OPEN LATE: Wednesday and Thursday Evenings Please Enquire

Tel: 01494 782884

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Dr Peter Boast

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Gladstone Surgery

Dr Rachael Morrell / Chess Medical Centre
Dr Katherine O’Brien / 260–290 Berkhamsted Road

OPEN: 8am to 6.30pm Monday to Friday

OPEN LATE: Wednesday and Thursday evenings please enquire

at reception

/ Chesham HP5 3EZ

GLADSTONE SURGERY

PATIENT PARTICIPATION GROUP (PPG)

Report February2015 (2014/2015)

INTRODUCTION

Many surgeries are beginning to introduce Patient Participation Groups as a means of improving the services they offer to their patients and allowing patients a chance to have their say. Gladstone Surgery is one such practice and our first patient group was formed in 2012. For an explanation of how the group was formed please see Appendix A. This report gives a summary of how the group has improved services during its 4 meetings over the last year and how it hopes to change the face of the surgery over the coming months.

RECENT DEVELOPMENTS (JUNE AND OCT2014MEETINGS)

REVIEW OF PREVIOUS YEARS REPORT AND ACTION POINTS (JUNE 2014 MEETING)

During the June 2014 meeting the group reviewed any action points from the last meeting and previous years patient group report. An exert from the minutes of this meeting is included below and shows the developments the group had made at the start of the financial year:

-The surgery now has an automated BP machine next to main reception – potentially location needs a rethink so that patients do not feel intimidated or ‘on display’ when using the equipment, ideally either small area next to New Surgery play area or in the corridor by the GP rooms if there is room.

-Practice Manager and one group member have had a meeting with the council and the Chiltern CCG to discuss moving the out of hours service (OOH) back to Chesham (within the spare suite of rooms at the Chess Medical Centre on the 1st Floor). The council (who have taken the lease on the spare suite of rooms) were fairly keen on the idea and have invited the patient representative to partake in the steering group focusing on developing the Chesham area. Practice Manager also listed the other services that will be offered by the Council in the vacant rooms.

-DNA (Did Not Attend) policy – Practice Manager circulated the new DNA policy for the surgery. Analysis showed that since 1st January 2014 x 521 patients have DNAed, of which there is a fairly equal distribution between males/females. Highest offenders are children aged up to 9 years (specifically boys) and females aged 30 to 39. All felt this was probably because of the huge demands on working mums and the fact that children can be ill one minute and miraculously improve the next and parents are not cancelling appointments.

During the meeting with the council mentioned earlier, there was a suggestion that recent research showed putting DNA notices up encouraged people to DNA as it becomes normalised, so all agreed no need to continue with the DNA notices.

All felt happy with the new DNA policy and accompanying letter, review in Dec 14 and see if DNAs have reduced from the 521 in the first part of the year.

-Bogus NICE Alerts displayed on website and in sub waiting.

-The grey Exit sign has been replaced by a more prominent green sign in the corridor between New and Gladstone consulting rooms.

-A list of PLT (training afternoon) dates have been put up in sub waiting and on the website.

-Sign to turn off mobiles is now in sub waiting.

-Catch it, bin it, Kill it poster in sub waiting.

-The group nominated a member (who had recently become a carer herself) to become the surgery’s patient carer champion since she would have ‘hands on’ experience of what issues carers face. Practice Manager explained the current options for carers at the surgery including carers break scheme and carer identification protocol including self referral form. Practice Manager had also recently received a poster and booklet listing care choices for the locality – poster to be displayed and more copies of the booklet to be obtained for sub waiting.

SURVEY (OCT 2014 MEETING)

Back in the June 2014 meeting the group felt a patient questionnaire was still the best method to obtain patient feedback. It should be A5 in size, available on the website and consist of only 4 or 5 main questions. 1 – 5 scaling measurement to be used if question desires it eg 1 for poor, 5 for excellent. It is also to be called an Improvement Survey rather than questionnaire.

The patient participation enhanced service requires the group to focus on 3 core area’s for improvement and the group hopes to find these core areas through this survey. The group previously decided back in June that ‘Carers’ was to be a key area as it was felt more work could be done to support this group of patients, hence the meeting with Carers Bucks earlier in the year (see next section ‘Focus on Carers’). Practice Manager and group carers champion discussed the type of questions to use with the Carers Bucks representative and put the ideas to the group in October 2014.

There was some further discussion on what other area’s to concentrate on and as well as reviewing last year’s internal patient survey, the July 2014 National Patient Survey was considered and one particular result stuck out – 25% of patients questioned said they didn’t like the fact they could be overheard in reception. Therefore it was a unanimous decision to include dignity and respect in terms of confidentiality within the questionnaire.

The complaints received so far in 14/15 were also considered. Luckily there had not been many and certainly not sufficient for a pattern to develop. In previous questionnaires problems with prescriptions had been an area the patients seemed to focus on and indeed today a couple of group members had had problems in obtaining their prescriptions, therefore this was to be our third and final area for improvement.

Practice Manager to finalise the questionnaire and distribute during the flu clinics in October 2014.

The final questionnaire can be found in Appendix B.

FOCUS ON CARERS

The second key focus of the October 2014 meeting centred around carers in the locality. The Practice Manager and the patient group carer champion had recently met with Carers Bucks following which various actions emerged and are summarised below:

-A ‘Carers Event’ in November 2014 (shared with New Surgery) allowing patients to meet with Carers Bucks and speak to other carers and surgery staff. They will be able to sign up to Carers Bucks and the flexible break scheme on the day, as well as complete forms enabling the surgery to log them as a carer on their medical record.

-After this event monthly carer group meetings will be put into place, again shared with New Surgery patients.

-A ‘carers corner’ will be establish within Gladstone Surgery enabling carers to find all the forms they need easily within the surgery.

-The Carers Bucks team will be attending the flu clinics to try and ‘pick up’ carers during the sessions.

-More carer information has been installed on the practice website.

-Flexible break scheme forms are now available to pick up on reception along with the carers bucks referral form and carer consent forms.

ANALYSIS OF SURVEY RESULTS (DECEMBER 2014MEETING)

The focus for the group’s third meeting of the year were the results of the patient survey and actions arising as a result. 101 surveys were completed in all and a summary of the patient survey results can be found in Appendix C. The following action points were a direct result of feedback from our patients and discussion with the group as to what should be implemented.

Carer Awareness

- Only 6 patients knew of a carer not registered with Carers Bucks. This either indicates that uptake of carer support is very good in our surgery or the patients questioned just do not know any carers. On reflection this question could have been worded better.

- Many of the comments regarding carer awareness centred around friendly support for carers and information sharing. The surgery has recently run a Carers Event in conjunction with New Surgery which picked up a lot of new carers – in the New Year a regular carers group meeting will also be held at the surgery which will be an ideal time for support initiatives and the sharing of information. Also in the New Year the surgery hopes to instill a ‘Carers Corner’ housing an abundance of information for carers and their loved ones.

- Practice Manager and one member of the patient group noted that the flexible break scheme funding had come to an end for this year. All were concerned that this important initiative may be stopped or funding cut so Practice Manager to initially find out more details as to the situation and then Practice Manager/group carer champion to write to the relevant bodies on behalf of the patient group to explain why we think it should continue and list the various benefits it has to carers and their families.

- One suggestion was that more consideration should be given to carers when trying to book themselves an appointment, so Practice Manager to remain the staff that a carer would quality for one of the evening extended hour appointments usually reserved for commuters and the like.

- In terms of the support for carers, Practice Manager to investigate Silver Line and the existing Befriending Service and report back at the next meeting. This type of information could then be added in to the Carers Corner

Dignity and Respect

- It surprised the group that more patients did not know about the small side room where patients can speak in private to a member of reception. Only 17 out of 101 patients questioned knew this was available 10 patients had concerns about confidentiality. Possibly a lack of advertising since the only poster is found in main reception and most of Gladstone Surgery patients reside in the small sub waiting area. Therefore Practice Manager to put another poster advertising this service in the sub waiting area.

- Again with regards confidentiality in reception, Practice Manager suggested for patients waiting in a queue to speak to reception a bollard could be placed a few feet away from the desk in order to respect privacy as per New Surgery. However these are expensive so the group conceded that a yellow line of tape for patients to wait behind might prove a better initiative. This was later agreed by the doctors so Practice Manager to implement.

Prescriptions

- Only 6 patients out of 101 were not happy with the prescription service which was very encouraging. Of those that were not happy a couple of suggestions mentioned being able to order prescriptions online, a service the surgery has been offering for quite some time now and which is publicised well throughout. There were 2 personal comments regarding depression medication review and a prescription incorrectly remaining at the surgery for collection which would need to be discussed with the patients themselves. Therefore all felt no further action on this topic.

General comments

- One patient mentioned a poorly copied travel vaccination request sheet. Practice Manager had already been notified of this some weeks before the questionnaire results were analysed and this had already been rectified.

- One patient requested a first aid/minor injury service which is available from our nursing team if they have appointments or immediately if it is immediately necessary care.

- All felt the comment relating to waiting 2 weeks for a GP appointment and other similar threads referred to patients who wanted to see one particular GP – patients that are happy to see any clinician generally do not wait that long for a routine appointment.

- One patient would like to see his/her GP out of hours which is not possible at present.

- Most comments regarding the receptionists were highly appreciative and very complimentary, all of which have been passed on to the team.

- One comment regarding magazines implied that these were far too out of date. Reception staff to regularly go through the issues and get rid of those that are old/tatty.

- The comment regarding a water dispenser was picked up on by a group member, who also felt strongly about this issue. Initially it was suggested a sign could go up in sub waiting telling patients they can ask reception if they require a glass of water, but subsequently the group wanted the Practice Manager to investigate whether it would be possible to have a free standing water dispenser linked to the mains and only dispensing tap water. Costs would be to install/maintain plus for the cups and the group felt this would be a good use of the Friends of the Surgery Funds. However there is only £81 in the account. Practice Manager to discuss with GPs.

- Group member mentioned the pictures on the walls again, but the group discussed why this had been rejected in the past and this suggestion was put on hold.

- Group member felt the seating in the main reception was too ‘blocked’ and intimidating for new patients walking in. Practice Manager to discuss with New Surgery a solution, possibly breaking up the seating into smaller areas.

- Blood testing at the youth centre was brought up again on this years questionnaire, but since the surgery had entered an agreement for the majority of bloods to be taken here there was not a lot which can be done. Having recently visited the youth centre, group member felt there should be better signage for the car park and possibly more information/map on the patient information leaflet.

- With regards supplying more toys for the children, this has previously been discussed but decided to be a health and safety risk. Books/childs table were provided instead.

- Also the request for specimen drop off times to be extended is impossible since they need to go via the brake at lunchtime in order to get to the lab in time to be analysed.

REVIEW IMPROVEMENTS AFTER SURVEY

(MARCH 2015MEETING)

Completed action points resulting from the analysis of the patient survey were discussed during the March 2015 meeting. Summary:

- Automatic Blood Pressure machine has been moved from the front desk to a more secluded area at the back of reception to improve patient confidentiality, dignity and respect.

- A ‘Wait Here’ bollard/sign has been placed at reception to stop patients crowding at the desk and improving confidentiality.

- After researching the support options available to carers, the practice manager established the flexible break scheme is due to resume in April 2015.

- The surgery’s reception team have been reminded that a carer would qualify for an extended hour appointment in the evening.

- Practice manager and patient group carer champion researched Silver Line (helpline for older people) and various befriending services – all to be made available to patients in the new carer corner.

- Practice manager has installed a poster in sub waiting area informing patients if they require a drink of water this is available from reception – more plastic cups purchased for this purpose.

- Practice Manager contacted the phlebotomy team at the youth centre and has asked for better information and possibly a map on the patient leaflet and better signage in the car park.

CONCLUSION

It has been a very worth while exercise involving our patients in the direction the surgery is heading. The survey and patient group meetings have identified many areas for improvement, some of which have already been implemented. It is hoped going forward many more improvements will be made ensuring the surgery performs to an optimal standard.

Many thanks to everyone for their participation in this analysis, especially the patient group who have given up their time to help improve their surgery.

APPENDIX A

FORMING THE GROUP

Gladstone Surgery has approximately 5350 patients and wanted to establish a patient group reflective of as many demographic sectors as possible (*). Initially the surgery encouraged potential members to join by advertising on our website, within our practice leaflet and on posters dotted around the surgery. Unfortunately this produced a fairly limited response, so the Practice Manager met with the GPs and discussed which patients they felt would have greatest impact on the surgery as a whole ensuring coverage of as wide a base of patient sectors as possible. Once a selection of patients had been identified the Practice Manager contacted each patient individually to explain what the surgery was trying to achieve and how they could help.