Re-Audit of Performance at the Medical Centre.
GP Patient Survey. Published July 2016.
Comparing The Medical Centre’s results to two local practices, CCG and National averages
Published 26.07.16.
Re-Audit . 27.01.16
Method and Background.
In January and July each year, the GP Patient survey is published on the website- gppatient.co.uk . It is a thorough and detailed set of survey results that allow patients and practices throughout the UK to evaluate and analyse the data.
The site also publishes past survey results that enable patients and practices to monitor performance and results against past survey results. Furthermore, the site enables users to compare results of local practices and this is an extremely helpful index to measure current and past performance against practices with a similar patient demographic.
The survey enables users to compare results at both CCG (local) and National averages.
Note* We have not named the two neighbouring practices when comparing the results due to confidentiality.
Although the findings are a helpful barometer to monitor the Medical Centre’s progress/weaknesses in certain areas, it is by no means definitive as the completion/sample rate is relatively low.
For instance, in Jan 2016, 356 surveys were sent out with 127 being returned, giving a completion rate of 36%. In July 2016, 295 surveys were sent out with 110 being returned- giving a completion rate of 37 %. The current list size of the practice is around 9700, giving an overall survey completion sample of around 1%.
We have compared our practice to the two neighbouring practices using the following method.
Taking the July % findings of every single question/result, then comparing them to % findings to the Jan 16 result and recording the + or – difference between the two corresponding results. Then we added up the difference to give an overall differential added score (DAS score) + or – result.
Eg % of patients who say the last nurse they saw or spoke to was good at treating them with care and concern. In Jan 2016 survey, the result was 85%. In July 2016, the result was 89%.
Therefore the DAS score for this question was +4.
By using this method, we can then see how each practice team has performed and if they are improving or if that particular area requires improvement. We can also compare plus or minus shifts and trends with neighbouring practices, Borough practices and the National Average.
Interestingly, it provides us with an opportunity to analyse how our patients have reacted to the changes and improvements that we have implemented over the last year or so.
Findings:
Appointments/Reception
The entire survey covers three main areas of practice life- appointments/reception, nursing and GP experience. Then there are three general questions at the end of the survey that cover overall experience.
The first area that the survey covers is ease of appointments and reception experience by the patient. The full results can be found on the GP patient survey site but we will provide some interesting and relevant results over the remainder of this study.
% of patients who find it easy to get through to the surgery on the phone. / Medical Centre44%
+3 (DAS score) / Surgery B
58%
+2 (DAS score) / Surgery C
60%
-2 (DAS score)
Local /CCG
69%
0 (DAS score)
National Average
73%
0 (DAS score)
At first reading, these results were disappointing as the practice had invested significantly in an extremely advanced telephone system in October 2015 and after very positive feedback from staff, patients and our PPG, we were hoping to see a higher score.
We have been monitoring the answering times with up to date software and physically phoning up the surgery at busy times and recording the data. We have found significant improvements in efficiency.
However the results still represented a 3% improvement that returned a result of 41% in the January survey. This would therefore give a +- differential of +3 for this particular question. The neighbouring two practices returned scores of +2 and -2.
The surgery has also introduced many positive changes to improve patient access at first reception. Please see below some of the changes that the practice has implemented.
1. The new ‘cloud’ telephone system informed patients where they were in the queue.
2. Receptionists only take breaks at non-busy times.
3. Receptionists have been trained to deal with calls in a polite and efficient manner.
4. The practice greeting message was changed to inform patients to avoid calling the practice at busy times unless the appointment was urgent.
5. The practice introduced SMS texting to remind patients about their appointments and implemented major changes to the DNA policy. The new policy achieved results of about 20% from the previous year, freeing up more appointments.
6. The practice put a prominent message on the Jayex board politely asking patients to inform reception if they were not able to attend their appointment.
7. Every month, a notice is put up on the reception window informing patients how many DNA’s occurred the previous month.
8. A BP machine was purchased to free up more clinical time and encourage patients to manage their health in a more convenient way.
We are optimistic that as the improvements get bedded in, our % results will improve significantly. Our telephone providers have confirmed that our waiting times are extremely efficient and compare favourably to other surgeries. On NHS choices website, we received a ‘likely to recommend’ rating relating to telephone access.
Please see below results for convenience of making an appointment with a GP.
% of patients who describe their experience of making a GP appointment as convenient / Medical Centre90%
(+6) / Surgery B
79%
(-1) / Surgery C
85%
(+5)
Local/CCG
89%
+1
National average
92%
0
We were extremely pleased with this result as it resulted in a +6 improvement from the January survey. The two neighbouring practices returned results of -1 and +5. CCG results were +1 and National Average was 0.
The overall DAS score for all 8 questions about appointments/ease of access was :
Medical Centre+5 / Surgery B
-9 / Surgery C
+7
CCG/local
+4
National average
0
GP results
The highest DAS score in the July 2016 survey results was in reply to the following result.
% of patients who say the last GP they saw or spoke to was good at involving them in decisions about care. / Medical Centre68%
(+9) / Surgery B
77%
(+2) / Surgery C
63%
(-6)
Local/CCG
75%
(+1)
National average
82%
(0)
We have attributed this result to continuity of GP staffing and as a Practise we have worked hard to improve continuity of care. Effort is invested in encouraging all GPs to be caring, competent and professional. We believe that the significant improvements we are seeing are due to more familiarity and trust in the practice GPs.
As a practice, we are constantly monitoring patient reaction to our GPs and all clinicians. Receptionists are encouraged to ask for feedback from patients about their experiences and how they got on with the GP. We also talk to our PPG about individual clinicians.
The lowest DAS score in the July survey was a still a +2
% of patients who say their last GP they saw or spoke to was good at explaining tests and treatments. / Medical Centre75%
(+2) / Surgery B
78%
(+1) / Surgery C
68%
(-4)
Local/CCG
80% (o)
National average
86% (o)
The overall DAS scores for all 6 GP questions were as follows:
Medical Centre+39 / Surgery B
-10 / Surgery C
-20
CCG/local
+1
National average
0
Nursing Results
The highest DAS score related to nurses being good at getting patients involved in their care.
Again, for some considerable time, the nursing team has been settled and well- led. We think that encouraging patients to be actively involved in their own care (like ICPs) have contributed towards this significant improvement. We have also signed the practice up to the EPP scheme with our CCG.
% of patients who say their last nurse they saw or spoke to was good at involving them in decisions about their care. / Medical Centre84%
+9 / Surgery B
73%
-9 / Surgery C
70%
-1
Local/CCG
81%
+1
National average
85%
0
The lowest DAS score was -1 relating to explaining tests and treatments.
% of patients who say their last nurse they saw or spoke to was good at explaining tests and treatments. / Medical Centre83%
-1 / Surgery B
89%
-5 / Surgery C
69%
+4
Local/CCG
87%
+1
We will be discussing any areas for improvements and continue in house training.
The overall DAS score for all six Nursing questions was as follows.
Medical Centre+20 / Surgery B
-19 / Surgery C
+24
CCG/local
+6
National average
0
We believe that this score represented a significant improvement from the January 2016 survey.
Three General Questions.
The three general questions were as follows.
1. %of patients who are satisfied with the surgery’s opening hours. 46% (-9)
2. % of patients who describe their overall experience of the surgery as good. 61% (+4)
3. % of patients who would recommend this surgery to someone new in the area. 50% (0)
The overall scores were as follows.
Medical Centre-5
/ Surgery B
-5
/ Surgery C
+10
CCG/local
+3
National average
+1
Considering the Medical Centre received a -9 DAS score on patient opening times, we feel that the overall score above is slightly misleading as we have similar if not identical opening times to about 90% of all practices across England.
Overall DAS Scores for all areas of practice
Medical Centre+57
/ Surgery B
-41
/ Surgery C
+21
CCG/local
+14
National average
+1
Conclusions
Although there are clear signs that the practice is making significant and far reaching improvements with regards to patient care and access, we will continue to monitor performance and in particular, concentrate on areas for improvement and how we can achieve it.
Appointments and Reception are very disappointing but we will expect to see much better results in the January Survey when the changes filter through.
Obviously the preferred GP (25%) data is disappointing but not surprising.
We will hope and expect to see improved results after patients get even more used to seeing full-time and ‘familiar’ long term ANP/GP’s. This is a relatively new development at the Practice and in direct response to some poor GP results from the January survey.
Another benefit of this working trial is that it frees up a lot of home visits/slots for Dr Sahota.
We would like to recognise all the hard work from members of staff and praise the professional manner in which they have responded to change in a very challenging working environment.
Going forward, we will be discussing these results with all members of staff. We will also be sending out the survey and the re-audit to all staff, the PPG and place the survey and findings on the practice website.
Action Plan
1. Main area of concentration. Reception/Appointments. Need to completely review the system. More in-depth analysis of calls.
2. Possible call backs for feedback.
3. ANPs should lighten the workload. More slots available, freeing up time. The ANP/full time GP combination trial was only started in June.
4. Analyse software more. Tweak the telephone message to avoid busy times. Tweak Jayex board and monitor weighted results. Contact Daisy to discuss how to become more efficient and what other Practices are doing.
5. DNA’s. Ensure Clinicians are following DNA policy and calling up DNA’s /sending letters. Clinicians and patients must know how precious these appointments are. We must aim to be 2% below national average by the end of the next review. Make Jill Crawley from reception the DNA lead.
6. Training ongoing. Bluestream Academy.
7. Ensure Practice stays on top and maintains/improves areas of strong polling.