THE GRANGE SURGERY

Local Patient Participation Annual Report 2013-14

This report seeks to document the work carried out by the Grange Surgery and its PPG & PRG in creating the 2014 local patient survey. In addition to studying how the survey was constructed, the report aims to analyse the results it generated and the action plan which arose from it.

The report is broken down into the following sections:

  1. Profile of PRG and entire patient population.
  2. Agreed areas of priority with PRG.
  3. Collated patient views through use of a survey.
  4. Provide PRG with opportunity to discuss survey findings and reach agreement with the PRG on changes to services.
  5. Agree action plan with the PRG and seek PRG agreement to implementing changes.
  6. Confirmation of surgery’s opening times and extended hours.
  1. Profile of PRG and entire patient list

Since its inception 4 years ago the Grange Surgery has operated an ongoing recruitment drive for its PRG. The practice appreciates that the more representative the PRG is of the entire patient list the more useful a resource it is for patients and clinicians alike. New patients are given the opportunity to join at registration and existing patients may do so anytime they visit the surgery by completing one of the application forms made available at reception. The practice’s new website also provides patients with the opportunity to register online. Every effort is made to make the PRG as inclusive as possible over a wide range of demographics including; gender, age, ethnicity, disabilities and location. Let us take the area of ethnicity for example. The application form is set out in a simple format so that those people whose first language is not English will not be put off from signing up. Also reception staff are on standby to assist patients in completing the form.

In order to gauge how successful the surgery’s PRG is in representing the wider patient population it is necessary to analyse the composition of both of these groups. Ideally we should find a strong correlation between the two profiles with the PRG mirroring the full patient list on a micro level. For the purposes of this report we shall be studying gender, age and ethnicity.

Table 1.1 –

Profile of Practice Population – Age & Gender

Age / Male % / Males / Female% / Females / Total% / Total
0 - 09 / 6.25 / 465 / 6.51 / 484 / 12.76 / 949
1 - 09 / 5.83 / 434 / 6.47 / 481 / 12.30 / 915
20-29 / 4.40 / 327 / 4.88 / 363 / 9.28 / 690
30-39 / 5.05 / 376 / 6.18 / 460 / 11.24 / 836
40-49 / 7.70 / 573 / 8.40 / 625 / 16.10 / 1198
50-59 / 6.65 / 495 / 7.11 / 529 / 13.77 / 1024
60-69 / 5.44 / 405 / 5.52 / 411 / 10.97 / 816
70-79 / 3.39 / 252 / 4.14 / 308 / 7.53 / 560
80-89 / 1.80 / 134 / 3.05 / 227 / 4.85 / 361
90-99 / 0.31 / 23 / 0.90 / 67 / 1.21 / 90
Total / 46.83 / 3484 / 53.17 / 3955 / 100 / 7439

Table 1.2

Profile of PRG – Age and Gender

Age / Male % / Males / Female% / Females / Total% / Total
0-09 / 0 / 0 / 0 / 0 / 0 / 0
Oct-19 / 1.26 / 3 / 2.93 / 7 / 10 / 4.18
20-29 / 4.60 / 11 / 8.79 / 21 / 32 / 13.39
30-39 / 4.18 / 10 / 15.06 / 36 / 46 / 19.25
40-49 / 11.72 / 28 / 7.53 / 18 / 46 / 19.25
50-59 / 6.69 / 16 / 9.62 / 23 / 39 / 16.32
60-69 / 7.11 / 17 / 7.95 / 19 / 36 / 15.06
70-79 / 6.69 / 16 / 2.93 / 7 / 23 / 9.62
80-89 / 1.26 / 3 / 1.67 / 4 / 7 / 2.93
90-99 / 0 / 0 / 0 / 0 / 0 / 0
100+ / 0 / 0 / 0 / 0 / 0 / 0
Total / 43.5 / 104 / 56.5 / 135 / 239 / 100

The first point worth noting is the significant increase in the number of PRG members. As per this time last year, total membership amounted to 192. The jump up to 239 members represents an increase of almost 25%. Although in the future we would like to see a far greater figure than this, the increase does nonetheless mark a step in the right direction and demonstrates that the measures the practice are taking to boost PRG membership are working.

As Table 1.1 shows, 53% of the patient population is made up of females. This compares with 56% of females forming the PRG list. Correspondingly, there are 47% males in the total patient list against 43.5% in the PRG. These figures indicate that in terms of gender the PRG is achieving its goal of being representative of the wider patient population. Although a slight bias exists towards females, the numbers mark a significant improvement on last year’s report where 63% of the PRG comprised of females. The practice will continue to monitor the gender make-up of the PRG periodically to ensure that this trend towards equilibrium continues.

Next off all we shall take a look at the ethnic profile of the two groups. Tables1.3 & 1.4 show the profiles of the PRG and entire patient population respectively.

Table 1.3

Profile of PRG – Ethnicity

ETHNIC ORIGIN / Men / Men% / Women / Women% / Total / Total %
White:
British / 101 / 41.84 / 133 / 55.5 / 234 / 97.34
Irish / 1 / 1.16 / 0 / 1 / 1.16
British & Mixed British / 0 / 0 / 2 / 1 / 2 / 1
Asian:
Indian / 2 / 0.5 / 0 / 0 / 2 / 0.5
Total: / 104 / 43.5% / 135 / 56.5% / 239 / 100%

Table 1.3 reveals that just under 3% of the PRG is comprised of ethnic minorities whilst the full patient list is made up of 2.5%. This strong correlation is a positive result and demonstrates that the PRG is reflecting the ethnic diversity of the surgery’s entire patient population. Considerable effort has been made to encourage new patients of an ethnic minority to register for the PRG when joining the practice. The user-friendly registration form has been a major help in achieving this goal. Similarly during the running of the survey itself patients were given the opportunity to sign up to the PRG in a quick and easy manner. It is the surgery’s hope that the PRG will continue to grow in terms of number and participation levels, all the while maintaining a composition that mirrors that of the full patient list with regard to age, gender and ethnicity.

Table 1.4

Profile of Patient Population – Ethnicity

ETHNIC ORIGIN / Men / Men% / Women / Women% / Total / Total %
White:
British / 2115 / 28.43 / 2435 / 32.73 / 4550 / 61.16
Irish / 0 / 0 / 3 / 0.02 / 3 / 0.02
British & Mixed British / 689 / 9.26 / 817 / 10.98 / 1506 / 20.24
Other White / 637 / 8.56 / 661 / 8.89 / 1298 / 17.45
Mixed:
White & Black African / 2 / 0.02 / 2 / 0.02 / 4 / 0.04
Asian / Asian British:
Indian / 14 / 0.19 / 18 / 0.24 / 32 / 0.43
Pakistani / 3 / 0.02 / 2 / 0.02 / 5 / 0.04
Black & Black British:
African / 15 / 0.2 / 8 / 0.11 / 23 / 0.31
Chinese or Other Ethnic:
Chinese / 9 / 0.14 / 9 / 0.16 / 18 / 0.30
Total: / 3484 / 46.83% / 3,955 / 53.17% / 7,439 / 100%
  1. Agreed areas of priority with PRG.

The surgery commenced the process of creating a local patient survey by convening a meeting of the PPG on 19th November2013. For a number of years now the Grange PPG has been an invaluable tool through which the practice interacts with its patients. This meeting allowed for an open discussion to take place on what both parties felt would be worthwhile topics for a patient survey. A provisional list was drawn up to be forwarded onto the PRG (virtual) for their comments, amendments and suggestions;

Prescriptions

Practice Website

Patient Access

Communications

Any other priorities

This communication was emailed to the PRG on 25th November and they were given until 22nd December to submit their feedback to the surgery. In terms of format, the PRG was asked to rank in order of importance which subjects they felt were most deserving of further investigation. The results of this preliminary survey are shownbelow.

The area of most interest to those PRG members who completed the preliminary survey was that of “Prescriptions” (38%). The practice website (34%) also featured prominently. The area of “Patient Access” had been covered in last year’s report and this may account for the low figure it registered. The only new topic to come to light from this prelim survey was that of “Coordinated Care” (6%). Following on from the collation of these results another meeting of the PPG was convened in order to draw up a final patient survey based around the priority areas that had been identified. This meeting, which took place on Friday 10th January, enabled the PPG and Deputy Practice Manager to compile a list of questions that would form the basis of the Local Patient Survey 2014.

  1. Collate patient views through use of a survey

In terms of format, the practice management and PPG’s stated aim was to make the local patient survey resemble the preliminary outcomes as closely as possible. It is for this reason that “Prescriptions” garnered five questions in the final survey while “Coordinated Care” just one. Such a weighting allowed for more focus to be given to the most popular topics that had been identified. The Local Patient Survey was emailed to the PRG on 17th January and ran until 25th February. In addition to being sent electronically to the virtual PRG, the survey was also made available to patients attending the surgery. Over 200 hard copies were printed off for this purpose. Once again the PPG contributed enormously in this endeavour, giving freely of their time to come into the surgery and ask patients to complete the survey. This exercise also allowed them the opportunity to explain the work carried out by the PPG. In particular the PPG were able to engage with patients who may otherwise not have completed the survey, elderly and ethnic minorities being two categories that readily spring to mind. Those patients who live in care homes and are unable to attend the surgery were sent the survey by post. Lastly the survey was also posted up on the practice’s website where patients could print it off and return via email, post or hand. In this sense the surgery did all it could to engage with difficult to reach patients. The sample space was made open to the entire patient population and the PPG/practice are confident that no grouping was discriminated against.

Figure 3.1 on the previous page displays the local patient survey and also includes the results that the questionnaire generated. These results are extremely interesting and provide valuable insights into how patients feel on the areas investigated. In order to gain a deeper insight into the findings of the survey we shall now examine each question individually.

Coordinated Care

The survey commenced by asking patients that receive their treatment from more than one organisation if they were happy with the way in which their care was coordinated. The response saw 82% of patients register their satisfaction. This positive result comes off the back of a lot of hard work undertaken by the surgery in conjunction with other community services. Once a month the practice hosts an integrated care meeting where it invites a wide range of different care providers to the surgery to discuss common patients and ways in which processes can be improved upon. This meeting is open to the district nurse, the midwifery team, elderly mental health and occupational therapists. Concerning the terminally ill, the practice convenes periodic Gold Standard Framework meetings which enable staff from MacMillan and the Rosemary Foundation to attend the surgery and discuss treatment strategies for these patients. By providing this platform for discussion the surgery hopes to continue providing effective coordinated care to patients who are treated in this multifaceted way.

Patient Access

The next two questions of the survey sought to address the issue of patient access. A useful question to ask for both patients and practice alike was to identify what is the preferred time to see a GP. This would guide the surgery on how to schedule its clinics in line with patient preferences. Pleasingly the answer to this question corresponds very well with the clinics that the practice already has in place. A combined figure of 87% stated that their preferred time to see a GP was either between 0800-1300 or that they had no preference at all. Interestingly only 6% of patients stated that their preferred time was from 1800 onwards. At a time when the government seems to be pushing for extended evening hours it is worth noting that the Grange Surgery’s patients, for the moment at least, do not seem to have a desire for such a service. Not surprisingly the prospect of weekend appointments does seem to be something patients have an appetite for with 72% stating that this is a provision they would like to see come into being. This is a very topical issue and as always the surgery will do its best to adapt to the changing needs of its patients in line with the resources it is provided with.

Practice Website

In Q.4a almost 30% of those people surveyed stated that they did not use a computer. This is a very high percentage but not entirely surprisingly given the fact that almost 25% of the practice’s patients are aged 60 or over (see Table1.1). A significant number of these patients are not going to be computer literate. It is for this reason that the practice operates a delicate line between embracing technological innovation and retaining traditional methods for patient engagement. In order to ensure that computer illiterate patients are not ostracised the surgery continues to make the majority of its appointments available though telephone bookings. The practice also provides a large amount of information within the surgery though leaflets, booklets and posters.

Question 5 asked patients if they had visited the surgery’s new website. Rather disappointingly 74% of those surveyed answered that they had not yet visited the revamped website. Clearly the surgery has much work to do in raising the profile of this resource. Following on from one of the action points of last year’s survey the practice designed and launched a new website. The main reason for doing this was to provide patients with the opportunity of booking appointments online and ordering repeat prescriptions. These functions are now in place alongside many other new features which should benefit patients in a number of ways.

Communication

One of the priority areas identified by the PRG for inclusion in the survey was that of “Communication”. This led to the PPG posing its fellow patients with the question “Are you happy with the level of communication from the surgery regarding the notification of new services?” 83% of patients who completed the survey registered their satisfaction on this matter. Once again this positive outcome comes as a result of a concerted effort by the practice to keep its patients aware of new services. A major aid in achieving this end has been the surgery’s adoption of the MJOG text messaging service which has been widely publicised since its launch. Not only has this tool served as a means through which the practice can remind patients of their appointments, it also allows for messages to be sent informing them of new services being launched.

Prescriptions

The final section of the survey dealt with the topic the PRG had identified as warranting most attention – “Prescriptions”. This topic was subsequently broken down into a number of sub-sections so as to derive the most information possible. The first question (7a) posed in this section was “Do you use the surgery’s repeat prescription service?” 70% of those surveyed confirmed that they availed of the service. The ability to order repeat prescriptions online is now available to patients once they register for Patient Access. If the medication they require is not on repeat they are able to submit a request for it by emailing the surgery. Of those people who answered “Yes” to this question 94% of them said that their prescription was up to date, a figure which suggests that the service is operating effectively.

The next question posed to patients asked if they had any medication in their home that is no longer being used and needs to be disposed of. 16% responded that they did have medication which needs to be disposed of. This is quite a significant figure and suggests that a problem may exist in the processing of prescriptions. One possibility for this stockpiling of drugs may simply be due to the fact that patients are not using all of the medication they have been prescribed. Alternatively they may not be taking the medication as prescribed. Another more worrying explanation for this excess, both in terms of patient welfare and public finance, is that patients who are on managed repeats are not having their prescriptions administered efficiently by their pharmacy. This issue has been a source of contention between the practice and local pharmacies for quite some time. It would seem that in some instances pharmacies are not contacting the surgery to check for changes before issuing prescriptions. This is a dangerous practice as it may lead to patients being provided with incorrect medication. Furthermore any excess medication being issued erroneously to patients is being paid for from local government finance. Certainly there is a role for patients to play in objecting to these incorrect prescriptions but the crux of the problem will not be resolved until pharmacies exercise more diligence in providing this service.

Of the 27% patients who stated that they do avail of managed repeats, 95% said that they were being provided with the correct medication. Clearly this points to a high level of patient satisfaction with managed repeats for those people who completed the survey. However the practice will continue to monitor this activity closely to ensure that patients are being provided with the correct prescriptions.

  1. Provide PRG with opportunity to discuss survey findings and reach agreement with the PRG on changes to services

Once the results to the survey had been collated they were made available for patients to view. These results were posted up on the Grange Surgery website and emailed to the entire PRG membership on Monday 24th February. This email also gave PRG members the opportunity to communicate to the practice/PPG any suggestions/thoughts they had based upon the results of the survey. One week was allotted to the PRG to complete this exercise. On 3rd Marcha meeting of the PPG was convened to discuss the results of the local patient survey and the feedback received from the PRG. These discussions led to the drawing up of a provisional action plan Table 4.1.

Provisional Action Plan

Raise Awareness of Practice Website – 74% of patients disclosed that they had not yet visited the new surgery website. With the introduction of booking appointments online and ordering repeat prescriptions this is a resource patients need to made more fully aware of.

Monitoring of Managed Repeat Prescriptions – more work needs to be done to ensure that patients on managed repeat prescriptions are being provided with the correct medication.