when they have missed or DNA’d their appointments.
ACTION PLAN
They following suggestions were made by the Patient Group:
1.That patients should be given the facility to text cancellation requests
2.On line cancellation facility should be provided
3. Provide an on line appointment booking – Dr Downey explained that the intention is to achieve this within 2014.
4.Every patient who has 2 DNAs within a 12 month period should get a letter. There was also a suggestion that perhaps there might be a way in which the computer system software could be programmed to auto generate such letters.
The following was suggested but is not really appropriate to action for the reasons stated:
5.The question was asked if the Surgery could use a name and shame policy working around the patient confidentially issue, maybe by using postcodes for example? However, there was a real concern that this would break not only patient confidentiality rules but data protection laws as well.
CONCLUSION
The Patient Group were very happy with the survey content, feedback given by St James Surgery and for the time taken by the Doctors and staff at the surgery in attending the meeting. They thanked the Surgery for the ongoing work with the Patient Reference Group to find solutions when problems arise or exist and forcontinually improving the service to patients.
Published March 2014
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