Lister House Surgery
Local Patient Participation Report – 2011/12
Introduction:
Lister House Surgery (www.listerhouse.nhs.uk) is a 7 partner GP Practice based in Hatfield, Hertfordshire.The Practice was established 30 years ago. Major reworks to the premises were completed in September 2003, resulting in a first class spacious facility with the latest IT and medical equipment.
The practice did not have any Patient Participation group (PPG) before the Patient Participation Direct Enhanced Service (DES) was introduced in April 2011. The practice agreed to participate fully in the Patient Participation DES at the start of the financial year beginning 1st April 2011.
Our patient list size on 1st April 2011 was 12072 .
The person accountable for this DES is the Practice Manager, with the support of two senior managers and a GP partner.
This DES was communicated to all practice team, at monthly meetings as well as ad hoc meetings with reception and administrative support team. These communications took place early June 2011. Further reminders were sent to all staff in September 2011; encouraging staff to engage patients in joining the group.
Step 1 – Develop a Patient Reference Group:
As there was no patient group before this DES was introduced, it was felt that the initial period of setting-up would be difficult to start with. A support tool was introduced to help analyse the patient population profile and to try and demonstrate that the PRG is representative of the practice population. The practice website was updated to reflect the changes in due course.This DES was communicated to all practice team, at various meetings as well as ad hoc meetings with reception and administrative support team. Staffs were encouraged to engage patients in joining the group.
The practice manager analysed the practice population profile using the support tool from PRIMIS as well as an external company. The practice also identified a number of care home patients who were managed by the GP’s (the practice manages 8 care/residential homes), as well as a register of carer and patients on learning disability register was analysed.
The practice population profile showed an equal number of male and female patients registered with the practice, with a broad spectrum of age range and predominantly a White British patient’s base.
Sign-up forms with an Introduction to the DES and an F&Q were devised. This would ensure that the group set-up can be a combination of both virtual and face-to-face. It was felt that the patients who wanted to join should be communicated (hence the F&Q’s) at an early stage and let them know of the plans. The purpose of this is to ensure that we are not only capturing patients to be part of our PRG and discuss what they believe are our focus areas, but to also become recipients of our patient survey. These sign-up forms were left at the front desk for patients to see/read. Staffs were encouraged to speak to the patients about the PRG to get a more favourable response (subject to time). Staff explained that the practice were planning to do an online survey to give patients the chance to give their (the patients) feedback, views and suggestions about the services that the practice provides.
At the same time PRG posters were displayed in the patient waiting area, reception check-in, prescription drop-in box, patient toilets as well as on the main front door of the surgery.
The aim was to collect contact details and permission to contact in the future. All sign-up forms were collected by the practice manager and stored in a secure file.
The surgery website (www.listerhouse.nhs.uk) was updated with reference to this DES, where registered patients can sign-up to the group. A brief summary of our intentions was stated and a link to completing a sign-up form was available. Our aim was to gather around a hundred patients from as broad a spectrum as possible to get a truly representative sample. We needed young people, workers, retirees, people with long term conditions and people from non-British ethnic groups.
With the launch of our first newsletter in summer, we started marketing this DES on the front covers (see Newsletter – Summer and Autumn 2011). Patients could access this newsletter via the website or at the reception check-in desk.
All newly registered patients were encouraged to join the PRG.
The practice set-up a Facebook account for patients to give feed-back or comment on the services provided.
In mid-August the practice manager (in consultation with the GP partners) reviewed the marketing strategy for recruitment of patients to the PRG. The responses were collated and a demographical data was completed on patients who had responded. It was seen that the data did not reflect the under-represented group. There were only 16 sign-up forms received since the marketing of this DES. It was decided that further work needs to be done to ensure that the PRG is representative. It is very difficult to have a completely representative PRG.
The following steps were taken to recruit patients from group that was not fully represented:
(a) patients attending flu clinics on Saturday by handing out the sign-up forms/F&Q directly(September to December)
(b) sending sign-up forms/F&Q to a different age group(e.g. under 16)
(c) sending sign-up forms/F&Q to a different group(e.g. patients with Learning Disability)
(d) sending sign-up forms/F&Q to all Carers
(e) Putting the posters in local Pharmacy and local ethnic minority shops near the surgery
(f) Consultation/meeting with PCT Public Engagement Manager to see how better to expand the group and encourage better representation
(g) Each GP/Nurse in the surgery to encourage patients to personally invite them to sign-up during the medical consultation(subject to time)
(h) Set up account on Facebook/Twitter
(i) Access email addresses of patients who request services via our online booking system. Do an email shoot to these patients to join the PRG
(j) All patient paper-mail communication from the practice was enclosed with a sign-up form/F&Q for a week
(k) Practice manager approaching patients in the waiting area
An Interim report on this DES was submitted to the PCT in October 2011.
As a result of the above the numbers wanting to join increased, with a notable increase in the groups underrepresented e.g. under 44 age, more non-British ethnic groups and more females.
However, the practice has realised that targeting patients who are either in full time employment or in education, are not able to offer their time to attend meetings. However, patients have been encouraged to join its virtual PPG group via email.
The PRG demographics is as follows:
Gender:
Male = 43%
Female = 57%
Age Range:
Under 16 = 0%
17-24 = 6%
25-34 = 17%
35-44 = 11%
45-54 = 15%
55-64 = 32%
65-74 = 13%
75-80 = 6%
Over 80 = 0%
Ethnicity:
White British/Irish = 75%
Mixed = 2%
Asian or Asian British = 21%
Black or Black British = 0%
Chinese = 0%
Other = 2%
All patients who had signed-up to join the PRG were invited to the first PRG meeting in December 2011. The meeting was to introduce the management team and to brief the new group the aim and objectives of setting-up a PRG. The meeting was almost a listening exercise and to hear the members views/feedback about the surgery in general.
Step 2 - Agree areas of priority with the PRG:
At the meeting held in December, the practice manager explained the purpose of the meeting and each attendee was allowed to share their suggestion/comments at the meeting. The practice was very keen in engaging patients to help deliver and design services around the needs of its patients. The practice was keen to ensure that before it sought the views of its patients on the priority areas, that the group understood its roles and responsibilities and why as a group they are central to everything the practice does.The practice used a well established questionnaire survey – General Practice Assessment Questionnaire (GPAQ V3). GPAQ V3 has been widely used in the UK and validated over a number of years. This was presented to the PRG for comment as to whether the questionnaire was suitable and met the areas/priorities to be included within the survey. The PRG unanimously supported the use of the GPAQ V3 within the Practice.
It was felt that the survey should broadly incorporate the following key areas:
(1) Issues regarding quality and efficiency of staff
(2) Surgery appointments
(3) Opening hours
(4) Telephone access
(5) Seeing a GP of their choice
(6) Use of Internet facility
The Practice had also used feedback from complaints, significant events, comments and suggestions by patients to help indentify some of these priority areas.
Majority of the members agreed that it would like to survey patients on these priority issues, which should be incorporated in the survey.
Step 3 – Collate patient views through the use of survey
Patients were encouraged, upon arrival to the surgery, if they would be happy to participate in the local questionnaire survey. The survey forms were displayed on the front reception desk. The practice was actively involved in ensuring that patients participated in the survey by handing out questionnaires to patients before and after their appointment at the Practice. The practice manager was personally giving out the survey forms whilst patients were waiting to be seen.Patients were encouraged to fill-in the questionnaire survey when they (patient) had a consultation with the GP/Nurse.
The practice also looked at specific groups of patients visiting the surgery e.g. Diabetic clinic, Ante-natal clinic, so as to target a broad representative group of patient and giving them an opportunity to participate in the survey.
Posters were displayed at the front reception desk. Random letters sent to patients had a note requesting these patients to fill-in the survey questionnaire.
The local questionnaire survey was uploaded onto the practice website which also enabled patients visiting the website (for prescriptions, information etc) the opportunity to participate. Patients whose email ID was available were sent a link to the survey. These included patients who were Virtual PPG Members.
The survey was conducted over 6 weeks.
Questionnaires which were completed by patients (on paper) were returned to the Practice manager. A total of 183 questionnaires were completed (paper+ online) and sent to the website company for analysis. Website company has a facility to detail the responses received from the survey which are then uploaded to the surgery website for all patients to see (see – www.listerhouse.nhs.uk – Appendix A).
The practice received an analysis of the local patient survey which pinpointed the areas where the Practice had scored well and also those areas where improvements might be needed. The analysis was circulated to all PPG members before the meeting.
The results were discussed in detail at this meeting, which enabled the PPG to compile an action plan based on the findings/results. The Practice was able to agree an action plan with the support of the PPG which was approved by the group at its meeting.
Copy of the survey results were displayed on the notice board next to the reception check-in desk. The survey was discussed at the partners meeting and also circulated to the surgery staff.
Summary of results and survey comments: See Appendix A and B
Step 4 – Provide PRG with opportunity to comment and discuss findings of local practice survey. Reach agreement with PRG of changes in provision and manner of delivery of services. Where the PRG does not agree significant changes, agree with the PCT
Patients were asked 40 questions in relation to issues regarding quality and efficiency of staff, surgery appointments, opening hours, telephone access, seeing a GP of their choice and use of internet facility.183 responses were received from questionnaires handed out in the surgery and questionnaires completed via the Practice website. Initial analysis suggests that the respondents may not fully reflect the range of people registered with the Practice and some more work may be needed to get a representative sample next time.
There was also an opportunity to make comments at the end of the questionnaire and the Practice received comments regarding the telephone system, problems in getting through to the Practice first thing in the morning and problems experienced in getting an appointment with a specific GP.
The newly formed PPG had an initial look at the results at its March meeting and will use the detailed results to help in more detailed discussions of services provided by the Practice as part of its 2012 Business Plan. Some issues were identified in initial discussions and these form an initial action plan. Other actions will be developed following more detailed work by the PPG and Lister House Staff.
Overall the survey results were very positive, showing that overall people felt they got a good service.
This practice’s highest performing areas were:
- GP good at listening and explaining test results.
- Recommend GP surgery to new patients.
- Patients had enough support to understand and cope with their health problems.
The lower scoring responses were related to:
- Telephones and the appointment process. More work is needed to understand all the issues here.
- Getting Appointments with a specific doctor.
- Many people were not aware that they could speak to a doctor on the phone; a 'telephone consultation'.
During the PPG's initial discussions the following themes emerged:
· Consider ways of making it easier to make follow up appointments and consider how/when the available appointments are made available to patients.
· Think about different styles of appointment/consultation.
· Need to raise awareness of the online appointment process and consider making more types of appointment booking available on-lines.
· DDA compliance of the building.
The practice have identified a number of 'easy wins' that can be introduced or trialled to improve the issues identified and also inform the PPG's future more detailed discussions in these areas.
Step 5 – Agree action plan with the PRG and seek PRG agreement to implementing changes