Strand Medical Practice surveys/The Strand... · Strand Medical Practice ... NBSurvey, to enable the collection of views from patients in multiple locations across various

Strand Medical Practice

2‐6 The Strand

Goring‐by‐Sea

Worthing

West Sussex

BN12 6DN

Practice Manager: Jane Kimber

T: 01903 243351

Local Patient Participation Report March 2013

Strand Medical Group Local Patient Participation Report 2013 | 2

Executive Summary The following report outlines requirements for a Local Patient Participation Report to satisfy the PP‐DES 2011 – 2013 requirements as directed by the; THE NATIONAL HEALTH SERVICE ACT 2006 The Primary Medical Services (Directed Enhanced Services) (England) (Amendment) Directions 2011 Insertion of new direction 12A ‐ “Patient Participation Scheme”. The survey results in this report have been collated since 1st April 2012, and continue on from results in the 2012 Local Patient Participation Report. Strand Medical Group participated in the PP‐LES from 2011‐2012 and then the PP‐DES from 2012‐2013 Strand Medical Group 2‐6 The Strand Goring‐by‐Sea Worthing West Sussex BN12 6DN

Practice Manager:

Jane Kimber

Number of full time doctors (FTE) 6.67 Number of patients 13814

PP DES Methodology The practice engaged with NETbuilder to provide their comprehensive managed survey solution, NBSurvey, to enable the collection of views from patients in multiple locations across various demographic groups. This enabled us to canvass our patients opinions via an input channel most suited to them, from in‐practice touch screen kiosk, paper surveys through to virtual online surveys. The practice has a ‘virtual’ Patient Reference Group. This means that patients are invited and encouraged to give their feedback via surveys on various aspects of the practice in a number of ways. The Patient Reference Group is a member of the National Association for Patient Participation and we distribute their newsletters to our group members. We also encourage our PRG members to engage with the local (CWS) Patient Participation activities by circulating details of meetings and requests for patient representatives. The current number of PRG Members is 49. Recruitment is on‐going.


Results Summary Item Total Number of Surveys 8 Number of Responses 477 Number of Input Channels 4

Summary Outcomes & Action Plan – PPDES Year 2 Results The Practice has built on the work that we carried out through participation in the Patient Participation LES in 2011 and is now signed up to the Patient Participation DES for 2012. We have worked to increase the membership of the virtual Patient Reference Group and work on this will be on‐going through the next year. We also have plans to hold meetings for our Patient Reference Group members to consult with them further on our plans and to focus on their priorities for our service. Our Action Plan covers four main areas which focus on:

• Opening times • Telephone consultation • Making an appointment • Telephone answering

We will be agreeing further surveys with our Patient Reference Group so that we carry out surveys over the next year to ascertain the impact on our service of the changes that we making.


CONTENTS

Executive Summary 2

PP DES Methodology 2

Results Summary 3

Summary Outcomes & Action Plan – PPDES Year 2 Results 3

About The Practice 6

Service available at the practice 6

The Doctors 7

The Practice Staff 7

Practice Nurses 7

Reception 7

Administration 7

Opening Hours 7

Home Visits 7

When the Surgery is closed 8

Local Survey Methodology 9

The NBSurvey Methodology 9

Input Channel Evaluation Criteria 14

Patient Reference Group 16

PRG Membership 16

Member Profiles 16

PRG Recruitment & Representation 16

Agreement of Priorities 16

Results, Outcomes & Findings 17

Summary Information 17

Survey results by Input Channel 17

Representation of Registered Patients 17

Survey Results 18


Discussions & Action Plans 22

Summary of Year 1 Outcomes & Action Plan PP LES 22

Implementation of Year 1 Outcomes and Action Plan PPLES 22

What Strand Medical Group did 22

The Strand Medical Group outcomes 22

Year 2 of the PPDES ‐ Discussions 23

Year 2 of the PPDES ‐ Action Plans 24

Summary of the PPDES 2011‐2013 26


About The Practice The Practice is located on The Strand at Goring‐by‐Sea, Worthing, West Sussex. Appointments are bookable either 3, 7, 14 or 21 days in advance with the remaining appointments (approximately 40%) available on the day. The Practice also offers telephone consultations and a telephone triage service. Patients are able to book either in person, by telephone or online; all face to face appointment types are available online. Patients on regular medication will require repeat prescriptions and for a safer and speedier service, repeat prescriptions are computerised. Repeat prescription requests can be handed to a Receptionist at front desk, sent by mail, delivered through the local pharmacy repeat prescriptions services or requested online through the SystmOnline website.

Service available at the practice

Diabetes Run by specially trained Nurses who offer an annual health review as well as on‐going check ups, dietary and general advice. If problems arise, patients will be referred back to their usual doctor. Asthma Our specially trained Nurses will ensure that treatment is effective by checking inhaler technique and measuring lung function regularly, referring patients to their usual doctor. Patients attending for Asthma appointments are requested to bring along their inhalers. Cardiac This clinic provides a service for patients who currently have heart disease. It offers advice about maintaining health and reducing the possibility of any further heart problems. It is run by specially trained Nurses and assessed by invitation only. Travel To book a Travel Clinic appointment, Patients are asked to pick up a form at our Front Desk 6‐8 weeks prior to their travel. An appointment with our trained Nurses will be given based on vaccination type. Cervical Smears The Nurses are trained to do cervical smears. All women aged between 25 and 64 years of age are automatically invited for a smear through the screening programme run by the local health service with follow up service for non‐responders managed by the Practice. Minor Illness These Clinics are held on a daily basis to deal with minor ailments ‐ eg Sore Throats, Urine Infections, Coughs, Rashes. Minor Surgery We have regular clinics to remove "lumps & bumps", moles, cysts etc. It is essential that patients have an appointment with the GP first so that the lesion can be properly assessed. If we are able to remove it at the surgery we will arrange for patients to have an appointment at the Minor Surgery Clinic.


Family Planning Services The Family planning service offers confidential advice and information about contraception and sexual health from our Nurses and Doctors. Smoking Cessation At this clinic, specially trained Counsellors help patients cope with their dependence on tobacco products. The therapy involves individual counselling as well as group sessions and may include the dispensing of pharmacological aids. Child Vaccinations There are some diseases that can harm children or cause permanent damage to their health. Immunisation ‐ also called 'vaccination', 'jabs' or 'injections' ‐ provided by our trained Nurses will help prevent them and keep children healthy.

The Doctors

The Practice has four Partners, three salaried GPs and GP Registrars working at the surgery.

The Practice Staff

Practice Nurses The Doctors are assisted by a team of 6 Practice Nurses and 4 Health Care Assistants who run our Minor Illness clinics and Chronic Disease Management clinics. Reception There are 14 Receptionists who have undertaken special training and always respect patient confidentiality.

Administration Our administration team comprises 4 Medical Secretaries and 4 Administrators who support the Practice in areas such as patient referrals, scanning and attaching of letters and IT and financial services.

Opening Hours

The surgery opening hours are 8am till 6.30pm Monday to Friday with late surgeries running till 7.30pm on Monday and Wednesday. Nurse clinics (pre‐bookable appointments only) are also available once a month on Saturday.

Home Visits

In cases of severe illness, infirmity, or emergencies, the GP or Nurse will visit the patient at home. Patients who are too ill to attend surgery are asked to call the surgery before 10.00am whenever possible, in order for visits to be planned. Patients are encouraged to describe their symptoms so that the Receptionist or a Duty Doctor can assess the urgency of the call. Doctors may phone before visiting to assess the urgency of the visit.


When the Surgery is closed

The out of hours is provided by Harmoni from 6.30pm to 8am Monday to Friday and 24 hours Saturday, Sunday and Bank Holidays.


Local Survey Methodology The practice engaged with NETbuilder to provide their comprehensive managed survey solution, NBSurvey, to enable the collection of views from patients in multiple locations across various demographic groups. This enabled us to canvass our patients’ opinions via an input channel most suited to them, from physical paper and in‐practice touch screen kiosks / laptops, through to virtual online surveys. Findings from previous studies carried out by NETbuilder exposed that multiple short surveys with a maximum of 8‐10 questions each are more effective than one long survey running continually throughout the survey period. Each survey was customised to the investigational design and measures, for example measuring how effective it is for patients to get an appointment using a short survey (The Access Survey). Additionally, this encourages patients to give feedback for the areas relevant and important to them.

The NBSurvey Methodology


Step Description Surgery Comments / Experiences Continual Development of Patient Reference Group (PRG)

The PRG is a representative group of patients from the practice. They are responsible for providing feedback to surveys and collaborating with the practice to analyse the results and agree realistic change opportunities.

Patients are encouraged to join the Group by completing a registration form with an email address where available. New patients registering at the Practice are given information about the Group. Information is also included in the Practice Leaflet and on our website.

Determine Priority Areas

Key areas include but are not limited to the following: • Access • Overall Satisfaction • Seeing a Doctor • See a Nurse • The Reception • The Surgery Environment • Demographics • Specialised Clinics (e.g. Flu,

Vasectomy) The PRG and other patients complete the Patient Priorities Surveys to priorities the areas (above) to determine the order in which key areas are addressed by the practice. Patients are also given the opportunity to provide comments regarding other areas they would like to see addressed.

In year 1, we completed local LES which included undertaking a patient survey. We designed our own survey which included questions on: • Ease of getting appointments

(within 24 hours, ability to book ahead etc.)

• Ease of getting through on the telephone

• Opening times • Provision/availability of chronic

disease management appointments and support

• Attitude of GPs and Practice staff

We sought the views of our PRG members via email on the content of the surveys. In year 2 of the PP DES; our choice of surveys was agreed to measure the impact and outcome of the changes that we planned to implement as set out in our Action Plan. Surveys completed

• Making an Appointment • Overall Satisfaction • Seeing a Doctor or Nurse • Surgery Environment • Surgery Opening Times • Surgery Telephone • Telephone Consultation • Telephone Triage


Following the results of the PP LES and the key objectives set out in the PP DES, we chose to complete the above surveys in year 2.

Design & Build Surveys

The practice worked closely with NETbuilder to design and build the surveys. Each survey is designed to measure the patient’s view of the identified key areas. The majority of surveys contained between 8‐10 questions. Patients are able to choose to complete the surveys they believe are relevant to them and ignore those that are not.

The practice collaborated with the patient group through email to agree the questions for the 2011‐2012 surveys. As a result we agreed the Action Plan for 2012. The Practice Team met to review the results. We also discussed the findings of the surveys with our Clinical Governance Group which includes lay members. We agreed a report and action plan with The Practice Team and our Clinical Governance Group. We shared our report and action plan with the members of our PRG and published them on our website.

Decide on Input Channels and Publish Surveys

The practice worked closely with NETbuilder to agree which input channels are suitable for the surgery and patients. Input channels available are: • Surgery Kiosk • Web Portals • Paper • Face to Face Each survey can be used on (published to) one or more of the input channels listed above.

In year 1 of the local LES, we used the Input Channel Evaluation Criteria to help us decide which channels to use for The Strand Medical Group: • In‐surgery Kiosk: to capture

patients from all demographics visiting the surgery

• Web Site: open to all practice patients

• Patient reference group portal • Paper survey In year 2 we continued to use the following input channels: • In‐surgery Kiosk: to capture

patients from all demographics visiting the surgery

• Web Site: open to all practice patients


• Patient reference group portal • Paper surveys were made

available for those with a preference for more traditional means of completing a survey.

Advertise Feedback Channels

Inform patients of the available input channels and current surveys, in order to create a greater number of participation responses. Types of promoting include but is not limited to: • Encouragement slip given by the

doctor • Posters • Leaflets • Encouragement from all Practice

Staff & PRG • Surgery Website • Notice Board

The Practice leaflet advises patients of the surveys. Reception staff encouraged patients to complete the surveys using the kiosk. The scrolling news section on our website invited patients to complete the surveys on‐line. We also had paper copies of the surveys in reception for patients to complete while at the surgery or take home, complete and return to us. This information was then added via a secure portal by a member of the Practice team.

Capture Patient Experience

Patients complete surveys using the available input channels as listed above.

There appears to be reluctance on the part of our patients to join the Patient Reference Group and we have found it necessary for staff and clinicians to actively encourage patients to participate in our surveys.

Produce & Distribute Reports

Results in the form of reports are produced for each individual survey and distributed via the Practice Website, Practice Meetings, Surgery Notice Board, PRG consultations.

The results of the surveys were emailed to the Patient Group and feedback was requested. The results will be published on our website and displayed on the Notice board together with this completed report. The results were discussed by the Practice team and subsequently with the lay members on our Clinical Governance group. The results as previously were published on the website. In year 1, we completed the LES. Our surveys were designed and agreed by email with the PRG. We agreed our


Action Plan for 2012 with the PRG and since implementing the changes to our services, we have again surveyed our patients as agreed to ascertain the outcome of the changes. The PRG is still virtual. However, we have met 3‐monthly with our Clinical Governance Group on which we have lay members which has enabled us to discuss our actions with some of our PRG. We have agreed to hold a meeting for our PRG in June and hope that we will be able to build on the continued support so that face to face meetings become a regular feature of the group.

Collaborate with PRG to Analyse Results

The Practice Manager will discuss & analyse the survey results with the Practice Doctors and then discuss with the PRG for further analysis.

The results of the surveys and comments from the Group were discussed by the Partnership and Management Teams and shared with the whole Practice for their comment. Our PRG has been consulted in order to agree the priorities for our surveys and assist in the design of the surveys. Our face to face contact is through our Clinical Governance group which has lay membership and we hold Practice Team meetings 3‐monthly as well as being able to discuss our surveys at Practice Training sessions (4 in‐house sessions per annum). Using these vehicles, we established an action plan for 2012. We have continued to meet as above and to canvass opinion from our PRG by email throughout the year. With the publishing of the survey reports for 2012/2013 and the Action Report in the Practice and on our website, we plan to hold a meeting in June for our PRG.


Input Channel Evaluation Criteria Input Channels should be thoroughly evaluated for their suitability for use by patients belonging to a practice. The following table describes the advantages and disadvantages of each input channel currently supported for practices. Input Channel

Advantages Disadvantages

Paper Surveys

Suitable for a large percentage of patients across most services

Known and trusted media for many patients

Production, deployment and collection of surveys required

Data input required

Public Web Instant feedback Limited to patients with internet

Agree Action Plan Detailed action plans are created at the end of year 1 (2011/2012) of the PP LES and the end of year 2 (2012/2013) of the PP DES.

An agreed action plan between the PRG & Surgery was created after the year 1 result (2011/2012) according to the outcome of the analysis from the results. The PP LES required us to carry out a patient survey and to meet to review the results. We agreed a summary report, with the priorities and proposed actions decided as a result of the surveys. This was agreed with the PRG and the Practice Team before being made available to patients on our practice website. A further action plan has been created following the year 2 results (2012/2013). Details of the year 2 action plan are provided in the section Discussions & Action Plans below.

Implement Change Practice must obtain the agreement of its local PCT to its proposals for any significant change, e.g. change of opening hours. Approved changes can then be implemented.

Details provided in the section Discussions & Action Plans below.


Surveys Fast deployment of survey

Easily changeable access

Limited to patients with the ability to use technology

Email Surveys

Instant feedback Fast deployment of survey Easily changeable Excellent for tracking feedback for

specific treatments (e.g. specialised clinics)

Limited to patients with internet access

Limited to patients with the ability to use technology

Limited to patients with email accounts

Limited to patients who have provided Trust with email addresses

Phone Surveys

Instant feedback Fast deployment of survey Easily changeable Excellent for tracking feedback for

specific treatments

Limited to patients with telephone access

Limited to patients with the ability to use a telephone

Additional cost to practice Touch Screen Kiosks

Immediately and conveniently accessible before and after appointments

Instant feedback Fast deployment of survey Easily changeable

Limited to patients with the ability and willingness to use a touchscreen kiosk

Requires suitable physical location

Touch Screen Tablets / Laptops

Instant feedback Fast deployment of survey Easily changeable Immediately and conveniently

accessible before and after appointments

Portable Fashionable

Limited to patients with the ability and willingness to use a touchscreen tablet

Requires overnight charging

Standard Desktop

Instant feedback Fast deployment of survey Easily changeable Immediately and conveniently

accessible following treatment

Limited to patients with the ability and willingness to use a desktop PC

Requires suitable physical location Requires protection from being

damaged, lost or stolen Face to Face interviews

Instant feedback (proving tablet used to input response)

Fast deployment of survey Easily changeable Immediately and conveniently

Canvasser must be independent Additional resource required Patients may be reluctant to give

honest answers to canvassers


accessible following treatment

Patients able to converse with a person, puts at ease

Rapport building

Patient Reference Group PRG Membership

Member Profiles We currently have 49 members in our Patient Reference Group.

PRG Recruitment & Representation Surveys are presented in multiple formats that allow a survey to be completed from within, but also off the premises of the surgery including Kiosk and Website Portal. Surveys can be filled in on belhalf of others, this enables any patient with the ability to be able to participate in any survey and represented in data collected. Members of the group have been recruited by notices in the waiting room, sign up forms in Reception and information on the Practice website. Throughout the summer months, we ran a campaign with flyers and sign up forms at the front desk. Note: Feedback is not solely reliant on the PRG, surveys are also completed by other Patients from the Practice via the surgery kiosk and web portals etc. The PRG members are ‘virtual’. Our Action Plan was shared and agreed with our PRG members in March 2012. We have implemented the actions and the surveys undertaken this year are in line as agreed with our PRG so that we can measure the impact of our actions. Our communication with our PRG has been by email. As a member of NAPP, we receive their regular monthly bulletins which we forward to our PRG members each month. Additionally, CWS Comms (the Clinical Commissioning Communications) sends us emails with details of local Patient Participation meetings, requests for patient representatives to sit on groups which we forward to our PRG members.

Agreement of Priorities Our Practice took the strategic decision not to solely rely on our Patient Reference Group for feedback to our surveys and wanted to capture the views of as many of our patients as possible. To support this decision we invested in a touchscreen kiosk and web portal technology in year 1. The intention was to encourage patients visiting the practice to provide us with “in the


moment” feedback about the service they had just received. The web portals enable us to reach‐out to patients who are unable to visit the surgery. We believe that this strategy will provide the practice with feedback from a representative demographic of our patient population.

Results, Outcomes & Findings Summary Information Item Total Number of Surveys 8 Number of Responses 477 Number of Input Channels 4

Survey results by Input Channel Input Channels

Survey Kiosk Website Reference Group

Paper Total

Overall Satisfaction 42 70 13 12 137 Seeing a Doctor or Nurse 16 10 0 22 48 Making An Appointment 32 27 0 0 59

Environment 23 36 12 0 71 Opening Times 18 23 0 0 41

Telephone 17 21 0 0 38 Telephone Consultation 20 20 1 10 51

Telephone Triage 13 12 4 3 32 Total 181 219 30 47 477

Representation of Registered Patients

Nationality Practice Profile

PRG Profile

White British/Irish 3405 14 Black 67 0 Asian 61 0 Indian 129 0

Pakistani 9 0 Chinese 32 0 Mixed 125 9

Not known 9955 26

Age Group Practice Profile

PRG Profile

20‐29 years old 1615 0 30‐39 years old 1482 4 40‐49 years old 1938 6


50‐59 years old 1794 4 60‐69 years old 1685 20

70‐79 1153 10 < 80 1021 5

Gender Practice Profile

PRG Profile

Male 6749 18 Female 7034 31

Ethnicity: we still have a large number of patients with historical records and do not have their ethnicity recorded. As we do not know the ethnicity of a significant proportion of our patients, it is difficult to know for certain whether our PRG is representative in this respect. However, we have a small number of patients recorded as being from ethnic group other than White British/Irish but to date we do not have any from these other groups in our PRG so this is an area that we need to target. Patients in age groups 60 – 69 and 70 – 79 are over represented while all other age groups are under presented and we will try to target young parents bringing their children in for vaccination and patients attending our Saturday nurse led clinics (who tend to be younger, of working age) in order to address this imbalance. Survey Results Detailed reports for each survey can be found on Strand Medical Group website www.strandmedical.co.uk All results were discussed with the PRG and relevant practice staff, the key outcomes for each survey are highlighted below. Please note that the reports found on the website display the latest feedback captured and therefore may contain more results than are summarised in this report.

Overall Satisfaction

• 80.3% of patients rated the cleanliness and infection control at the surgery as ‘fairly clean’ or ‘very clean’

• 51.82% of patients said that they can be overheard at reception but they didn’t mind • 81.03% of patients said they found the receptionists fairly and very helpful • Patients following booking pre‐booked appointments waited the following times

o 7.30% of patients said they were seen on time o 6.57% of patients said they waited less than 5 minutes after their appointment time o 46.72% of patients said they waited 5 to 15 minutes after their appointment time o 11.36% of patients said they felt they didn’t have to wait too long, an additional 53.03%

were ok with waiting • 81.01% of patients said they were ‘satisfied’ or ‘very satisfied’ with the care they get at the

surgery


• 56.20% of patients said they would recommend the surgery to someone who has just moved

into the area

Seeing a Doctor or Nurse

• When patients were asked about the following areas when seeing a doctor ; ‘giving you enough time’,’ asking about your symptoms’, ‘listening’, ‘explaining tests and treatments’, ‘involving you in decisions about your care’, ‘treating you with care and concern’, ‘taking your problems seriously’, patients rated the Doctor as ‘good’ 73.53% and ‘satisfactory’ 18.9% or more for each of the areas

• 75% of patients said that they had confidence in the Doctor they saw, a further 16.67% had confidence to some extent

• 91.67% of patients said that they would be happy to see the same Doctor again • The reasons patients gave for the seeing the doctor were

o 55.56% ‐ on‐going problem o 19.44% ‐ one off problem o 13.89% ‐ to ask advice o 5.56% ‐ prescription o 5.56% ‐ other

• When patients were asked about the following areas when seeing a Nurse or practice health care assistant; ‘giving you enough time’,’ asking about your symptoms’, ‘listening’, ‘explaining tests and treatments’, ‘involving you in decisions about your care’, ‘treating you with care and concern’, ‘taking your problems seriously’, patients rated the nurse as ‘satisfactory’ or ‘good’ 100% for each of the areas

• 100% of patients said that they had confidence in the Nurse they saw • 91.67% of patients said that they would be happy to see the same Nurse again

Making an Appointment

• How appointments were normally booked o 15.25% of patients booked in person, 10.17% preferred this method o 74.58% of patients booked by phone, 61.01% preferred this method o 10.17% of patients booked on line, 23.73% preferred this method o 5.08% would like to book by text message

• 49.15% of patients were able to get an appointment to see a doctor the same day or the next day

• Patients reasons for not being able to see the Doctor on the same day were o 50% ‐ no appointments left o 7.5% ‐ times offered didn’t suit o 22.5% ‐ couldn’t see doctor of my choice o 20%‐ another reason

• 91.53% of patients tried to book ahead to see a doctor • 24.07% of patients were able to book an appointment for more than 2 days in advance • 71.19% of patients had made an appointment by phone in the last month • 89.83% of patients were aware that the surgery operated as a group practice and they may be

asked to see any doctor


Surgery Environment

• 67.61% of patients said the level of privacy in the surgery at ‘good’ or ‘excellent’ • 65.55% of patients said the appearance and comfort of the surgery to be ‘good’ or ‘excellent’ • 67.61% of patients felt there was enough facilities in the waiting area for adults and children • 36.62% considered that the hand sanitizers were easy to access around the surgery • Patients said the following areas were ‘good’ to ‘excellent’

o 76.06% ‐ reception o 63.23% ‐ toilets o 82.35% ‐ treatment rooms o 74.28% ‐ waiting area

• 87.32% of patients found the signage around the surgery as helpful • 80.28% of patients were happy with way they were called into the treatment room

Opening Times

• 51.22% of patients said the opening times suited them • Patients rated improvements to the service, 15.38% were happy with existing service

o 30.77% ‐ later opening times o 7.69% ‐ earlier opening times o 40.38% ‐ Saturday morning openings

• 48.78% of patients were aware that there were late evening surgeries Monday and Wednesday • 29.27% of patients were aware that there was a monthly nurses clinic

Telephone

• Patients rated ‘good’ to ‘satisfactory’ the response when they contacted the surgery by phone o 56.52% ‐ getting test results o 29.23% ‐ getting through o 53.57% ‐ speaking to a doctor o 50% ‐ speaking to a nurse

• 36.84% of patients found the surgery answer‐phone message useful • 94.74% of patients would prefer to be put in a queue when the line is busy • 73.68% of patients had tried to book an appointment by phone in the last month

Telephone Consultation

• Patients reasons for speaking to a Doctor or nurse o 45.10% ‐ ongoing problem o 33.33% ‐ new problem o 21.57% ‐ urgent problem

• 69.57% of patients using the service, saw the same Doctor that had dealt with this previously • 70.59% of patients found it useful to see the same Doctor for the same problem • 66.66% of patients rated their phone experience as ‘good’ to ‘very good’


Telephone Triage

• Patients reasons for speaking to a Doctor or nurse o 50% ‐ ongoing problem o 43.75% ‐ new problem o 6.25% ‐ urgent problem

• 68.75% of patients using the service, spoke with the same Doctor that had dealt with this previously

• Patients outcome of the telephone triage o 15.63% ‐ advice given o 28.13% ‐ appointment that day o 12.50% ‐ appointment for another day o 9.38% ‐ made a routine appointment o 21.88% ‐ prescription issued o 12.50% ‐ other

• 78.13% of patients rated their telephone triage experience as ‘good’ or ‘very good’


Discussions & Action Plans Summary of Year 1 Outcomes & Action Plan PP LES In 2011 to 2012, the Practice carried out the Patient Participation LES offered by CWS. We formed a virtual Patient Reference Group. This was done through recruitment in the surgery and through our website. We consulted with the PRG to design patient surveys, and surveyed both members of our PRG and patients attending the surgery. Following the results of the surveys, we agreed an action plan with our virtual PRG. This can be categorised into 3 main areas:

• Appointments • Telephone answering • Communication with patients

Implementation of Year 1 Outcomes and Action Plan PPLES

What Strand Medical Group did We discussed the findings of the patient surveys carried out in 2011 to 2012 with the Practice Team and with our PRG, as required by the CWS Patient Participation LES. We agreed an action plan which we anticipated would address the issues raised in our surveys.

The Strand Medical Group outcomes Feedback from our PRG and patient surveys suggests a link between the two main issues raised: the telephone answering and the availability of appointments. We circulated the results of our surveys to the members of our PRG for their comment. Their feedback was used as the basis for the prioritization for our Action Plan. Our Action Plan covered three main areas: Appointments: • Introduce Telephone Consultation service • Review appointment system including proportion of Same day / 3 day / 21 day pre bookable

appointments to provide more flexibility • Consider changes to unify the ways that Doctors work to increase capacity and audit patients brought

back as “follow up” Telephone answering • Ensure that there are at least 5 staff answering the phone between 8am to 8.30am each day • Encourage patients not needing to be seen same day to phone after 8.30am • Review appointment system in endeavour to reduce demand at 8am (as above) • Repeat survey once Telephone Consultation service and changes to staffing rotas have been

implemented


Communication with patients • Raise awareness of Group Practice policy and what this means for patients ‐ consult with PRG to find

effective ways of communicating this to patients

• Raise awareness of Extended Access Opening hours and reason for opening hours offered ‐ consult with PRG to find effective ways of communicating this to patients

Year 2 of the PPDES - Discussions Feedback from our PRG and patient surveys suggests a link between the two main issues raised: the telephone answering and the availability of appointments. As a result of the surveys, in April 2012, we introduced a completely different way of working for the Doctors by overhauling our appointment system and with the introduction of a telephone consultation service and telephone triage service. Appointments: The Doctors’ morning surgeries now start with traditional appointment types – a mix of same day and pre‐bookable. These are followed by a number of telephone consultation “appointments” and then followed by telephone triage “appointments”. The remainder of the surgery is the traditional appointment types – a mix of same day and pre‐bookable appointments. Patients self‐select for the telephone consultation appointments; they are asked if they consider their problem to be suitable for a telephone consultation. If they reply yes, then the receptionists ascertains whether this is a new or on‐going problem and wherever possible, arranges for the same Doctor who has been dealing with any on‐going problem to take the consultation to provide for continuity of care. The telephone triage service has been introduced to meet the increasing demand by patients on the service, so that patient’s needs can be prioritised and we can provide the most appropriate care for our patients. A new protocol was designed by the Doctors and Management Team in conjunction with representatives from the Reception Team to ensure that patients’ calls were appropriately routed. All Receptionists received training in the use of the protocol. The balance of appointment types was reviewed and approximately 40% of appointments are same day appointments, with the rest being divided equally between appointments which are bookable 3 days, 7 days, 14 days and 21 days in advance. Telephone answering: New staffing rotas have been introduced to ensure that there are usually 5 receptionists available to answer calls each day between 0800 ‐ 0900. A virtual PRG was developed in line with the requirements of the PP DES. We are planning to invite the members of our virtual PRG to a meeting to develop and further the engagement of members


of the PRG who wish to be involved on that basis. The meeting is to be held early in June following another recruitment campaign designed to expand the membership of the Patient Reference Group.

Year 2 of the PPDES - Action Plans

The results of our surveys have been shared within the Practice and with the members of our PRG. The findings of the surveys have been summarised in this report – see section above: Results, Outcomes & Findings. The Action Plan has been developed and shared with the Practice Team and the PRG. Overall Satisfaction and Surgery Environment The overall satisfaction with the premises and the cleanliness of the surgery is rated satisfactory or better by the patients. We are currently carrying out a refurbishment programme, mostly in the patient area: walls and flooring being refurbished or replaced. The waiting room and patient corridors have already been decorated and flooring to the corridors is on order. Redecoration of the patient toilets in planned for completion in April. Therefore, the Practice does not intend to put forward any plans for the Surgery Environment. Seeing a doctor or nurse Generally, there is satisfaction and confidence with the doctors and nurses in the Practice. Surgery Opening times The findings of this survey are disappointing since the Practice already opens for more hours that our core NHS contract requires (0800 – 1830, Monday to Friday). We operate extended opening times with doctor’s appointments available in weekly late evening surgeries on Monday and Wednesday (1830 to 1930) and nurses’ appointments available in monthly clinics on Saturday mornings (0800 to 1200). Although the percentage of patients reported as wanting later opening times is 30%, the number is quite small (26) and we will survey further to ascertain whether , despite this information being available on our website), these patients are aware of the late evening clinics. Although 40% of the patients completing the survey want Saturday morning surgeries, this is again a small number (21 patients). Four of the Doctors in the Practice work for the Out of Hours service and Saturday opening at the Practice would deplete the Out of Hours workforce. Although only a small percentage of patients are reported as wanting early morning surgeries, the Practice has decided to operate a weekly early morning surgery to test the demand for this service and to find ways to better publicise the late evening surgeries and monthly Saturday morning clinics since these times would appear to suit a number of patients and are already available. Actions: Commence weekly early morning surgery with appointments available between 0700 – 0800. Increase publicity of weekly late evening surgeries Increase publicity of monthly Saturday morning clinics Publicise weekly early morning surgery


Telephone consultation Overall, the findings of this survey are encouraging and the new service appears to be well received. However, 20% of respondents report not finding this service helpful and we would like to establish the reasons for this; to ascertain whether this might be due to lack of continuity of Doctor, whether the problem could not be resolved by a telephone consultation, whether an on‐going problem – if this is the case, we would need to revisit our protocol for Receptionists to ensure only patients are offered this service appropriately. Actions: Amend survey to include questions to ascertain reason for dissatisfaction with telephone consultation service. Share finding with PRG to agree whether any action should be taken and if so, what is most appropriate. Telephone Triage service This new service appears to be well received and almost 88% of respondents feel rate this service as average or above, with 78% rating it as good or very good. It would appear that this service is working well in triaging patients to the most appropriate healthcare professional for their need, making best use of both clinician and patient time (for example, over one third of the patients did not need to attend the surgery but had their problem resolved with advice and or/issue of a prescription. Making an appointment Despite the introduction of different appointment types (bookable 3 days, 7 days, 14 days and 21 days in advance) and two new services: the telephone consultation service and the telephone triage service, availability of appointments continues to be an issue at the Practice. With the introduction of the two new services, we have increased the number of Doctor: Patient contacts by 60% during the last year and this has still not matched the increasing demand on appointments. We will carry out a large scale survey of patients through our website and attendees at the Practice to ascertain whether we should increase the ratio of pre‐bookable to same day appointments as the lack of pre bookable appointments appears to be the main concern for patients. Telephone In May 2010, we purchased a new telephone system with a secure queuing system, which guaranteed that patients would be answered in the order in which they joined the queue (our previous telephone system had a bug which could not be rectified). At the same time, we also increased the number of incoming lines to 8. We have amended our staffing rotas to provide the maximum number of staff on duty at 0800. We already have as many or more telephone lines per 1000 patients than any other surgery in the Worthing area. We are introducing new ways of working for the reception and administrative staff in April and this will provide another member of staff on the answering facility at 0800. The number of calls decreases rapidly after the first half an hour of the Practice opening. The volume of calls received at 0800 appears to be related to the availability of appointments and we will survey our patients to ascertain whether this assumption is correct. Once completed, we will be able, with our PRG, to decide on the most appropriate actions.


In summary, our proposed actions are: Issue raised Action Lead Action

Date Opening times

• Commence weekly early morning surgery with appointments available between 0700 – 0800.

• Increase publicity of weekly late evening surgeries

• Increase publicity of monthly Saturday morning clinics

• Publicise weekly early morning surgery

Partners / Patient Services Manager

April 2013

Telephone consultation

• Amend survey to include questions to ascertain reason for dissatisfaction

• Share finding with PRG to agree any action

Business Manager

May 2013 June 2013

Making an appointment

• Carry out a large scale survey of patients to ascertain whether we should increase ratio of pre‐bookable to same day appointments

Business Manager

May 2013

Telephone • Implement new staffing rotas • Survey patients as above

Patient Services Manager

April 2013

Summary of the PPDES 2011-2013 In 2011, the Practice participated in the CWS PP LES. This required that only a patient survey be carried out. However, the Practice determined to set up a virtual Patient Reference Group. We started this process in the summer of 2011 and a small number of patients signed up. Since that time, we have actively promoted the PRG to our patients through notices in the waiting room and on our Practice website in an effort to build the PRG during this year. However, the uptake has still been low and this has been a disadvantage of participating in the LES in the first year. We recognise that we need to be yet more proactive in engaging our patients in this process. Participation in the Patient Participation DES focussed our attention on the development of the Patient Reference Group and we ran campaigns last summer to increase the membership of this group. It is regrettable that there appears to be reluctance on the part of our patients to sign up for this although we did see a small increase in the number of members. We have, however, been able to survey the users of our services through the kiosk in the waiting room and paper surveys which are available to pick up at reception so that we reach as many patients as possible and not just those who are IT literate and use our online services or access our website. The surveys have been helpful to us in understanding how the changes that we implemented in 2011 have impacted on the service that we provide to our patients. Although our PRG is not yet


truly representative on our patient profile, it is progressing and we have now identified which groups we need to target. Our patient profile is of a more elderly population that the average practice in England and patients in the age groups 60 – 69, 70 – 79 and 80 and over, are well represented. These age groups are a significant proportion of users of our service and their views are valuable to us. Due to the age profile, we have established that most patients prefer to make appointments by telephone or in person; the use of technology (online booking services) is of less importance to these groups of patients. Although the PRG membership is small, they have been most supportive in responding to requests to help us determine the priorities for our surveys and in giving feedback on our survey results to provide input to the development of our Action Plan. We are planning to hold a meeting in June of this year to which we will be inviting all our PRG members, to share our Action Plan and discuss further the priorities for this year.

Documents

Strand Medical Practice surveys/The Strand... · Strand Medical Practice ... NBSurvey, to enable the collection of views from patients in multiple locations across various