Harness Harlesden Practice

HARNESS HARLESDEN PRACTICE

PATIENT REFERENCE GROUP(PRG) REPORT 2013/14

Introduction:

Harness Harlesden Practice believes that patients play a great role in how the practice functions and what services it should provide. Our PRG group was set up in 2011 Patient Participation refers to Patients taking an interest in their health care, hence a public voice and real involvement and input on health issues. In October 2011 a practice meeting was held with all staff, to involve staff in the start up of the new PRG. This would also ensure that staff ideas were actioned and a comprehensive “virtual and face-to-face” patient group was compiled.

Establish a PRG comprising only of registered patients and use best endeavours to ensure PRG is representative

Mission Statement of the PRG:

“To give an opportunity to patients and the practice to come together to develop and sustain an accessible, high quality and innovative patient – focussed primary care medical services”

The purpose of a Patient Representative Group (PRG) is about getting the local people, patients, carers and users involved in planning local enhanced services and identifying local needs. Its function is to help improve communication and understanding between practice staff and patients, and to improve the quality of services being offered to patients. It provides practical support and assist in the future policies and direction of the Practice. It enables patients to become more involved in their own care and offers the opportunity to be involved in patient forums.

The Aim

Of the patient Representative Group (PRG) is to engage patients and allow them to be active in the decisions made by the practice in terms of the way it is run and the services that it should provide to patients. The patient forum was formed to listen to patient views, in order to help improve the service provided by the practice. It also wants to include patients in the decisions that lead to changes to the service the practice provides.

Practice Profile

The practice population consist of 2,356 patients who are of varied aged group and from diverse ethnic backgrounds. The ethnic representation is reflected in the practice geographical location as following:

The description of the profile of the members of the PRG

In order to ensure adequate representation from all patients including the minority groups e.g. unemployed, carers, mental health, and disability community and drug users within the community, all staff actively invite all groups of patients to a face to face patient group meeting. These meetings are held 3 times a year. The times of the meetings are held during the day or late afternoon taking consideration the working patterns of patients.

In order to ensure that various group will engage in the PRG meetings all patients including minority groups within the population are invited to attend. The following steps are taken to recruit patients and to ensure that all patients are actively represented.

We encourage patients to join in PRG in the following ways:

Advertise in the practice

Publishing PRG meetings on the practice website

Displaying information on the LED JAYEX board in the waiting area

All staff actively encouraging patients to join the group

Telephone contact is established with the hard to reach group, house bound patients and carers

In line with the Equality Act, all our promotional resources to encourage patients to be involved with decision making and provide valuable feedback are aimed at our entire practice population through a variety of methods, as detailed below to capture the broader membership. It is really out of our hands as to who responds. We think we would be open to criticism if we targeted a particular ethnic group or age range.

To ensure that all patients are given an opportunity to join in if not as a core member but as an email member etc then a sign up sheet is made available when a new patient registers along with the GMS1 registrations forms.

The Group representation is as follows:

Age

17-19 = 12%

20-29 = 16%

30-39 = 15%

40-49 = 16%

50-59 = 10%

60-69 = 6%

70-79 = 5.5%

80-99 = 2%

Sex

Female: 51%

Male: 47%

Ethnicity

White & Black Caribbean = 2%

White & Black African = 2%

Black or Black British = 15%

Black African = 9%

Afro Caribbean = 55%

Asian or Asian British = 5%

White Irish = 4%

Chinese = 2%

Pakistani = 6 %

Any other 2%

Other Groups

Practice had 7 patients on the LD register

Practice has 13 registered carers

Practice has 27 patients in the residential nursing home

The PRG representatives from the Surgery are:

Senior Salaried Doctor
Practice Manager
Assistant Practice Manager
Practice Nurse

Below please find examples leaflets advertising the PPG group. The hand outs the sign-up sheet and the A4 posters.

Communication;

We correspond with the group members by:

Email, telephone, text messaging service as well as face to face. All patient forums are advertised within the practice.

In order to identify any variations between the Patient Representative Group and the practice population, monitoring forms were completed by patients during these meetings. Results revealed that there is now an equal representation of Male and Female.

Groups not well represented were mainly patients who reside in Nursing Homes and house bound patients. Hard to reach groups were contacted and the views collated and raised during the PRG meeting.

Agree with the PRG which issues are a priority and include these in a local practice survey

Harness Harlesden Practice is one of the 16 Harness Practices. The patients from Harness Harlesden attend the Harness PPG meetings three times per year. The feedback during the meetings has been the constant complaint from patients with regards to accessing appointments.

The Harness Network group decided to find a solution for all 16 practices and sought and got an agreement from all the Harness Practices to approach a company called Alpha to carry out an in-depth Access survey of patients, through the individual Practice.

When deciding on the questions to be included in the annual patients survey Harness Harlesden Practice also looked at the National GP patient survey issues, the verbal complaints, the complaints posted on NHS choices website and listened to the their patients who attended the Harness PPG group. The main questions were the following:

Telephone contact
Opening Hours
Seeing a Doctor of your choice
Length of time waiting in the Practice
Appointments
Patient experience
Seeing a Nurse
Issues arising from patients complaints
issues raised by patients at our Patient Participation Group meetings,
Issues from 2012-2013 patient survey results

A summary of the progress made within the surgery during 2012 – 2013 is also listed below

You said / We did / The result is
PRG suggested refresher training in customer service and passing on information to patients for admin staff / New admin staff joined the practice. Both new and existent admin staff have had in-house customer service trainings. Also refresher trainings will be provided early by Harness Care. / The number of complaints reduced from three in 2012-2013 to one complaint in 2013-2014.
After having trainings admin staff feel more confident in answering patients queries and book them into appropriate clinics.
PRG requested to have regular GPs attending clinical sessions / Harness Harlesden Practice has now two regular salaried GPs, male and female. The male doctor is in the practice 4 days per week and the female GP is seeing patients one and a half days per week. / Patients are not booking repetitive appointments to see preferred GP or to have second opinion. The use of appointments improved hence for the waiting time to see GP is 2 working days since.
PPG requested for patients to be registered with practice regardless the area where they live / We now register patients from outside catchment area. If the patients are living outside the catchment area they are informed at the time of the registration about the fact that GP will not be able to visit them at home. / Not many patients from outside the practice catchment area registered with practice, however the existing patients moving outside our catchment area can still remain registered with Harness Harlesden Practice.
PPG enquired about surgery being opened on Saturdays / PPG request has been brought up in Harness Locality meeting. New HUB has been running on Hillside Medical Centre and patients can access it on Saturday. It has pre-booked appointments and it is for patients with acute medical problems. / We notice a decrease in use of A&E and Walk in services.

Carry out the local practice survey and collate and inform the PRG of the findings

Harness Harlesden Practice – Access Survey

The Harness Harlesden Practice survey of patients regarding access and appointments and opening times was collated and sent to Alpha to analysis and benchmark.

The survey carried out during 2 weeks in July 2013. This was given to Harness Harlesden Practice who attended appointments and when doctors attended home visits.

The number of patients surveyed was 50 in July 2013.

The Practice ensured that in the Surgery:

Posters were hung up and patient survey questionnaires were made available at reception

Receptionists canvassed the patient survey questionnaires to the patients at the desk and on the telephone

Doctors canvassed the patient survey questionnaires to the patients at the end of consultations.

Nurses canvassed the patient survey questionnaires to the patients at the end of consultations.

Hard to reach groups and monitory groups were posted the patient survey questionnaires

Message on LED JEYAX display in Reception,

Patient survey questionnaires attached to repeat prescriptions

Patients questionnaires distributed at local pharmacies

A receptionist was assigned to input the survey answers and comments and collated onto a spreadsheet

The results of the survey were benchmarked against the other 15 Harness Practices. The results were also discussed in a Practice Meeting.

The results were shared with the Harness Harlesden Practice PPG on 6th March 2014.

Attached is a summary of the results detailing overall practice scores.

PPG members were also informed about Harness Harlesden Practice benchmarking against the 15 Harlesden Practices.

Provide the PRG with an opportunity to comment and discuss findings of the local practice survey. Reach agreement with the PRG of changes in provision and manner of delivery of services. Where relevant, notify NHS England of the agreed changes.

At the meeting on 6th march 2014 PRG members analysed the results from the local annual survey carried out in July 2013 and the following actions were agreed:

Q1
How do you normally book your appointments to see a doctor or nurse at the surgery
In person / By Phone / Over The Internet / Walk-In
17 / 29 / 1 / 4
33.3% / 56.9% / 2.0% / 7.8%

Action:

Two receptionist on duty at all times therefore all incoming calls and patients coming into the surgery can be dealt with without delay.

Q2
The last time you tried to see a doctor fairly quickly -were you able to see a doctor on the same day or in the next 2 weekdays?
Yes / No / Can't Remember
23 / 21 / 5
46.9% / 42.9% / 10.2%

Action:

A better use of appointments, introducing telephone consultation for doctors (four per day) and nurse (two per day)

Q3
Is there a particular doctor you prefer to see at the surgery?
Yes / No
21 / 29
42.0% / 58.0%

Action:

Reducing the use of locum doctors and having regular GPs will give patients stability.

Q4
How easy is it to see the doctor you prefer to see at your practice?
Very Easy / Fairly Easy / Difficult / V Difficult
10 / 17 / 19 / 4
20.0% / 34.0% / 38.0% / 8.0%

Action:

Practice aims to improve this indicator in the next year to minimum 80%. Regular GPs have been hired since September 2013.

Q5
How often do you see the doctor you prefer to see at your practice ?
Always or almost always / A lot of the time / Some of the time / Never or almost never
7 / 4 / 31 / 7
14.3% / 8.2% / 63.3% / 14.3%

Action:

Practice aims to improve this indicator in the next year to minimum 80%. Regular GPs have been hired since September 2013.

Q6
How many times would you say you visit your GP per year?
1-3 times / 4 - 6 times / 7 - 9 times / >10 times
9 / 12 / 16 / 13
18.0% / 24.0% / 32.0% / 26.0%

Action:

Practice aims to improve this indicator in the next year to minimum 80%. Regular GPs have been hired since September 2013. Locums will be booked to cover only when lead GP is on annual leave or study days.

Q 7
If you ring the surgery looking to see a GP within the next 2 days and your preferred GP is not available would you..
Ask to see another GP / Ask when your preferred GP is available & wait for an appointment until then / Ask to see another GP AND look for appointment with preferred GP when available
28 / 8 / 15
54.9% / 15.7% / 29.4%
Q 8
In the past 6 months, have you tried to book ahead for an appointment with your preferred doctor but was told that there were no appointments available for the next 2 weeks..
Yes, happens regularly / Yes, happens on occasions / No, has never happened / If yes - would you ask to see another GP / If yes- would you ask when preferred GP is available & wait for them / If yes - would you ask to see another GP & look for appointment with preferred GP
11 / 24 / 12 / 13 / 8 / 2
23.4% / 51.1% / 25.5% / 56.5% / 34.8% / 8.7%
Q9
How satisfied are you with the hours that the GP surgery is open?
Very Satisfied / Fairly Satisfied / Fairly Dissatisfied / Very Dissatisfied
26 / 20 / 2 / 2
52.0% / 40.0% / 4.0% / 4.0%
Q10
Would you like your GP surgery to open at additional times?
Yes / No / Makes no difference / If Yes -Before 8.00am / If Yes - at lunchtime. / If Yes - after 5:30pm / If Yes - after 6:30pm / If Yes - Saturday am
2 / 15 / 4 / 28 / 6 / 1 / 2 / 10
4.0% / 31.9% / 8.5% / 59.6% / 20.0% / 3.3% / 6.7% / 33.3%

Action:

Due to the opening times of the premises where Harness Harlesden Practice is operating it will not be possible for the practice to be open before 8.00 am. However the practice nurse has sessions open on Saturdays and patients can attend these clinics.

Q 11
Last time you saw a doctor at your surgery, how good was the doctor at giving you enough time.
Very good / Good / Poor / Very Poor
14 / 27 / 7 / 1
28.6% / 55.1% / 14.3% / 2.0%
Q 12
The last time you tried to see a nurse fairly quickly -were you able to see a nurse on the same day or in the next 2 weekdays?
Yes / No / Can't remember
24 / 4 / 22
48.0% / 8.0% / 44.0%
Q13
Is there a particular nurse you prefer to see at the surgery?
Yes / No / Not Applicable
12 / 27 / 12
23.5% / 52.9% / 23.5%
Q14
How easy is it to see the nurse you prefer to see at the practice?
Very Easy / Fairly Easy / Difficult / Very Difficult
11 / 26 / 9 / 1
23.4% / 55.3% / 19.1% / 2.1%
Q15
How often do you see the nurse you prefer to see at the practice?
Always or almost always / A lot of the time / Some of the time / Never or almost never
5 / 2 / 30 / 9
10.9% / 4.3% / 65.2% / 0.0%

Action:

Harness Harlesden Practice has a full time Practice Nurse who is able to met the demand of all its patients.

Q16
Last time you saw a nurse at your surgery, how good was the nurse at giving you enough time?
Very good / Good / Poor / Very Poor
18 / 28 / 1 / 0
38.3% / 59.6% / 2.1% / 0.0%
Q 17
How many times would you say you visit your nurse per year?
1-3 times / 4-6 times / 7-9 times / >10 times
30 / 11 / 2 / 3
65.2% / 23.9% / 4.3% / 6.5%
Q18
Any Key Comments
Q 19
Have you attended in the last six months a
Walk in Centre / A&E / Urgent Care / If yes - did you attend because you prefer a walk-in centre / If yes - did you attend because you GP practice was closed / If yes - did you attend because you couldn't attend your preferred GP / If yes - did you attend because your GP practice advised you to / If yes - did you attend because you couldn't attend your GP at the time you required / If yes - did you attend because of another reason.
20 / 13 / 1 / 5 / 7 / 3 / 5 / 9 / 0
58.8% / 38.2% / 2.9% / 17.2% / 24.1% / 10.3% / 17.2% / 31.0% / 0.0%
Q 20
If you answered yes to Q 19) did you then visit your GP practice for the same problem within a 48 hour period
Yes / No / If Yes - did you attend because you felt more unwell / If Yes - did you attend to get reassurance from your GP / If Yes - did you attend because you were advised to by other centre.
6 / 18 / 3 / 0 / 4
19.4% / 58.1% / 9.7% / 0.0% / 12.9%

The doctors who work at Harness Harlesden Practice are salaried GPs and work part time. Before the doctors changed on a regular basis and only a couple of GPs stayed the same, hence the rebooking.

Publicise the Local Patient Participation Report on the Practice Website and update the report on subsequent achievement
Publish results and Agreed Action Plan:
The patient participation report is being published on the Practice website by 28th March 2014 and will be circulated by email to PRG representatives. Results of the survey are displayed in the practice waiting area including all clinical rooms. Hard copies are retained at reception and will be made available upon request. A copy report will be submitted to North West London GP contract team.
CONCLUSION
A meeting of the PRG was held at the surgery on 6th March 2014 to discuss our achievements and non-achievements of the Action Plan in 2012-13. The PRG were happy with the outcome and we hope to continue our successful relationship in the coming years. An action plan for 2013-2014 was agreed.
Practice Core Opening Hours
Monday 08.00 -18.30
Tuesday 08.00 -18.30
Wednesday 08.00 -18.30
Thursday 08.00 -18.30
Friday 08.00 -18.30
Saturday 08.00 -12.00
Our opening hours are advertised on our website, practice leaflets and posters in the reception area.
Patients can contact the practice via telephone, face to face, email and can also use Emis Access to book appointments. We in turn can also contact patients using the same mode plus via text messaging using MJOG (with consent)
Appointment System
We operate a mixed appointment system as follows:

daily appointments can be booked in advance
10 urgent same day appointments / booking on the day
4 telephone consultation/triaging – a dedicated doctor consults daily over the phone
2 telephone consultation/triaging – practice nurse will advice patients over the phone
Phlebotomy clinics will operate one day per week in the practice therefore patients will not have to go to Willesden Health Centre for blood tests
Emergencies which can not be seen by GPs within opening hours of the surgery will be re-directed to HUB which operates in the same premises every Monday 3.00 -7.00 pm, Friday 3.00 – 7.00 pm and Saturday 9.00 -12.00 pm.

Currently patients can book up to 2 month in advance. All clinical sessions are entered onto the computer up to 2 months in advance to allow for patients to pre-book within this period.
When patient ring the practice to make an appointment they either say which doctor they want to see or are asked for a doctor of their choice. If a patient need to be seen within 48 hours and the doctor of their choice is not available they are offered a choice of other doctors but if they prefer to wait to see the doctor of their choice we either book the patient or leave a message for the doctor to call the patient back.
We use GRIP and language Line for booking interpreter in other languages including sign language.
Out of Hours:
Patients can access the following services when the surgery is closed.
BARNDOC is the service covering the surgery when the practice is closed at weekends and Bank Holidays. Please contact them for emergencies only
Tel: 03000 333 777.
Patients can also contact – 111 for medical advice and information or 0203 402 1111 if for some reason 111 is not accessible.
Health information, opening hours and out of hours service information can all be obtained on the practice website or NHS Choices website
Summary
Having a PRG has enabled the practice to focus on objectives and priorities for future plans and identify continues needs for development. It has helped improve the relationship between practice and patients. It has offered both parties the opportunity to actively engage in development. The practice will continue to strive to improve the level of customer service offered to patients.