PRG Report &  Action Plan

 

PATIENT PARTICIPATION REPORT 2012- 2013

 

1. Establish a Patient Reference Group (PRG) comprising only of registered patients

The table below reflects the practice population and the PRG profile by age, ethnic group and gender.

 

Practice population profile

Number

% of total

PRG profile

Number

%  of total

A  G  E

%  Under 16

1798

17.6

%  Under 16

 2

 1

%  17-24

 856

 8.4

%  17-24

 9

4.5

%  25-34

 951

 9.3

%  25-34

13

 6.0

%  35-44

1324

13.0

%  35-44

29

14.0

%  45-54

1416

13.9

%  45-54

30

16.0

%  55-64

1228

12.0

%  55-64

38

19.0

%  65-84

2187

21.5

%  65-84

75

37.5

%  Over 84

 422

 4.1

%  Over 84

 4

 2.0

E T H N I C I T Y

White

 

 

White

 

 

% British Group

More than 97%

 

% British Group

186

93

% Irish

 

% Irish

8

3

Mixed

 

 

Mixed

 

 

% White & Black Caribbean

ca 2.3 %

 

% White & Black Caribbean

2

1

% White & Black African

 

% White & Black African

2

1

% White & Asian

 

% White & Asian

0

0

Asian or Asian British

 

Asian or Asian British

 

 

% Indian

 

% Indian

1

0.5

% Pakistani 

 

% Pakistani 

0

0

% Bangladeshi

 

% Bangladeshi

1

0.5

Black or Black British

 

Black or Black British

 

 

% Caribbean

 

% Caribbean

0

0

% African

 

%  African

0

0

Chinese/other ethnic group

 

Chinese/other ethnic group

 

 

% Chinese

 

% Chinese

2

1

% Any other

 

% Any other

0

0

G E N D E R

% Male

4815

47.3

% Male

69

34.5

%  Female

5367

52.8

% Female

132

66.5

 

a.    Process used to recruit to the PRG

 

·      We used a number of different ways to recruit patients to our PRG

·      Information leaflets in waiting rooms

·      Offered leaflets to all patients attending the practice for appointments

·      Offered leaflets to all patients collecting repeat prescriptions

·      Face to face invitation by doctors

·      Practice Nurses invited all new patients to join at registration

·      Asked patients to join via our practice website

Comment:

Recruitment has been difficult and patients have generally shown limited interest in joining the group.

It is hard to be certain as to the exact reasons for this, but there seems to be a degree of “survey fatigue” amongst our patients.

Our PRG now has 200 members and we will continue to attempt to gather more volunteers during the next year.

 

b. Differences between the practice population and members of the PRG:

 

Looking at the age demographic profile of our patient list compared to our PRG, we feel that all expected age groups are represented.

Representation is unsurprisingly low in the 0-16 age group. In most situations we would expect these patients to be attending with their parents and their parent would be their advocate in providing input into our services and survey, filling the survey in as a family member rather than an individual.

We are slightly low on the 17-35 age groups and high on the 55-84 and over age groups. This reflects the fact, that our practice population is age heavy and that elderly patients are much higher attendees of our surgery than the younger patient group. This suggests we have captured our attending population well.

In comparing our ethnicity profile of our PRG to our practice profile, we used Public Health data from the London Health Observatory. This suggests the percentage of ethnic minorities expected for our population to be 2.3% and that of our PRG is 4 % suggesting all ethnic groups are proportionately represented.

Our gender representation is slightly low for males. This would be in keeping with observations that the working male group are the least frequent attenders at the surgery. Whereas it is usually mothers who with their children and females have higher average attendance due to routine follow-up appointments for pill check and smears. So again this accurately reflects our attending population.

However in spite of our best efforts the composition of our PRG remains largely unchanged from 2011/12. Is seems that we lost some members, but recruited similar numbers of new recruits.

 

2. Agree areas of priority with the PRG

 

1. The areas of priority agreed with the PRG:

 

As the first stage in the survey we asked our PRG members to tell us what they thought our key priorities should be for the next year. They were asked to choose from the following options:

  • Clinical Care

 

  • Getting an appointment

 

  • Reception Issues

 

  • Opening Times

 

  • Parking

 

  • Getting Your Prescriptions

 

  • Telephone Access
  • Other (please specify)

 

 

b.      The three main priorities selected were

 

Clinical Care – according to the responses collected from the PRG, the main priority of our patients with 66% of responses rating this   as most important

 

Appointment Availability- close run second priority with 61.8 %

 

Telephone Access – third by some distance with a rating of 29.1 %

 

1. How the priorities were decided:

 

The practice team met and reviewed the findings of our last patient survey.

We then selected, what we felt were the priorities to be surveyed during 2012/13 and requested the members of our PRG to give feedback on the proposed priorities and associated survey questions and also make suggestions regarding potential alternative topics or questions.  The doctors and nurses and receptionists, also tried to engage patients during routine visits to the surgery. We then agreed a final survey.

 

 

 

3. Collate patient views through the use of a survey 

 

  1. When was the survey conducted? How was the survey distributed

 

The Survey was conducted in January and February 2013.

 

We emailed all members of the PRG an invitation to undertake our survey using the surveymonkey webpage

 

It was also available from the receptionist on an opportunistic basis for patient not having access to email or wanting to disclose their email addresses

 

 

 

  1. Which questions in the survey relate to the priorities in (2a)

 

  • Clinical Care

 

  • The last time you saw a doctor at the surgery how good was that doctor at giving you enough time?
  • How good was the doctor in asking about your symptoms?
  • How good were they about listening to your problems?
  • About involving you in decisions about your treatment?
  • How good at treating you with care and concern?
  • Do you have confidence and trust in the doctor you saw?
  • On your last visit to the surgery did the doctor know the answers to the questions that you asked?
  • Does your doctor explain things to you in a way you find easy to understand?
  • In general haw satisfied are you with the clinical care at the surgery?
  • On your last visit to your GP did they know enough about your existing condition or treatments?
  • Would you recommend the surgery to someone who has moved into the area?
     
  • Appointment Availability
  • How easy is it to get an appointment with a doctor at the surgery?
  • How easy is it to get an appointment with the practice nurse at the surgery?
  • Thinking of when you want to see your doctor, how long does it take to see them?
  • If you are willing to see any doctor for an urgent problem how quickly are you seen?
  • How important is it to you to see the same doctor for every problem?
  • Are you happy to see a nurse practitioner for on the day problems and illness?
  • Are you offered the option to see your preferred GP at our other surgery if that is sooner?

 

  • 3. Telephone Access
  • Do you know how to have a phone consultation?
  • How easy do you find it to get through on the phone?

 

 

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

a. Describe the survey findings:

Overall we are extremely pleased with the survey results.

 

(97% of respondents were either very satisfied (69%) or fairly satisfied (28%) with the clinical care at the surgery.

91.5% would recommend the surgery to someone who has just moved into the area. This is up from 84.7% in 2011/12.

80% were happy to see a nurse practitioner for on the day problems.

88% said that the receptionists never made it difficult for them to see their GP.

86% said it was very easy (25%) or fairly easy (63%) to get an appointment with a doctor

80% said that it was very easy (10%) or fairly easy (70%) to get through to the surgery on the telephone.

93% were aware that they could be seen at either surgery and that all records were computerised.

85% waited no more than 15 minutes to bee seen and 19% were seen at their given appointment time.

92 % were seen within 2 working days, if they were happy to see any doctor, with 53% seen on the same day.

94% feel they were given adequate time to discuss their problems.

 

When asked what their future priorities were, the majority responded by saying they would wish us to continue doing the same.

 

B . Describe how the survey findings were reported to the PRG:

 

The results of the survey were emailed to our PRG members, who were invited to give suggestions and feedback on the survey findings. We also displayed a copy of the survey findings in the PRG folders in both surgeries and invited patient’s to comment in writing.

 

The practice team then met to discuss the comments from the PRG members and used them to draft a proposed action plan.

 

This draft plan was then circulated to the PRG again via email and comments and suggestions were invited.

After collating and evaluating the comments a final action plan was agreed

 

  1. Changes the practice would like to make in light of the survey findings:

 

 

In spite of the largely positive report, we feel that we should increase available appointments. We will therefore:

 

Increase the hours of the part time salaried GP post to full time to increase available doctor’s appointments

 

Increase nurse hours by 20% and assist the newly appointed senior nurse in doing the nurse practitioner training to benefit our skill mix..

 

This should also assist in the development and provision of high quality clinical care.

 

Open Little Gaynes Surgery on Thursday afternoons. This will increase available doctor and nurse appointment slots and reduce workload for receptionists at Cranham Village Surgery.

Additionally it will increase telephone  and physical access at Little Gaynes Surgery.   

 

Increase the number of on the day appointments at busy times e.g. after bank holidays

 

 

 

d.  Recommendations from the PRG based on the survey findings:

 

It appears that most members of our PRG want us to continue what we are doing with minor changes to our appointment system and access methods.

Most comments received we of a positive nature and to our surprise our patients did not seem to be aware just how much we have struggled to maintain our standards during the past year.

In particular we were surprised at the high satisfaction rate with our appointment availability.

This seems to confirm our own sentiment that we have all worked extra hard.

 

e.  Agreement reached with PRG on changes to be made?     Yes

 

f.  Changes the practice cannot make, and the reasons why:

 

Over the last few years our list size has gradually increased and we have been asked to look after and increasing number of patients in nursing and residential homes in the area.

Upminster has a high density of these types of institutions.

Compared to past years, we are no longer able to regulate our list size, therefore demand on our surgery services has steadily increased. This is making it much more difficult to maintain our own, high standards of patient care.

Trying to comply with Quality Improvement Programmes, Local and National Enhanced Services, Quality Care Commission Registration and transition to Local Commission Groups in placing increasing demands on all team members. On the basis of the experienced during the last year, burnout is a real concern among all team members. And most of these issues are not solvable at practice level.

 

 

g.  Changes the practice will make:

 

Open the Little Gaynes Surgery on a Thursday afternoon to increase access to doctor’s and nurses.

Increase the hours worked by the salaried GP to make this post a full time post.

Increase nurse time

Increase number of on the day appointment during times of increase demand, e.g. after a bank holiday

 


 5. Agree an action plan with the PRG and seek PRG agreement on implementing changes

 

 

Action

(change in practice)

Person responsible

(to lead the change)

Completion date

(when the change will be applied)

Review

(what result the practice/patients saw as a result of the change)

1

 

Increase salaried GP post to full time

Partners

1. 4.2013

Increased availability of routine and emergency appointments with a doctor

2

Increase Nurse hours

 

Partners

1.3.2013

Increase availability of routine and emergency appointments with a doctor

3

Increase the number of available on-the-day appointments in times of increased demand, e.g. after a bank holiday

 

Practice Manger

1.4.2013

Increase appointment availability during busy times

4

Open Little Gaynes Surgery on Thursday afternoons

 

Practice Manager

1.4.2013

Increase appointment availability and provide better access

 

Update on action plan for 2011/12:

 

Appointment Availability:

 

In the year since our last survey we have been opening both surgeries from 8 AM. This provided better morning telephone access and increased the number of available early appointments.  Together with better patient awareness of cross site bookings, adjusting on the day appointment numbers and telephone consultations, we were hoping to provide even better access than in previous years.

Unfortunately a number of unplanned staff changes in reality actually reduced the available doctor and nurse appointments during much of 2012 and early 2013.

First our salaried GP fell pregnant and we needed to appoint a temporary maternity locum. Then Dr Yu, who had been working with us for about 5 years as a salaried GP with his own list decided on a career change. Thereafter Nurse Kim decided to leave to become a full time foster mother. Finally Dr Yu’s replacement was offered a partnership at a neighbouring practice and left after only a few months working for us.

Since the beginning of March we finally have a full compliment of clinical staff.

Interestingly the survey does not show any perceived worsening of appointment availability.

 

Clinical Team Information:

 

We emailed a copy of a generic timetable for doctors and nurse with our survey results and action plan to all our PRG members and also displayed it in our PRG folders in the surgery.  This years survey shows that patients have taken note of this and appear much more aware that they can be seen across sites.

 

Telephone Appointments:

The survey results show that patients are no much more aware that they can request telephone consultations. This seems to be welcomed by most responders, but we also received some comments from patients stating that they would always prefer face-to-face consultations


6. Additional Information

 

a. The opening hours of the practice premises Cranham Surgery:

 

Monday – Friday 08:00 – 18:30

 

Little Gaynes Surgery:

 

Monday – Friday 08:00 – 18:30

 

The method of obtaining access to services throughout the core hours:

 

 

Phone or walk into surgery to book appointments

 

 

 

b. The times individual healthcare professionals are accessible to registered patients under an extended hours access scheme:

 

Mondays                                18:30 – 20:00

Wednesdays                        18:30 – 20:00

Alt Saturdays                        09:00 12:00