Bath Row Medical Practice

PATIENT REPRESENTATIVE GROUP REPORT MARCH 2013

WHAT IS THE PATIENT REPRESENTATIVE GROUP (PRG)?

The first Patient Panel at Bath Row Medical Practice (BRMP) was formed In September 2006. This was a group of around 12 members who were prepared to share their views as ‘consumers’ of our services and who were keen to work with the Practice to improve the way we deliver health care. Meeting for 1-2 hours once every two months, the Panel met regularly over a period of three years, helping to shape patient experience through feedback on issues ranging from appointment booking, receptionist training and planning for our new Health Centre. At the same time, members learned about primary health care, changes taking place within the NHS both locally and nationally and the issues affecting their GP Practice.
Over a period of time a number of members left the Group and others joined but in 2010 the Panel decreased in number to around half its original size. Its stalwart members were very keen to re-build the Group and in 2011 the Practice undertook a major drive to re-launch the Group and to attract new members. The newly re-formed group is now known as our Patient Reference Group (PRG).
The National Association for Patient Participation (to which our own PRGis affiliated) states that:
"People have the right and duty to participate individually and collectively in the planning and implementation of their health care."
In trying to meet this aim our objectives have been to:
•Involve as many of our patients as wish to be involved in our PRG.
•Encourage all our patients tocomment on their experiences of health care and service delivery at BRMP, to ask questions about how we work, to tell us how we are doing andto suggestimprovements that need to be made. We do this through the use of surveys, comment, compliment and complaint forms and our ‘You Tell, We Say’ patient feedback board.
•Feedback to our PRG on issues that are affecting us as a Practice so that its members can understand the pressures, constraints and demands that may affect the way we deliver services.
•Feedback to members of our PRG all comments and suggestions received so that we can agreechanges with its members and then elicit feedback to understand what the changes feel like from a user perspective
The Group remains open to new members at all times.

PRG AND PRACTICE PROFILE

Our Practice population currently comprises 9,491 patients (March 2013). The patient population at Bath Row Medical Practice reflects that of many inner city practices in that it is a highly mobile population and thus we have a considerable turn-over of patients. In the 12-month period to end February 2013, 1,935patients joined BRMP’s list while 2,558 patients left the list. Turn-over of this magnitude is highly unusual in suburban and rural practices and brings its own challenges. One of these is engaging people who may only be registered with the Practice for a short while to join a Patient Reference Group.

As an inner city Practice we also have a younger patient population than many other GP practices, particularly as we have several student residences situated within our catchment area. This also represents a challenge in trying to build a PRG that can be considered to be representative of all our patients.

Our current PRG has shrunk since its re-formation in 2011-12. From an original membership of 28, 12 members have dropped out citing other commitments precluding their continuing involvement. Of the remaining 16 members, only 9 are regular, active attenders. All are aged 55+ and as such are not representative of the profile of the Practice population as a whole. The electronic ‘e-forum’, which the PRG hoped might attract more and younger members has so far failed to get off the ground.

The following tables demonstrate the current age profile of our total Practice patient population. This shows that 25% of the male population of our Practice is aged between 16 and 35 years of age while just 6.7% of our male population is aged over 55 years. Of the 5 current male members of our PRG only one is aged under 55 years and he is more than 35 years of age. Similarly, 26% of our female Practice population is aged under 35 years of age but of the 11 current female members of our PRG, all are aged over 55 years.

Practice Population Profile
Male / Practice Population Profile
Female
% Under 6 / 3.5 / % Under 6 / 3.1
% 06-15 / 2.9 / % 06-15 / 2.4
% 16-25 / 7.1 / % 16-25 / 10.8
% 26-35 / 18.1 / % 26-35 / 15.1
% 36-45 / 9.6 / % 36-45 / 5.3
% 46-55 / 6.0 / % 46-55 / 3.8
% 56-65 / 3.6 / % 56-65 / 2.6
% 66-75 / 2.0 / % 66-75 / 1.6
% 76+ / 1.1 / % 76+ / 1.5

STEPS TO ENSURE GROUP WAS REPRESENTATIVEREASONS FOR DIFFERENCE IN GROUP AND PRACTICE PROFILE

Ensuring true representation for any group is often problematic. There are a number of steps the Practice has continued to take to try to obtain a more representative PRG:
1. Given that we have a younger population than many other GP practices, we have been very keen to try to recruit younger people to our PRG, if not in person then as part of an e-forum. During September each year a large number of students arrive at our local student residences and all should register with a local GP. These are almost exclusively individuals under 25 years of age. Each year we prepare 1,000 registration packs, which we deliver in person to the local Halls of Residence and student accommodation blocks. These packs include details of how and where to register for health care locally and information about local health services. As part of this pack, for the past two years we have included information about how to provide feedback as a young patient together with an explicit invitation to join our PRG. This information and invitation has also been provided in poster format for residence notice boards. Sadly, despite this encouragement we have had little response from students to participate.
2. Being mindful that new patients and in particular many of our younger patients access our website, information about our PRG is posted on our Practice website. Despite considerable patient use of our website this year, this has not yielded any new enquiries about joining the group.
3. We always respond to both verbal and written complaints. In many instances, a complaint has provided an opening for informing a patient about our PRG and encouraging them to work actively with us to help find a remedy for the issue they have raised. One person has recently joined the group from this approach.
4. Bath Row Medical Practice does not discriminate on any grounds and welcomes all patients on an equal footing. We have not chosen to positively discriminate by targeting particular ethnic groups to seek additional members.
5. Members of the Practice team have continually attempted to swell the numbers and address the profile imbalance of the PRG by taking any opportunity that presents itself to invite patients to join the group. Despite initial enthusiasm, no-one has actually joined the group afresh.
6. At the end of the day, our PRG comprises a group of individuals who have volunteered to give their time and energy on behalf of others to work with us to improve patient services. There are a large number of reasons why individuals choose to participate or not and these include personal, social and cultural factors. We are very grateful to those individuals who have agreed to work with us and look forward to welcoming others to the group over time.

FREQUENCY OF MEETINGS

The PRG aimed to meet once monthly during 2012-13 with the exception of August when many members anticipated being on holiday. Inclement weather caused the majority of members to send apologies for the December and January meetings and these meetings were therefore regrettably cancelled. A direct consequence of this was that the group made a formal decision in February 2013 about what should constitute a quorum in similar circumstances in future. It was decided that henceforth meetings would take place with reduced attendance provided that at least 3 PRG members and a member of Practice management were present.
Our timetable of meetings and work carried out in 2012-13 was as follows:
18 April 2012 / Taking our Action Plan Forward.
The group affirmed its intention to cover 4 activities in 2012-13:
To improve the functioning of the PRG
To raise awareness of the flexibilities within the Practice’sappointment system
To increase staff awareness of variations in patients’ appointment needs
To introduce electronic appointment booking.
It was agreed that points 3 and 4 needed to be led by the Practice and these were put into the hands of the Practice Director. It was agreed that point 4 should not move forward before the Practice’s move to new premises had taken place.
It was agreed that the functioning of the PRG would be greatly improved by having agreed Ground Rules, Aims and Objectives and Terms of Reference. Ground Rules were discussed and agreed at this meeting. Possible aims and objectives for the group were tabled and members agreed to give this more thought in preparation for the next meeting. It was agreed that supporting papers and minutes would be produced and circulated at least 3 working days before each meeting. It was agreed that the PRG needed to be self-generating not looking to the Practice to set the agenda for it. It was agreed that the PRG would not be a forum for members’ complaints.
23 May 2012 / Agreeing PRG Aims and Objectives
It was agreed that the PRG would focus on two main aims:
Helping the Practice to improve services – this was thought to be the primary role of the PRG.
Offering support to other patients. There was some enthusiasm for this but also several concerns about how this could be done whilst keeping PRG members, the Practice and patients safe. It was agreed that this needed further thought.
27 June 2012 / Agreeing PRG Aims and Objectives – further discussion
After further thought PRG members agreed that they did not think thatoffering support to other patients was an area that they could move forward as an aim of the PRG at this time.
Increasing staff awareness of variations in patients’ appointment needs.
The Practice Director reported to the group that staff training had taken place on two afternoons in May and June to promote greater understanding of patients’ differing appointment needs and to enhance delivery of a more customer focussed approach to dealings with patients. Staff had been issued with a ‘crib sheet’ to help them to follow the agreed approach.
The PRG suggested that they could provide feedback as to whether this was being put into practice by staff by initiating a ‘mystery shopper’ survey.
Terms of Reference
These were discussed and agreed.(A copy of the final Ground Rules, Aims and Objectives and Terms of Reference of the PRG are attached as Appendix 1 to this Report).
25 July 2012 / Mystery Shopper Survey
A ‘mystery shopping’ proposal was tabled by a member of the group who had had previous experience of this. The feasibility of undertaking this and the requirements of members of the PRG to undertake this were discussed. It was agreed that the proposal would be refined for the next meeting and a timeframe then agreed.
Practice Move and Contract Variation
PRG members requested information about the current timetable for the Practice’s move to new premises given that Dr Hyman’s practice was set to move in August. The PRG were informed of the financial problems associated with the Practice’s move to new premises, which were linked to the introduction of a new contract with a requirement to meet Key Performance Indicators (KPIs). PRG members asked for information about the KPIs and also about the new Commissioning Groups. The group expressed concern about the future of General Practice services in the context of what they were reading in the press and hearing about KPIs.
August 2012 / No scheduled meeting.
26 September 2012 / Meeting cancelled as no member of Practice management staff was able to be present.
24 October 2012 / Mystery Shopping
The Mystery Shopper survey was finalised – to be undertaken during November 2012.
Move to new premises
The meeting was dominated by discussion about the Practice’s postponed move to new premises and the contractual issues and funding concerns that had led to this decision. The PRG gave its whole-hearted support to the position taken by the Practice, i.e. that it could not commit to new premises until the funding and contractual issues had all been resolved, and were concerned about the effect of the uncertainty over these on staff morale. Concerns were expressed by the PRG that funding cuts were being made despite political assurances at the last election that funding would not be withdrawn from the NHS.
28 November 2012 / Mystery Shopper Survey
Progress with the Mystery Shopper survey was discussed. The low number of ‘shopping surveys’ returned by PRG members was highlighted and gave rise to concern. Early feedback from members who had been ‘shoppers’ was that the main difficulty appeared to be in getting phone calls answered. The limitation of the current phone system was discussed and suggestions made as to the improvements required of a system in the new premises.
Failed Attendances
An increase in failed attendances was discussed with the PRG. It was decided that the Practice needed to implement a more robust system for dealing with people who waste appointments.
Move to new premises
The Practice Director provided an update on the outstanding contractual issues and the planned move to Attwood Green Health Centre. It was anticipated that the move would not go ahead before March 2013. There was considerable discussion about the continuing insistence on KPIs as part of the Practice’s proposed new contract. PRG members agreed that it could be irritating waiting at the Practice beyond one’s allocated appointment time but shared the Practice’s concern that the need to run more closely to time in order to avoid financial penalties would likely have a detrimental effect on the quality of consultations. The PRG felt this was a very difficult issue. Members expressed a need to understand why this KPI was being proposed and to understand better what the wider patient population thinks about this. It was agreed that this could be the focus for the PRG’s next patient survey.
19 December 2012 / Meeting cancelled due to adverse weather conditions.
23 January 2013 / Meeting cancelled due to adverse weather conditions.
20 February 2013 / Surveys
The Practice Director provided feedback from the Mystery Shopper survey.
A low survey rate was noted.
The Practice Director informed the group that, given the cancellation of the last two meetings, there would not now be time for the PRG to help devise and conduct a survey about waiting times in surgery before the end of the 2012-13 year. The Practice had therefore chosen to run the CFEP survey again, which it had last conducted in 2009-10. This was currently underway and would be completed by early March. PRG members were happy with this and looked forward to seeing the results.
Move to new premises
The PRG was informed that whilst the matter of KPIs was still under discussion and a response was still awaited from Birmingham and Solihull NHS Cluster on this matter, funding issues affecting the Practice’s contract had now largely been resolved and it was anticipated that the move to new premises would proceed in March 2013.
Reflection on 2012-13 Action Plan
The PRG felt that the year had been a very difficult one for the Practice and the PRG with uncertainty about the move, funding and the Practice’s contract. However, the Group had defined and started to work to its agreed Terms of Reference and had become more cohesive, had attempted and learned from its ‘Mystery Shopper’ survey and had stayed focussed on its primary aim of helping the Practice to improve patient services.
The PRG were advised that the Practice had produced an information sheet for patients on how to access urgent care as a key part of raising awareness of the flexibilities within the Practice’s appointment system. This information had been made readily available for patients in the Reception area, was being sent to all patients who had attended the hospital A&E department recently and had been posted on the Practice’s website.
It was noted that progress had therefore been made on 3 of the 4 action points set for the 2012-13 year and it was hoped that progress on the remaining point (electronic appointment booking) could be advanced once the Practice had settled into its new premises.
The PRG wished to feedback to Practice staff that the overall impression from the Mystery Shopper survey was that staff were providing a good service and were trying hard to be responsive to the patients’ agenda.
The Group remained concerned about the lack of representation on the PRG of younger members of the patient population and agreed that encouraging new, younger members needed to be a priority in the year ahead.