Full Report on the Recent Patient Consultation

During the period December 2011 to March 2012 we undertook a patient consultation exercise. This is described in detail below. A Summary is available from Reception, or through the website.

We followed a standard 6-step process, in accordance with Department of Health Guidelines.

This report is structured in accordance with Hampshire PCT Guidance.

Step 1:Develop a structure that gains the views of patients and enables the practice to obtain feedback from the practice population, e.g. a Patient Consultation Group

1.1 How we analysed our practice profile.

We established the practice profile from the clinical database, as being the most reliable source. Full information was available on the age and gender of patients. Following consultation with the PCT, we opted to select slightly different age bands from the usual 15 – 25 etc, as can be seen below. The rationale was to try and find groupings which were more likely to have common needs, and could more easily be approached through a channel appropriate to their age and likely interests. As children of 12 and under are unlikely to be able to respond effectively for themselves, we have added their numbers to the 25-39 age group, which will contain a majority of their parents. The resulting percentages are summarised as ‘Adjusted %’.

The practice population is almost exactly equally split by gender:

On ethnic origin, we had data for 3,071 patients, just over a quarter of our practice population, which number is more than sufficient statistically to support an assumption that this distribution is representative of the wider patient population. Patients declaring themselves to be British, mixed, British, or White British constituted the overwhelming majority at 87%. The only significant sub-groups were:

  • Other White, at around 5%. Our clinicians were unable to identify any particular group that might make up a significant component of this group, and who might therefore have particular needs.
  • A small Indian or British Indian contingent at around 2%. This group as really too small to target, but clinicians were in any case not aware of any particular issues this group might have.

As a result, we did not feel there was a case for targeting any particular ethnic group under this DES.

Given that ethnic origin did not seem to be a significant issue, we also greatly condensed the number of ethnic groupings from the above list for data gathering purposes during PCG recruitment. Given the difficulty in securing returns, we omitted it altogether from the questionnaire, to economise in the number of questions asked, in the interests of improving the response rate.

In addition we investigated the numbers of patients in some other groups as shown below, but did not feel these were sufficiently large in number to form the focus of this first round of consultation, at least:

1.2 What methods we usedto invite members to join the PCGthis time, and what methods will be used in future

Here in St Luke’s we already have an active Patient Participation Group (PPG). To emphasise the difference between them and the group being put together as part of the current exercise, we have chosen to call the latter our Patient Consultation Group (PCG):

  • Patient Participation Group (PPG). Meet monthly, actively join in various events at the surgery, eg flu clinics.
  • Patient Consultation Group (PCG). Primarily for consultation, rather then active participation, although will be invited to consultation evenings following the issue of questionnaires, to discuss findings and actions.

The two primary means of recruiting patients to the PCG were:

  • Handouts available at Reception, and also advertised on the large screens in the waiting room.
  • Information available on our web site.

It would be fair to say that we found this stage of the process the most difficult, in terms of generating a response. To boost the numbers of respondees, we made a number ofadditional approaches as follows, with a focus on Teenagers who we (correctly) anticipated being the hardest group to reach. Not all of these approaches received a response:

  1. Face to face with patients in waiting rooms
  2. Stickers on scripts
  3. Encouraging clinical staff to hand out (if appropriate) after consultations.
  4. Mrs Killick, Youth Leader at St Lukes Church, Hedge End
  5. Botley and Hedge End SureStart Centres
  6. WildernSecondary School
  7. Quitters
  8. Paediatric Diabetes Outreach Clinic
  9. A new mothers’ group meeting near the practice.
  10. Kings Community Church Youth Club leader
  11. Residents of Kitnocks Nursing Home.
  12. HALO - luncheon club for older residents

In view of the relatively low levels of response to the PCG recruitment phase, we also asked for additional volunteers on the main questionnaire (see Step 3 below).

Next year, in addition to repeating the approaches above:

  • The recruitment form will be simplified.
  • We will consider using the text message reminder service being set up as one output of this work – subject to a small-scale trial of acceptability.
  • We will also consider attaching an invitation to campaign communications, such as for flu vaccination.
  • We will try again to find new ways of reaching Teenagers, as these are the most under-represented group.
  • We will run the web campaign in particular over a longer period, and try to tie it in with popular areas of the site, such as Repeat Prescriptions.

1.3 The size and profile of the PCG.

The response to our initial request for patients to join the PCG was rather disappointing, at 47 in total, after a sustained effort over 4 weeks. With hindsight, we should have kept the form simpler, and perhaps found another way to consult you(our patients) on the areas to be covered in the main questionnaire. The demographic breakdown is shown in the table below.

In the light of the low response, we asked the same questions (apart from ethnicity) as part of the main questionnaire, to boost the numbers of the PCG, which in fact rose to 105 as a result. With the contact information collected, we will have a much better basis for next year’s work.

The PCG’s gender profile was somewhat biased towards the female side in both the initial and final groups. This basically reflects the profile of active surgery users, as one might expect. It is difficult to see what one could do to encourage more men in general to respond.

On age profile, the initial PCG was a good match for the adjusted population profile, except that Teenagers were under-represented, and Younger Retired over-represented, again as one might expect. It was disappointing that the initiatives above did not generate a greater response from Teenagers. In the second pass, there was a slight increase in representation among the 40-54s in the wider group, at the expense of 25-39s (which includes children less than 12).

In terms of ethnicity, there is an unexpectedly large representation of White (other). This is so out of line with the practice population that we suspect the design of the form was at fault, rather than this being a real distinction. For the second round, we did not ask the question, in the interests of not putting people off by the length of the form, as noted above.

Step 2: Agree areas of priority with the PCG

2.1 The areas that were considered to be included in a local survey

An independent survey undertaken by our existing Patient Participation Group in Summer 2011 highlighted some areas of potential concern with a minority of respondents.There were also some areas where we felt it would be helpful to gain objective evidence of satisfaction, or otherwise, prior to CQC (Care Quality Commission) registration. The result was a longlist of potential areas, as shown below.

2.2 The method we used to identify the areas to be considered and the priority areas agreed with the PCG

As part of the registration form for patients interested in joining our Patient Consultation Group, we asked you to tell us which of the areas on the longlist you would like us to focus on. We then based the questionnaire on patient responses. The total list offered, and scores registered, was:

a How easy is it to telephone us, and what improvements could we make? (We have made some changes this year, and would like to understand how you have found them in practice).(13 votes)

b How easy is it to get a routine appointment? Would online booking/ cancellation of appointments for example be of interest? (Our PPG survey indicated that urgent appointments were less of an area of concern) (32 votes)

c Could our communications with you be improved? (Our PPG survey earlier this year let us know that the website for example was not completely satisfactory) (17 votes)

d Could our care for you be improved? How well do we explain treatment options, tailor them to your needs, listen to your views and seek your consent? (10 votes)

e How well do we use our buildings? And are there improvements we could make? (7 votes)

f If you are a carer, how well do we support you? (1 vote)

g If you have a disability, or other particular needs, could we make it easier for you to use our premises or services? (0 votes)

In addition, individual patients mentioned:

  • Mum’s group wanted (2 mentions, all others one only)
  • Parking
  • Magazines wanted in Reception
  • Doctors should be more smartly attired.

2.3 The method used for discussing and agreeing the priorities.

This was done through the registration form for membership of the PCG, as described above. Patients were asked to indicate the areas of concern to you. Many of you said that none of the above were an issue for you. We decided to focus on the top 4 areas, as voted on by patients in the PCG.

2.4 The date(s) the discussions took place

These consultations took place between 23 December when our PCG enrolment form was released, and end-January when we drew a line under PCG recruitment and moved on to the main survey itself.

Step 3: Collate the views through the use of a survey

3.1 The method used for the survey

There were two methods used for the survey:

  • Paper forms, available in Reception, and sometimes handed out following consultations.
  • A web questionnaire, available through the website.

We used the contact information provided by people in response to PCG recruitment to contact them and request their input, by post, phone and text, according to their preferences.

The survey was active throughout February, until just before the meeting on 29 February (See below), with a handful of late hard copy returns received into early March.

3.2 How we decided on the questions.

We picked up the higher-scoring questions from the registration form submitted by PCG members, and based the survey on these. We felt that 7 questions was the maximum people would be prepared to answer..

Registration Question / Votes / Questionnaire Question(s) – précised.
a) How easy is it to telephone us? / 13 / Q6: How easy is it to telephone us
Q7: Which ways of making it easier would you like to see?
b) How easy is it to get a routine appointment? / 32 / Q4: Is the wait for a routine appointment acceptable?
Q5: If not, would a telephone appointment help?
c) Could our communications with you be improved? / 17 / Q3: Would you find it useful to have appointment reminders (in various ways)?
d) Could our care for you be improved? / 10 / Q1: Do our doctors & nurses explain your condition well?
Q2: Do they involve you in treatment choices?
e) How well do we use our buildings? / 7 / Not addressed this time
f) If you are a carer, how well do we support you? / 1 / Not addressed this time
g) If you have a disability, could we make access easier for you? / 0 / Not addressed this time

3.3 Analysis of the returns and themes emerging from your feedback

The total number of completed questionnaires received back was 105. A surprisingly-low 24% of these were online responses, despite the survey being clearly signposted from the home page. Responses to individual questions were as follows.:

With almost all of our patients feeling that we did at least Fairly Well here, this did not seem to be an area offering much scope for improvement, and no action was proposed to the PCG at the Open Evening, or set by them.

Here the results were a little less positive, although still good overall. Time pressures frequently limit the extent of discussion possible during a consultation, and research shows that patients do not always remember the detail of what was discussed, for understandable reasons. Therefore it was felt that what might help is to focus more on material that they could take away with them for later study, and this was put to the PCG, who agreed.

There was a clear majority here in favour of text reminders, and this was put to the PCG, who agreed. We will however continue to issue paper slips.

The issue of the availability of routine appointments was the strongest area for potential improvements picked up by the earlier survey last summer, and here there is clearly a significant minority who endorse this view. The possibility of telephone appointments was discussed within the practice team, and then with the PCG, and was felt to be worth a try.

We are aware that some patients find it difficult to get through at peak times in particular (although the great majority do not, as shown above). Here we were looking for ways to take some of the pressure off, and came up with a number of options. One effective measure would be sufficient – we do not need to try them all. Those present at the Open Evening confirmed the online booking option as being the preferred approach to trial first.

Step 4: Provide the PCG with the opportunity to discuss the findings and reach agreement with the PCG on changes to service

4.1 The method used for those discussions and the date that discussions took place

Everyone who responded to the questionnaire was invited to attend the open evening on 29 February, as part of the survey, together with members of the Patient Participation Group (PPG), who kindly co-hosted the evening with us. Minutes of the meeting are attached.

4.2 The suggested areas for change (if appropriate). The rationale for agreeing areas where a change is appropriate and/or not appropriate.

At this meeting we presented an analysis of the results, and for each area discussed:

  • Whether any change was needed
  • If so, what those changes might be.

Patients present at the meeting largely agreed with the results from the questionnaire. The surgery’s proposals for addressing the issues were reviewed, and these suggestions – or one of them where multiple options existed – were adopted as the way forward. In addition to the options proposed by the surgery, patients came up with a number of additional ideas in several areas, some of them not directly related to the questionnaire. These will be researched for practicability and considered as options for the next round of consultations.

4.3 The changes that have been agreed with the PCG

These are listed on the foot of the minutes of the meeting, Appendix 1, and repeated here:

Action Items
Task / Person Responsible
1 / Signpost patients to the relevant service by the use of leaflets, a standard set of handouts, or useful websites to further explain conditions/diagnoses. / AH/SM/RD
2 / Look at difference in responses between the two surgeries. / SM – for next questionnaire
3 / Look into text to mobile service as an appointment reminder. / SM/RD
4 / Investigate telephone appointments. / SM/AH
5 / Look into an on-line booking system for making/cancelling appts / SM
6 / Write up action plan, implement action points and publish results. / SM/RD/AH
7 / Track DNA’d (missed) appointments for one week / RD
8 / Track website usage – preparatory work for next questionnaire / RD/SM

Step 5: Agree action plan with PCG and seek PCG agreement to make changes

5.1 The actions agreed with the PCG NHSH

See 4.3 above.

5.2 An indication of the priorities (if appropriate)

Most of the items included in the action list above are for immediate action, although full implementation may take some months to complete. A couple have a longer implementation timeframe. Other suggestions made on the Open Evening need to be reviewed for practicability before further testing with the PCG, as part of next year’s work,and these are noted in the minutes of the meeting. See the table under 5.3 below.

5.3 The timeframe for implementing the changes

Where possible, the changes have already been implemented. In some cases we are dependent on our suppliers, as shown in the table below, or on the availability of a vacant slot in the partners’ meetings schedule.

Action Plan

Task / Person Responsible / Status
1 / Signpost patients to the relevant service by the use of leaflets, a standard set of handouts, or useful websites to further explain conditions/diagnoses. / AH/SM/RD / A meeting has been programmed for review with partners at the first available slot in their meetings calendar, 27 April. At this meeting, the available handouts for the most common conditions will be reviewed, and where necessary project team member Rachel Diaper will be asked to refresh and update them, in particular with web references, under clinical guidance.(Update: 27 April: The meeting has been held, actions placed, and meeting minutes are available at Appendix 2)
2 / Look at difference in responses between the two surgeries. / SM – for next questionnaire / Not yet due – will be built into the next questionnaire, probably early Autumn.
3 / Look into text to mobile service as an appointment reminder. / SM/RD / We have engaged with the PCT, with our clinical system supplier, INPS, and with our planned texting package supplier, MJOG. Unfortunately there are some restrictions laid down by the PCT/INPS which mean that it will not be possible to proceed immediately. However we hope to be able to implement in the summer. See Note 2, below the main table, for further details.
4 / Investigate telephone appointments. / SM/AH / Action complete. This process is now live, for a trial period. We reviewed our internal processes and developed a process by which telephone appointments can be offered where there is a significant wait for a routine appointment. See Note 3 below the table for more information.
5 / Look into an on-line booking system for making/cancelling appts / SM / We have requested installation of this option at the earliest opportunity from our clinical system supplier, INPS. There is no further action that can be taken until they can fit us in. See Note 1 below the table for more information.
6 / Write up action plan, implement action points and publish results. / SM/RD/AH / This action is complete with the publication of this report.
7 / Track DNA’d (missed) appointments for one week / RD / This action has been completed, for the week commencing 12 March. See Note 4 below.
8 / Track website usage – preparatory work for next questionnaire / RD/SM / This action is not yet due. We are however already in discussion with our website package supplier, My Surgery Website, to see how we can monitor visits at a level below total page hits across the site.

Note 1.INPS have informed us that they are not undertaking any further online appointment bookingimplementations based on the current version. The release of the next version is expected with the next release of the system, due for rollout from early June onwards. We have therefore lodged a request for an implementation of online appointments as soon as possible following this rollout.