bury road surgery patient reference group report 2013/14

Bury Road Surgery

Patient Reference Group Report 2013/14

This year’s report has been laid out based on the advice form the BMA/NHS employers guidance for the Patient Participation Direct Enhanced Service. Description of the profile of the members of the Patient Reference Group (PRG)

The PRG consists of two groups of patients. The original Patient Participation Group, whose numbers are around 30 and a virtual group. The virtual group have been recruited from new patients joining the surgery. There are 300 patients in the group and this continues to grow. The PRG is split approximately 50% male- 50% female and with the inclusion on the virtual group members, we have achieved a broad age range, representing the age range profiled in the practice which is detailed below: The age and percentage split of the respondents to the survey is listed further down in the report.

Our practice ethnicity profile is predominantly white British. We do have a small number of patients from other ethnic backgrounds as listed below, those patients make up 0.008% of the practice population. All patients are offered the opportunity to join the virtual group or the PRG.

African 4

Carribbean 1

Chinese 2

Russian 1

Greek 1

Indian 21

Asian 4

Yugoslavian 1

Pakistani 1

Polish 1

Steps taken to ensure that the PRG is representative

The PPG was already in existence when the Patient Participation DES was announced. The PPG age range was not representative as it consisted of slightly older members of the practice. We decided to make the PRG more representative by trying to increase the number and offering an alternative method of taking part. We did this by creating a virtual group that could give feedback and complete surveys without the need to attend practice meetings. All new patients are offered the opportunity to join the “virtual group”. This means that we have been able to broaden the age range. We felt that there needed to be an electronic means by which patients could contribute as many do not have the ability to attend practice meetings during the working week.

Steps taken to determine and reach agreement on the issues to be included in the survey This year’s survey was created following a meeting of the patient reference group on the 26th September 2013, followed by an email to the virtual group asking for any ideas and thoughts. There was a broad discussion about the current operation of the surgery and consideration of future developments. We also reflected on the challenges facing general practice and the increased demand for our services. Two suggested areas were:

Continuity of care

Sharing information

Following discussion with the PRG Chairman, Dr John Buchanan, we decided to broaden the survey to include:

Ability to get through on the phone

Experience of consultations with clinical staff

Experience of dealing with reception

Ability to book future appointments In deciding on adding these elements we also looked at the areas that were being surveyed by other practices and the information that had been received from Wessex Local Medical Committee. The survey questions were finalised at a meeting with Dr Buchanan on the 12/11/2013 and he signed off the survey. The manner in which we obtained patient views The survey was published on the practice website on the 12/11/2013 and an email sent to the patient group and the virtual group, providing the link to be able to complete the survey online. A paper based copy of the survey was made available during December 2013 for patients attending the practice to complete opportunistically. The aim was to ensure that the survey was completed by as a wide a cross section of patients as possible.

Gender o Male 31% o Female 61%

o No response 8%

Age o 16-25 3% o 26-40 8% o 41-50 17% o 51-60 19% o 61-70 21% o 71+ 26% o No response 6%

Ethnicity o White British 89% o Other 1% o No response 10%

On reviewing the above figures we feel that there was a good cross section of patients answering the survey which is broadly in line with our patient demographics. We were particularly pleased that we managed to achieve a wide age range of respondents. Discussion of the content with the PRG The survey results were published to the website in early December 2013. The PRG was emailed to advise them that the results were available for perusal. A formal meeting of the patient group was convened for 30/1/2014 to discuss the results and consider ideas to address any concerns or suggest improvements. The meeting covered all aspects of the survey and consideration was given to the pros and cons of various proposals. A draft action plan was formulated at the meeting. A copy of the action plan was emailed to those members of the PRG that were not at the meeting, together with the virtual group, on the 24/2/2014, requesting any feedback or further suggestions. Dr Buchanan, Chairman of the group, commented that he was in support of the action plan and as there was no further input , the action plan was ratified. The minutes and suggested actions are listed below have been signed off by Dr Buchanan (27/02/2014) as being an accurate record of the meeting. Details of the action plan and summary of findings

Bury Road Surgery

Minutes

Extraordinary Meeting of the BRS Patient Reference Group held on Thursday 30th January 2014

at Bury Road Surgery Gosport PO12 3PW from 13:00 to 15:00

Attendees:

John Buchanan Chair

Dr Carl Anandan BRS General Practitioner

Joan Anderson Patient Representative

Alan Ball Patient Representative

Sue Chessman BRS Receptionist

Christopher Donnithorne Patient Representative

Elizabeth Donnithorne Patient Representative

Paul Edwards BRS Practice Manager

David Gattrell Patient Representative

David Gibbs Patient Representative

Roy Johnson Patient Representative

Rosemary Mumford Patient Representative

Dr Nicholas Peters BRS General Practitioner

Lesley W

Angela Wheatley BRS Receptionist

Rosemary Whitburn Patient Representative

Apologies:

Michael Branicki Patient Representative

Doreen Dodd Patient Representative

Bob Macey Patient Representative

Jeff Steele Patient Representative

David Reading Patient Representative

Sue Wallington BRS Receptionist

JB opened the meeting by advising that it had been called to discuss the results of the Bury Road Surgery Survey 2013-14 and to address any issues identified in the responses PE distributed a summary of the results and, where relevant, gave a comparison of results against those of the latest IPSOS Mori poll on local surgeries. A copy of the summary is attached as an appendix herewith. The response to each question was reviewed and it was agreed by the Group that most results reflected very well on the practice. Points that arose from discussing the survey results were as follows: Q5 - With a score of 94% this reflected well on the reception team. It was raised that there are a number of disruptive patients who insist on seeing a specific GP, usually to try to obtain medication that has been refused by another GP. It has been raised by the reception team that the behaviour of some of these patients is causing concern. A discussion ensued as to how to address this issue. JB suggested a zero tolerance poster in reception and DGi mentioned an NHS poster he had seen which depicts a “Choice of Treatment” and which shows the patient’s options as being either a doctor or a policeman depending upon the patient’s behaviour. SC will investigate suitable posters to display in reception. RW suggested that receptionists be given audible alarms and offered some personal safety alarms which she will bring to the surgery. PE advised that the practice is now identifying disruptive patients, issuing warnings and, where necessary, removing individuals from the patient list. The lack of privacy on reception was raised although it was agreed that this is somewhat better since we have added sound to the television. It was agreed that a poster could be displayed on reception asking that the privacy of other patients be respected. SC will arrange for this to be displayed. Action

Display zero tolerance and respect privacy posters in Reception SC

Review safety procedures PE

Personal safety alarms for use by receptionists RW

Q6 - With a score of 77% it was agreed that there is room for improvement. However PE explained that getting through on the phone is more difficult at some times of day than others. Most patients call early morning for triage and for making appointments. Call volumes generally dip during the day and increase again towards the end. It was suggested that calls be channelled, one option being use of a voicemail message advising patients to call during non-core hours for test results, routine appointments etc. DGi observed that online repeat prescriptions seem to work well and that the same may apply to triage. PE advised that IPNS, the company who provide the practice’s patient management system, have recently implemented this option as part of their Vision Online services.. Patients need to register their email address for this service and can then book appointments online. BRS will ensure that patients are aware of this option. Action

Attempt to channel calls for non-urgent matters to times of the day when the phones are less busy by using the voice options on the phone system

PE

Q7 - With a score of 60% the possible reasons for the low score were discussed. PE said that the GPs at BRS have very heavy triage volumes compared to other local surgeries. For example, the GPs at the Rowner Practice do 14-17 morning. triage appointment compared to the 27 at BRS - 20 slots for initial calls plus 7 slots for GPs to bring patients in following discussions and 2 further slots for GP recalls. The BRS afternoon triage has 8 slots for initial calls plus 6 slots for GPs to bring patients in and 2 further slots for GP recalls. GPs additionally sometimes have two further slots for asthma reviews. Historically, GPs would return triage calls within 2 hours, and NP said he would like to be able to do this, but it is becoming increasingly difficult due to volume of calls. PE explained that one GP acts as triage doctor each day whilst the other (or a locum if one of the partners is absent) carries out a standard clinic. DGi suggested that both GPs provide triage services for the first couple of hours or so on peak days to minimise the load on the designated triage GP. NP confirmed that the majority of triage calls are for genuine medical needs, but it was noted that slots are also regularly taken for patients requesting sick note extensions. PE said that he will liaise with the GPs to decide whether sick note requests will continue to be dealt with on triage. AB said that he would like to note that he never been disappointed with the triage service at BRS. It was mentioned that the call back target for the Out of Hours service is split into 1 hour, 2 hour and 3 hours slots dependent upon urgency. JB advised that the 111 service operates a similar system to RBS which has a call back time of between 2 and 3 hours. RW mentioned a recent article in the Portsmouth News about GPs dissatisfaction with A&E services. PE mentioned a recent survey of the Hampshire area which showed 4500 urgent on the day calls, compared to the 100 calls handled by A&E. The Portsmouth/ Fareham/Gosport/SE Hants Walk-in Centre deals with only 40 patients a day. RW said that she feels the Minor Injuries Unit at the GWMH is not publicised enough and ED pointed out that patients have to make an appointment to see a GP as the walk-in service only gives access to nursing care. Action

Consider use of both GPs for first section of triage call period on peak days

PE/GPs

Consider options for issuing sicknotes/extensions PE/GPs

Q8 - At 65%, this was the poorest score received. PE explained that c50% of appointments

are opened four weeks in advance. The other 50% are generally opened 2-3 days ahead. The number of GP appointments is comparable with other local surgeries but demand is outstripping supply. The recent government initiative as outlined by David Cameron only provides a pot for non-recurring costs so does not lend itself to providing more appointment slots. JB suggested the use of Nurses for handling some of the slots but PE advised that

BRS does not have sufficient funding to take on a Nurse Practitioner. He advised that an excellent Nurse Prescriber is covering some clinics on an ad hoc basis in GP absence but there are no long term plans for this. The Group agreed that BRS were utilising all available clinical time and PE said that he would have to look at tweaking clinics again and that BRS are constantly looking for ways to improve services with available resources. Action

Consider options for tweaking available clinical resources PE/GPs

Q9 - Survey results indicated that the majority of patients currently prefer to book by

telephone but DG pointed out that as patients start to use the online booking system, providing it works correctly, they will continue to use it. PE said that he believes all the appointments should be available for booking to encourage patients to use the online option. DGi suggested that BRS will have to look at ways of ensuring that, without receptionists taking calls, pts do not book GP appointments that the practice nurses could handle. Action

Investigate methods for ensuring online appointments are booked with appropriate clinician

PE

Q10, Q11 - All agreed that GP continuity is a benefit but not always possible and this did not seem to be a particular problem with a score of 86%. It was accepted that patients insisting on seeing a specific GP will have to be prepared to wait longer and should be clearly advised of this when booking. Action

Pts to be educated that they will have to wait longer to see a specific GP PE

Q12 - Q15 - PE quoted the adage that it is impossible to please all the people all the time in terms of opening hours. BRS provides services between 8.00 and 18.30 Tuesday to Thursday and 8.00 and 19.30 on Mondays. Outside of these hours patients have access to the Out of Hours service. However patients do not perceive the Out of Hours service as seeing their doctors. JB pointed out that one local practice opening on Saturday mornings had seen a poor uptake. PE said that all practices in Gosport are considering the pros and cons of adopting a single clinical system to provide a more holistic care option but this is still under discussion. Q21 - It was suggested that pts are generally unaware of how their information is shared and 2/3rds of BRS patients do not seem to have any issue with it. The NHS is currently sending another set of literature to patients explaining how their information will be shared and patients can elect to opt out. PE will add information to the BRS newsletter, website and notice boards to educate patients on what information will be shared and how it can be used. Action

Add explanation of information sharing to newsletter, website and notice boards

PE

Having discussed all points on the survey, JB briefly overviewed the last meeting of the CCG Governing Body which he had attended and advised the group that the minutes can be viewed online on the CCG website. JB and DG will be attending a meeting on 5 February at Ferneham Hall and will provide feedback at the next PRG meeting. JB said that the CCG reporting system seems to be working well and money appears to be being well spent. PE concurred with this. DG overviewed the recent meeting he had attended at Brune. DG said that he had visited the MIU on Sunday evening between 5-6pm and it was empty. He was seen immediately and was diagnosed quickly. This compared to a record level of attendees at QAH’s A&E Department the same day. RW said she felt the MIU was not advertised widely enough and

DG offered to speak with the Design Department at QAH with a view to them providing a display for BRS reception to raise patients’ awareness of the Minor Injuries Unit at GWMH. JB advised the group that the CQC had given BRS a very good review following the recent inspection. The inspector had spoken with JB and was pleased to note that the PRG meets regularly, and that the Practice Manager and a GP are always present. It had also been noted that the PRG have a good working relationship with BRS. Action

Produce display for BRS Reception to increase patients’ awareness of MIU

DG

Feedback from meetings attended JB/DG

Last Year’s Actions Last year’s actions and outcomes have been listed below as a reference.

Appointments

Action Taken In order to improve availability we decided to take the following action:

1. We decided to “hold” approx 50% of appointments. These appointments are released 2 days in advance. This has given us better capacity to provide an appointment for those patients who call and want to see the doctor within the next day or so.

2. We increased the number of routine slots by adding additional bookable appointments on the triage day

3. We increased the number of telephone consultation appointments 4. Appointments that are not held are available to be booked up to 4 weeks in

advance.

Outcome We have continued to manage appointments in line with the above. We had a good summer for appointments as we had Dr Anandan available which created extra resource. The system seems to be working reasonably well but increasing demand is an issue for all practices. Triage

Action

To try a nurse practioner/prescriber for the forthcoming GP absence in February 2013. If this goes well, we will aim to use a suitably qualified nurse for GP absence throughout the year. If a nurse is not available, then a locum GP will be used and one of the partners will do the triage. When both partners are here, one of them will continue to undertake triage.

Outcome

We used GP’s for triage throughout the year and this was well received. We have very recently used a nurse prescriber and again this went well. We plan to use a nurse for GP holiday cover. Telephone Consultations

Action Taken

Additional telephone slots have been added to each week

Receptionists now offer this as one of the options to patients to help publicise it

The search facility in the appointment system clearly identifies which type of appointment is available, which assists the receptionist in offering a range of appointment types

Outcome

Telephone consultations have proved to be popular and we plan to continue using them. Provision of female GP services Action We have budgeted to provide a female GP session once a week. The PRG were happy that we intend to continue the provision of female GP services. We will aim to maintain continuity with the same GP where possible. Dr Hall will be joining another practice as a partner in April and from that time on we will employ Dr Chantel Nicholson to provide a regular session each week. We will also give consideration to using female locums when there is a need to backfill one of our own doctors. Outcome Following a reorganisation in April 2013, we had an opportunity to generate more female GP appointment availability. We have managed to run 4 sessions per week. This has been a great boost to choice and we hope to keep going with 3 sessions per week in 2014.

Access A GP is available at the times listed below. Our practice nurse or health care assistant is available Mon-Thu 0815-1830 and Fri 0815-1230. Opening Hours & How to Contact Us Open Close Monday 0800 for telephone calls

0830 Doors Open 1300 Doors Close for 1 hour but phone calls still taken

1400 Re-Open 1945 Tues –Fri 0800 for telephone calls

0830 Doors Open 1300 Doors Close for 1 hour but phone calls still taken

1400 Re- Open 1830 Sat—Sun Closed How to Deal with Us. The surgery can be contacted by phone on 02392 580363 Our website address is www.buryroadsurgery.co.uk You can send an email via the website Prescriptions can be requested online as well as by handing in a prescription request. We do not accept prescription requests over the phone. You can join our SMS Text service to receive appointment reminders and other important information

PPG & Survey Results Report

Survey Results

Bury Rd Surgery Survey 13/2014

Number of Responses: 154

We would be grateful if you would complete this survey about your doctor and general practice. They want to provide the highest standard of care. A summary from this survey will be fed back to them to help them identify areas for improvement. Your opinions are very valuable. Please answer ALL the questions you can. There are no right or wrong

answers and your doctor will NOT be able to identify your individual answers. Thank you.

About Your Visit to the GP

How good was the GP at

Q1 Making you feel welcome and relaxed?

Very good 50% Good 29% Satisfactory 10% Poor 3% Very poor 2% Does not apply 2% No response 4%

Q2 Listening to you and involving you in decisions during the consultation?


Q3 Explaining your condition and treatment?


Q4 Would you be completely happy to see this GP again?

Yes 83% No 10% No response 7%

Please enter the name of the GP you recently saw and add any additional comments:

About Receptionists and Appointments

Q5 How helpful do you find the receptionists at your GP practice?

Very helpful 76% Fairly helpful 18% Not very helpful 1% Not at all helpful 1% Don’t know 0% No response 4%

Q6 How easy is it to get through to someone at your GP practice on the phone?

Very easy 22% Fairly easy 55% Not very easy 15% Not at all easy 2% Don’t know 1% Haven’t tried 1% No response 4%

Q7 If you want to see a GP urgently, are you happy with the practice's traige service?

Yes 60% No 11% Don’t know / never needed to 26% No response 3%

Q8 How easy is it to book appointments ahead in your practice?

Very easy 18% Fairly easy 38% Not very easy 24% Not at all easy 14% Don’t know 1% Haven’t tried 1% No response 4%

Q9 Which of the following methods would you prefer to use to book appointments at your practice?

(please X all boxes that apply)

In person 33% By phone 83% Online 26% Doesn’t apply 0%

Continuity of Care:Thinking of times when you want to see a particular doctor:

Q10 How important is continuity of care with the same doctor to you

Important 86% Not important 12% No response 2%

Q11 How do you rate how quickly you were seen when requesting to see the preferred GP?

Excellent 9% Very good 22% Good 18% Satisfactory 21% Poor 14% Very poor 3% Does not apply 8% No response 5%

Thinking of times when you are willing to see any doctor:

Q12 How quickly do you usually get seen?

Same day or next day 21% 2-4 days 21% 5 days or more 36% I don’t usually need to be seen quickly 13% Don’t know, never tried 5% No response 4%

Q13 How do you rate how quickly you were seen?

Excellent 11% Very good 24% Good 18% Satisfactory 18% Poor 14% Very poor 1% Does not apply 7% No response 7%

Thinking of your most recent consultation with a doctor or nurse

Q14 Is your GP practice currently open at times that are convenient to you?

Yes 82% No 11% Don’t know 5% No response 2%

Q15 Which of the following additional opening hours would make it easier for you to see or speak to

someone? (please X all boxes that apply)

Before 8am 30% At lunchtime 20% After 6.30pm 25% On a Saturday 41% On a Sunday 16% None of these 19%

Thinking about the last time you saw a nurse, how good was the Nurse you last saw at:

Q16 Making you feel welcome and relaxed?


Q17Listening to you and involving you in decisions during the consultation?


Q18 Explaining your condition and treatment?


Q19 Would you be completely happy to see this nurse again?


Thinking about how we share your information:

Q20 Are you aware of how your information is shared?

Yes 38% No 40% Unsure 17% 1% No response 4%

Q21 Do you have any concerns about how your information is shared

Yes 14% No 66% Unsure 16% No response 4%

Q22 Please let us know any concerns

Q23 Overall, how would you describe your experience of your GP surgery?

Excellent 16% Very good 41% Good 21% Satisfactory 11% Poor 7% Very poor 0% No response 4%

Q24 Would you recommend your GP surgery to someone who has just moved to your local area?

Yes, definitely 36% Yes, probably 43% No, probably not 7% No, definitely not 6% Don’t know 4% No response 4%

Q25 Did you find this survey too long?


It will help us to understand your answers if you could tell us a little about yourself

Q26 Are you ?

Male 41% Female 55% No response 4%

Q27 How old are you?

Under 16 0%

16 to 44 20% 45 to 64 34% 65 to 74 29% 75 or over 13% No response 4%

Q28 Do you have a long-standing health condition?

Yes 58% No 32% Don’t know / can’t say 5% No response 5%

Q29 What is your ethnic group?

White 92% Black or Black British 0% Asian or Asian British 1% Mixed 1% Chinese 0% Other ethnic group 0% No response 6%

Q30 Which of the following best describes you?

Employed (full or part time, including self-employed) 40% Unemployed / looking for work 1% At school or in full time education 0% Unable to work due to long term sickness 3% Looking after your home/family 5% Retired from paid work 43% Other 1% No response 7%

Patient Reference Group 2012

Number of Responses: 100

Patient Reference Group 2012

The questions below have been created in collaboration with our patient reference group to enable us to consider changes to the service we offer. Once we have gathered the results of the survey, we will have a further meeting with the patient reference group to discuss the way forward. A report will be produced advising you of the outcome and this

will be available on our website and at the surgery. Thank you for your co-operation.

APPOINTMENTS

Have you been able to book an appointment within a timescale that is acceptable to you


If not, how long have you had to wait for an appointment

Up to a week 15% Between 1 week and 2 weeks 15% Greater than 2 weeks 14%

Would you like us to consider making appointments available for booking online


TRIAGE

Have you used the "on the day" triage service


If yes, please indicate who did the triage

Doctor 41% Nurse 27%

If you have used the triage service, how quickly did you expect a call back

Within an hour 16% 1-2 hours 32% 2-4 hours 10% Greater than 4 hours 2% No response 40%

How long did it take to call you back

Within an hour 14% 1-2 hours 28% 2-4 hours 14% Greater than 4 hours 1% No response 43%

What was your experience of triage

It met my needs 42% It only partly met my needs 10% It did not meet my needs 4% I would have preferred to see a doctor 6%

Are there any comments that you would like to make about the triage service

TELEPHONE CONSULTATIONS

Have you used a bookable telephone consultation with the doctor


Are you aware that you can book a telephone consultation


If yes, please indicate your experience

I liked being able to talk to the doctor on the phone 34% It was easier than having to come to the surgery 25% I like the flexibility that it provides 23% I only accepted the telephone slot as there was no appointment available 3% I would have preferred to see the doctor in the surgery 9%

FEMALE DOCTOR

Do you value the ability to see a female doctor


Have you seen a female doctor within the last year


If yes, did you specifically want to see a female doctor


What was your experience when you saw a female doctor. Please select as many answers as are

appropriate

They were very helpful and I preferred seeing a female doctor 23% I wouldn't have wanted to see a male doctor on that occasion 10% On reflection I would have been happy to see a male doctor 11%

Please tell us a little about yourself

Gender

Male 31% Female 61% No response 8%

Age

16-25 3% 26-40 8% 41-50 17% 51-60 19% 61-70 21% 71+ 26% No response 6%

Ethnicity

White British 89% Other 1% No response 10%

If other please specify

Thank you for completing the survey. It will help shape the way we provide service for you.

bury road surgery patient reference group report 2013/14

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