PATIENT REFERENCE BRAMHALL

GROUP REPORT HEALTH CENTRE

MARCH 2014

This report summarises the progression of the Patient Reference Group (PRG), since its development in 2011.It includes the updates from actions arising from last year’s report, the process employed to identify the area(s) of most concern to the patients this year, and the outcomes of this investigation. It will also outline the action plan resulting from this year’s survey.

Bramhall Health Centre is situated in the village of Bramhall, Cheshire, a largely affluent area, which has a population of around 25,500. Bramhall Health Centre currently cares for approximately52% of the village population.

  1. Profile of Practice

Bramhall Health Centre currently has a patient population of 13149 of which 49% are male and 51% female, (the same proportion as in 2011/12 and 2012/13). 17% are aged 16 or under, 57% are aged between 17 and 64, and 26% are 65+. Last year we noted that 192 patients had a recorded ethnicity in their registration record, and we have now 4636 patients with a recorded ethnicity. In our PRG we have a 4% membership from ethnic minorities, and co-incidentally, the number of people who have specified an ethnic minority as their ethnicity in our full practice population is also 4%. However, as this is only the ethnicity of those who have chosen to state it and not the ethnicity of the full practice population, it cannot be truly compared it to our practice population as a whole. We do also have representation on the group from patients who are carers or housebound. The housebound patients tend to correspond by post.

  1. Profile of our PRG – and continual process to determine fair representation

We did again in the first instance communicate mainly using virtual means, owing mostly to the size of the group. Also, as we actively encourage patients to communicate directly with the Practice, some members have had ‘face-to-face’ discussions with the Practice Manager to air their views/opinions, as have non-member patients. We invited members to express their interest in forming a sub-group to meet in person and represent the larger group, and were successful in this endeavour.

We have found that our group was good at providing opinion and responding to surveys, and emails. We looked at ways of further improving the impact of the PRG and it was agreed that we would seek opinion from the existing members, plus any new potential members of their willingness to attend a smaller face-to-face focus group, with the intention of meeting every couple of months. It is hoped that this smaller group could then be a conduit to encourage better communication between the Practice, and the patient population, and the existing patient group.

We used our mini survey in which we asked patients their preferred areas of focus for our main survey as a vehicle to gauge their interest and invite them to express their wish to be members of the smaller group, should they so wish. This was successful and we had 25 expressions of interest in this group and have now set this up to compliment the virtual group.

It isstill very much felt that due to the size of the group for a practice with a population such as that of Bramhall Health Centre, a virtual group is more effective and easier to manage, as the logistics of accommodating 130+ patients in face-to-face meetings on a regular basis would be difficult and prove hard for all members to make their views heard. For this reason we will continue to reach out to the virtual group and keep lines of communication flowing between ALL members regardless of whether they meet in person or respond via post/email. The sub-group and virtual groups will work together to ensure that all people’s views are heard and opinions/ideas expressed, and all members of the group can communicate with the Practice.

To continue to engage/inform/recruit members to our PRG we have used the following methods:

  • We have a dedicated page on our website to enable patients to join and keep up to date with matters relating to the Group.
  • We are offering all new patients who register the opportunity to learn about the PRG and offer them an enrolment form.
  • We discussed membership with patients in person at reception and within the practice;
  • We put notes on prescription repeat slips inviting people to join/enquire
  • We have a dedicated page on our Patient Information Screen in the waiting area
  • We have a noticeboard in the waiting room specifically for PRG information, which is kept up to date.

Ourmember groupnow comprises of a 59% female and 41% male population, with 4% indicating they were from ethnic minority groups.Our initial group had more representation from patients in the 60+ age group, and we did see an increase in membership of the younger patients so that 56% were in the under 55 age bracket. With the addition of our face to face group, this has increased the older population balance slightly, but we do have representation from younger patients in this face to face group. It is an area that we will continue to concentrate efforts on. We continue to encourage the participation of all age groups in order to reflect the patient demographic proportionally.

We currently have 162 patient members (1.23% of the practice population), which is a significant increase this year, mainly attributable to the addition of our face-to-face group.

  1. Agreement of priorities for 2013/14 and compilation of main survey

This year, we conducted a mini-surveyfrom 8thNovember 2013 for a three week period, (when we also gave another update on the actions raised as a result of the previous survey in 2012/2013) to establish the areas of most concern to the patients of the Practice. Rather than just repeat the same categories as last year, we looked closely at the types of comments we had last year, indicating areas of concern. After consulting our group, we chose to again divide topics into the following options: Appointment availability/accessibility, How we manage your healthcare (GP Consultations), Provision of Patient Information, Premises and Access, Contacting the Surgery. We also gave the option for people to suggest their own area.

In this mini-survey, patients expressed preference for their opinions on Appointment Availability and Accessibility and GP Consultations. So that people would realise it was a new survey and not just a repeat of previous years questions, we used a different method. We placed the questionnaire using the service on our Website, which gives patients complete anonymity, hopefully making patients feel they could be completely honest in their responses.

The questions concentrated firstly on how patients felt their GP was at communicating, listening, and assessing their medical condition. Whether they then felt the GP responded to their needs appropriately and how they felt generally. We asked the same about their experience with our nursing staff and then asked questions about their experience obtaining their appointments and views on consultation time.

We chose some of the questions so that we could gauge the opinion of patients on the success of our action points for last year. For example, the actions were as follows:

Revisiting 2012/2013 actions:

  • More publicity would be beneficial to patients about the extended hours appointments that we currently offer. I suggest the Practice audits the current use of these appointments to determine which patient groups are utilising these and decide how to make more appropriate use of them (if indicated necessary) and inform more patients of the availability of these.
  • Continue to monitor access by telephone and look for any ways in which we can improve telephone response time in busy periods.
  • Publicise details of missed appointments to try and encourage people to cancel appointments when they are unable to attend, thereby making more appointments available and avoiding wasted GP time and increasing patient access.
  • Look at continued training for staff to help improve standard of communication and service from all staff.

To look at ways we could further improve telephone access, we had increased the number of people who could ‘log in’ to the telephone system at peak times, reducing telephone queues, but still found that there were times when people felt they had had significant difficulty in getting through on the telephone. We had a couple of instances where a patient had been holding on the line and was in the queue, receiving messages telling them that this was the case. After some 20minutes holding, their partner telephoned on their mobile, and managed to get straight through, jumping the queue, whilst the original phone call remained in the queue. Our telephone system is managed via a different organisation (namely Stockport Clinical Commissioning Group – SCCG). We spoke the SCCG about this, and it seems it is a known problem at times of high volume. Apparently it is a fault with their current telephone system, which cannot be rectified at present, and is something that happens rarely (to Practices with high volume calling period), but is being worked on. To try and compensate for this at the Practice, we have looked at the distribution of tasks for our reception staff and tried to allocate them in a way which increases flexibility in times of higher call volumes. This seems to be working well.

The main survey was then set up on our website via the link: and an Email was then sent out to patients, with the link to the survey, but also with a file attachment, in-case people had difficulty using the site. The official consultation period was from 30th December 2013 to 15th January 2014, however, we did include further completed questionnaires which continued to come in over the remainder of January 2014.

We sent the survey by post to those who had indicated a preference for that method. We put details of the survey on our waiting room display screen and had notices around the Practice. The practice continues to havea dedicated area established in the waiting room for people to obtain copies and further information about the Group on an ongoing basis. Copies were also offered to known housebound patients for whom it was felt may be agreeable to completing the information, we did have a response from a housebound patient this time, which is encouraging as it gives a fairer representation across the patient population.

  1. Survey Analysis

The survey responses which were completed solely via the website (and not the ones completed by hand/postal return) were automatically summarised in a document with the results breakdown for each question. The results from those alone can be viewed by clicking on the icon below. (click ‘OK’ on the pop-up box about microsoftword which appears three times when you click on the icon)

The results figures indicated below include all the responses which were received via non-electronic methods as well as those contained in the electronic document attached above. This year’s survey had more of a focus on GP consultations than previous surveys. However, we did also still focus on accessibility and appointment availability as this is quite rightly of primary importance to patients.

  • 92% of respondents said it was important to them to be able to book appointments ahead of time.
  • 60% of respondents said it was easy to book ahead in the Practice, which is an improvement on last year, indicating a continued positive trend in this area
  • 94% of respondents said they were satisfied with how quickly they were seen.
  • 65% of people usually booked by telephone alone, and a further 35% either came down in person or booked over the telephone.
  • 75% of people would prefer to be able to book on-line. We currently have 671 patients who have registered for on-line booking of appointments and repeat prescription requests.

As last year, patients were satisfied with the hours that the Practice is currently open for appointments, but when asked about additional opening hours, the following preferences were made:

  • 21% of respondents felt that it would be easier to see or speak to someone before 8am,
  • 12% stated lunchtime (we do not close at lunchtime and currently offer full telephone and reception access)
  • 31% preferred access after 6.30pm and
  • 31% also preferred Saturday access. (both of which we currently offer as extended hours appointments)
  • 9% of respondents wanted access on a Sunday.

This year we also asked more specific questions about your GP consultations, rather than just the ability to obtain a consultation with your GP. The following observations were made:

  • 97% of respondents felt that the GP was good at putting you at your ease
  • 96% said GP was polite and considerate
  • 97% said GP was good at listening to you
  • 100% stated the GP gave you enough time
  • 97% stated GP was good at assessing your medical condition
  • 94% said that GP was good at explaining your condition and treatment
  • 94% said that the GP was good at involving you in decisions about your care
  • 94% said that the GP was good at arranging treatment for you.
  • 100% of respondents said that they had confidence that the GP is honest and trustworthy
  • 97% said they had confidence that the doctor would keep their information confidential
  • 88% said they would be completely happy to see the GP they last saw again

We felt the above was a true reflection of what we believed to be the standard of care that the GPs strive to achieve at the Practice.

When we asked about GP consultations in relation to how long patients waited for them to start: 15% graded it as excellent, 25% said it was very good, 21% said it was good and 21% felt it was satisfactory. Just two respondents felt it was poor. We do monitor waiting times for appointments, in particular when we have new GPs or locums. When there are medical emergencies it is often unavoidable, but we do ask our Reception staff to keep patients informed when there is a delay of any sort. We have noticed some trends in waiting time and have addressed these internally and will continue to do so.

With regards to Practice staff, 91% of respondents felt staff were helpful and general comments made were very positive about the service patients had received. It is an area where we feel there has been an improvement and it is something we will continue to focus on, particularly relating to communication.

  1. Action Plan

Looking at the above data, (compiled from the responses from the patient members who participated in our survey), we have made the following observations and suggested them as a starting point for actions for the coming year. These initial findings were discussed with a small focus group at the practice in the first instance and also emailed out to the wider patient group. They were also put on the PRG noticeboard in the waiting area for people to see and comment on.

  • Continue to publicise to patients the Extended Hours appointments that we currently offer. Make posters/signage more prominent and encourage staff to communicate these appointments to patients. A recent audit of the current use of these appointments has indicated that they are being more widely used by the patient population and not just by a small number of frequent patients;
  • We will continue to monitor access by telephone and look for any ways in which we can improve telephone response time in busy periods. Since last year, we have made changes so that more staff members ‘log in’ to the telephone system at peak periods to respond to patient demand, and look at workflow streams to see if tasks can be better managed in busy periods;
  • Review our current process to monitor the frequency of missed appointments to try and encourage people to cancel appointments when they are unable to attend, thereby making more appointments available and avoiding wasted GP time and increasing patient access.
  • Publicise our new quarterly Patient Newsletter (first issue being drafted and due to be available in May) to keep patients informed of developments at the practice and improve communication
  • Continue to act on and respond to patient feedback/comments to ensure we are giving our best service

Patients were in agreement about our action plan and very positive feedback was received. Some comments were as follows:

Thank you for posting the results of your survey, it was most interesting. The surgery is very well organised, the staff answering the telephone are polite and pleasant and the reception staff are always helpful. I consider Bramhall is very fortunate to have this centre.

I have attended Bramhall Health Centre in the past 30 odd years and have never had a reason to complain. I can always get an appointment when I ring for one by telephone in the morning. Well done B.H.C.

Generally I think the Practice is very good, the ability to see a doctor on the same day when required is excellent

The Asthma nurses have ALWAYS been fantastic

Excellent standard of care

Unfailingly friendly and effective help from the receptionists. Best possible care always given by our preferred doctor and by every other doctor I have seen over many years as a patient at this surgery. The high standard of health care provided at Bramhall Health Centre should serve as a model for all other GP Practices.

I have always been treated with respect and kindness since I joined the Practice 3 years ago

Overall the practice is excellent. I consider myself very lucky to belong to this Practice.

Difficult to get through on the phone, message keeps saying you are in a queue, but there is no indication what number you are so you don’t know whether to hold or not

  1. Areas where we were not able to take action:

We did not have any specific areas where we could not take action. However a continuing theme of concern to patients and a source of frustration to us is the telephone system provided. With such a large practice population, our call volumes are high at times and although we have worked in conjunction with the CSU IT department, to address problems which arise, we find it occasionally does not meet desired performance standards, particularly at peak calling times. We have increased the number of practice staff who can answer calls at peak time but still on occasion, patients report that their call has ‘dropped out’ of the system or they are jumped in the queue whilst they are listening to the recording loop. This is an area we will continue to investigate.