Rockwell and Wrose practice
Follow Up Patient Experience Meeting
Monday 23 January 2012
Wrose Health Centre
5.30 pm – 7.00 pm
Hosts
Rachel Thompson practice manager
Dr Richard Haddad Partner
Facilitator/Scribe
Donna Ford
Support Team
Jeanette A Admissions & Refreshments
Helen P Photography & Refreshments
HOTS rep
Pauline Bland
Attendees Ethnicity Usual Branch Age
M & S White European Wrose >75
J & K A White British Wrose >75
A M White British Wrose >65
G H White British Wrose >75
G S White British Wrose >65
T B S White British Wrose >45
H & C P White British Wrose >65
F & H White British Wrose >80
A W White British Rockwell >50
I K White British Rockwell >60
P S White British Wrose >60
M M White British Wrose >65
P S White British Rockwell >75
D & M C White British Wrose >80
J & T M White British Wrose >50
Introduction
RT opened the meeting and thanked everyone for supporting the practice. RT noted some attendees were returning from the first meeting in October 2011 but also some new recruits swelling numbers to 25.
√ Housekeeping Drill – done
√ Mobile phones switched off
RT explained the aim of the meeting; to produce an “Action Plan” of improvements or changes (if any were identified) as a result of the patient survey, or any other issues were identified.
Patient Survey Results
RT produced a PowerPoint presentation which included a summary of the recent patient survey and explained that both doctors and staff had already had time to discuss, review and analyse the findings.
The practice was extremely pleased with the high number of responses, observing that approximately 330 patients completed the exercise providing the practice with a broad view of patient’s feelings. RT stated that most patients had chosen the paper format, although it was available “on line” for those patients registered for this service.
RT said that many of the responses held no surprises and the key points raised being:
- Opening times – more flexibility required
- More pre book able appointments
- Busy telephone lines at 8.30 am causes frustration and not always convenient
- Punctuality & waiting times
RT observed that some lessons had been learnt in terms of drafting questionnaire as it was clear that some questions had not been worded clearly and caused confusion.
The results generated discussion from group as follows
Patient ID - MS – “I often wish to pre book two appointments together for my husband and I, however this is always impossible as there is never two appointments together which can cause lengthy delays - can you explain why?”
RT explained that pre book able appointments are available on half and half basis (half the surgery is pre bookable and the rest is same day appointments). Historically, every other appointment is pre bookable and consequently there are never two appointments together that are free. Furthermore reception staff do not have “access” rights to override the system, with good reason as a lot of work goes into managing rotas. The current system is historical, and ensures that we can offer pre bookable appointments spread throughout the doctor’s session (either morning or afternoon) which reduces the incident of huge gaps.
RH explained that the practice does not like to see large gaps, and if possible reception staff work towards all appointments being “filled as “unfilled” appointments is not efficient use of doctors time.
RT said in response to the survey the practice has set up an Appointments “Task Force” to try unpicking some of our patient’s issues. Two small changes have already taken place
1) Mondays and Fridays are our busiest days. On Monday morning we are trying to see extra patients towards lunchtime on a “sit and wait” basis to reduce the backlog of patients being bumped forward in the week.
2) On Thursday nights we have created additional appointments to reduce the number of patients demand on Fridays.
Patient ID – CP - “ it is ridiculous that if I come into the surgery at 1.15 pm and told that the appointments for the rest of the day is full but that I could get an emergency appointments available after 2 pm - why cant the receptionist just book me in, rather than I come back/ring after 2 pm.
RT said this situation is historical, however there has to be some cut off point in the day to manage emergency appointments. With this there would be no slack in the system for patients who ring later in the day. In the past the surgery used to close completely for lunch between 1 pm – 2 pm which meant that no patient could contact us between those times. For the last year or so, the practice has remained open through lunch.
RH said that the practice has tried and tested many variations of appointments but we seem to have developed a culture ( due to political influences) of encouraging patients to ring at 8.30 am and always offering same day appointments… if possible we would like to break this cycle and raise awareness that pre bookable appointments are possible for later in the week should a patient prefer.
DF advised that the practice has just introduced a rolling appointment release system to make sure appointments can always be booked up to 7 days ahead.
Patient ID GS - “ can we book ahead longer than 7 days , for example two or even three weeks ahead”
DF and RH said that this could be considered, dependant upon the success of 7 day advance booking. RH said that the problem with appointments booked too far in advance is that these get forgotten and missed appointments are very frustrating for everyone.
RT explained that the practice had DNA (Did not attend) which allowed patients 3 missed appointments and then a warning letter. RT said each case is reviewed before a letter in sent to make sure the patient is not ill etc. Historically the policy has not always been robustly administered, but since the survey and subsequent appointment review it is being implemented fully. Furthermore, patients who fail to attend an appointment that is booked earlier the same day they get a phone call from the practice.
Finally the practice has drafted a Punctuality Policy in an attempt to improve both the doctors and patients timekeeping. RH pointed out that if 3 patients are 5 minutes late, then his surgery runs over by 15 minutes and we know from the survey that patients have a 20 – 30 minute tolerance.
RT invited comments about punctuality – both from patients perspective and from the doctors perspective.
Patient ID MM suggested the practice apply the punctually policy rigorously and was glad that the practice seemed to be addressing appointment problems. With regard to patients who do not attend - it was suggested we should “name and shame “. RT said this was impossible due to patient confidentially; however DNA incidents are noted and acted upon when possible.
Patient ID TM said the debate was fascinating and very interesting as he had no idea regarding the appointments system and its complexities prior to attending the meeting– he also stated that you could not please everyone.
Patient ID AW was keen to ensure that some same day appointments would still be available for those patients that preferred them - worried that these may disappear as a result of advance booking. RH assured that the practice would always have some same day appointments and also, partners often saw extra “sit and wait patients” if urgent. RT explained that not all the GPs see extra patients because they are employed by the practice and therefore have a job description and contract of employment stating how many patients they can expect to see each day – RT said to breach this would be breaking employment law regulations. DF said that if we could make some progress breaking the 8.30 am daily demand for appointments (once people realised that they could book ahead!) it should be manageable – however at the moment patients are “conditioned” to ringing in at 8.30 am.
RT attempted to explain how this phenomenon had arisen. In 2006 the government introduced “Access Targets” which were attached to doctors Income a follows:
GOVERNMENT NHS ACCESS TARGET
1 A PATIENT SHOULD HAVE ACCESS TO A HEALTH CARE PROFESSIONAL WITHIN 24 HOURS
2 A PATIENT SHOULD HAVE ACCESS TO A GP WITHIN 48 HOURS
For many practices, this was just not achievable or sustainable, as consequently the only answer was to block ability to pre book appointments and enforcing same day appointments. Many surgeries are now left with this legacy and t to change behaviour is very hard to change quickly. We must find a way to communicate and advertise “advance booking” to a wider audience. RT said the best way would be for tonight’s audience to spread the message to friends and neighbours about everything discussed in the meeting. In the meantime we would advertise through reception staff, newsletter, notice boards etc.
Patient ID AM said that Wrose Health Centre was “terrible” for disabled wheelchair bound patients as the heavy double doors are hard to maneouvre. RT apologized and recognized the problem and promised to raise it to the Landlords ( Bradford District Care Trust) – email sent 6.2.2012
Dear Mr AWe recently held a large patient experience meeting at Wrose Health centre, and the matter of disabled access was raised by a gentleman whose wife is in a wheelchair. He likes to take her out and bring to surgery if possible (and we would wholeheartedly this) and he mentioned that getting through the heavy double entrance doors is a mammoth task ( he is not a young man ) and requires tricky maneouvres.
I promised to flag this up with your good self (and Karens) to see if there is any chance of electronic door opening can be considered????
Hope this is ok
Regards
Rachel
Patient Id GS enquired regarding “on line” appointments, in particular why so few are available. DF said at the moment only 2 appointments per day are bookable “on line” as this system is still in its infancy and is less than perfect ( e.g. patients are only allowed one appointment on line) , however RH said the plan is to open more up in a bid to get less people ringing up at 8.30 am! DF said if the on line appointments are not filled, they are automatically converted to routine appointments that could be booked over the phone so that none go to waste. RT invited the audience to ensure they registered for on line appointments and also used the telephone appointments for results and reviews (this is much quicker and efficient use of the doctor’s appointments.
RT said the patient list size is increasing at quite a rate (200 in the last quarter) which will affect appointments capacity– although we had not reached crisis point yet!
RH said we are attempting to advance the use of electronic communications eg email to offer diversity and choice to allow better access to a health care professional and the surgery services. RT said she is aware that young people prefer quick answers electronically and the practice are currently looking into improving the technology and have even considered twitter and facebook (although have decided not to progress any further with this at the moment.
RT thanked everyone for their comments and being frank and open. RT felt there was sufficient information from the meeting to agree and action plan as follows
Action Plan
- Improve advance booking ( pre bookable appointments) beyond one week ahead
- Through education, aim to reduce telephone demand for appointments at 8.30 am
- Increase “on line” booking opportunities and the practice website as mode of communication
- Advertise “Did Not Attend” statistics on patient scroll board in waiting room and take a strong line with patients who waste appointments
Conclusion
Action plan agreed with the group and RT suggested a further follow up in Spring. RH said he would eventually like to see this group not only grow in number but start to take ownership and set their own agenda to feed back to the practice. RH invited a volunteer to be spokesperson for the group and take a lead role Patient ID AW agreed to accept this role and will meet with RH and RT to discuss further.