Lonsdale Medical Centre

Lonsdale Medical Centre

Lonsdale Patient Participation Group (PPG): Minutes of Meeting held on Monday, 24 March 2014at 6pm

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Lonsdale Medical Centre

Attendees:

Patients

Jill Mortimer – Temporary Chair

Valerie Brennan

Barrie Newton

Siobhan Mahony

Patrica Dale

Lucia Saxby

Robin Sharp

Anne Sharpe

Andre Wagner

Evelyn Cantor

Odeta Pakalnyte

Kim Jeffal

Pamela Leaves

Practice

Martin Chernick, Practice Manager

Nicholas Driessens, Practice Services Manager

Dr Heather Davis, Executive Partner

Dr Eric Britton, Partner

Dr Alexandra Panagoulas, GP

Apologies

Theresa Hayter, Reception Manager

Rosalind John, Community Outreach Liaison Officer, Kilburn Primary Care Co-Operative (KPCC)

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Lonsdale Medical Centre

Agenda (a copy of the charts used is attached)

Welcome and Introduction – Jill Mortimer: volunteer chair

Patient Survey 2012
- what’s been done since last survey

Patient Survey 2014 + supplementary questions
- main outcomes
- supplementary questions
- discussion on practical improvements (within the practice’s remit)

Future Meetings & Chair

AOB

Martin Chernick(MC) reviewed a summary of actions/outcomes following patient meeting discussions in 2012-13

Last Patient Survey (March 2012 – posted on website)

What’s been done since then

-Additional 50 duty doctorafternoon appointments each week

-New smarter and less expensive telephone system – better patient messages

-New computer server and clinical system

-New website

-Online appointment bookings (EMIS Access) - saves coming to surgery

-Electronic prescriptions to pharmacist of choice enabled – patient choice improved

-Clinical Pod – BP, weight, height, BMI and basic questionnaires – frees doctor and nurseresource to allow more appointment time

-Cancellations by EMIS Access – saves phoning or coming into practice

-On-line patient details update – saves patient time and easier than filling-in paper forms

-New Reception Manager – greater focus on ‘customer (patient) care’ - meeting’s comment: ‘more needed!’

-Mobile Phone - short questionnaire to 2,500 patients with ~20% response – similar requests sent via Email typically get 1-2% response.

Patient Survey 2014

Martin provided a summary of the recent patient survey, a copy of which had been circulated to all members of the PPG.

Was it Representative?

InTime, the independent company running the survey for the practice confirmed that the number of responses to the survey met the requirement of it being statistically representative.

Martin explained how the practice had tried hard to ensure the survey participants matched the general profile of the practice in term of ethnicity, age and sex. It was decided that the most effective way of achieving this was to get the doctors to hand out surveys to patients attending in a two week window. About 70% of surveys distributed this way were returned .5% of these were illegible or blank.

It was also necessary to seek the views of patients not attending during that period: this was attempted by sending Emails with an attached survey to almost 3,000 patients (about 20% of the list). The Email was designed to fit on a mobile phone screen to try to maximise the returns. In the event only 46 patients sent in completed surveys this way (1.5% - which is typical of such surveys).Sending letters to patients is impractical due to the prohibitively high cost.

Martin showed a chart of the ethnicity mix of the patients completing the survey and another of the whole practice populations. These are shown in the attached PowerPoint presentation. There was very close correlation between the two charts.

The age profiles of patients completing the survey and the whole practice had a similar shape reflecting the profile of patients attending consultations. The sex profiles reflected the fact that twice as many females attend the surgery than males which is does not reflect the profile of patients registered.

The meeting agreed that the attempt to match the profile of those participating was reasonable and the additional charts showing the huge difference in the ethnicity profile of the practice’s patient compared with Brent and London generated some surprise and discussion about how decisions could be taken at Brent and London levels about the provision of care relating to ethnicity in the practice when there are such huge differences in patient profile.

The chair suggested that these discussions should be held elsewhere so that the results of the survey could be fully discussed.

What did the Patient Survey tell us?

Martin asked the meeting to allow him to do through the six main findings before having a full discussion. The meeting agreed.

The following were the main findings. Comments raised in the open discussion are shown in red.

The meeting agreed that these were the main points that they had taken out of the survey and the individual patient comments added.

1. Generally extremely delighted with our doctors and nurses –

1. 90%+scores for each of individual doctors
2. Generally higher that other practices using same score.
3. Meeting felt that the practice offered a good very clinical service but sometimes ‘let down’ in other areas.

1. The open access double-attendance requirement is not liked – especially by mums withyoung children and the elderly – and by everyone in bad weather: there isn’t a good word said about it.

1. Dr Eric Britton explained that the late start of the Open Access Clinic was a known concern that we are about to address by switching the pre booked morning clinics and open access clinics for some doctors. This would enable the elderly and others ,who might find it difficult to return later in the morning, to wait in the practice as some same day open access sessions would start at 9am and not 11am as now.
2. Nick Driessens added that some Open Access clinic appointments would be available to book on-line.

1. Making an appointment with my doctor is too difficult

1. Martin clarified a misunderstanding held by many patients. Patients are no longer registered with a named doctor they are registered with the practice: this has been the case throughout the UK for the last 10 years. We choose, as a practice to record a ‘usual doctor’ in each patient record and where possible try to offer continuity of care. Typically this is only practical for those patients with conditions requiring a detailed knowledge of their clinical history.
2. There is regularly excess demand – a common problem in all the locality practices and to alleviate this, a Hub has been set up, whereby the locality funds additional shared doctor and nurse resource across all the practices but managed in two, in the evenings at weekends
3. Robin Sharp, elected Chair of the Kilburn Locality (also a Lonsdale patient) and Dr Britton, a Board member, explained how this works and the changes to be made during the initial three months of the new year (from 01 April) whilst a decision about its future is made.
4. NHS England has insisted that it can only operate outside ‘core GP hours’
5. [JM1]Dr Britton explained that the Hub can only be accessed by referral from the practice and not directly by the individual patient. All our appointments for the day must be taken before Hub appointments are offered.
6. The meeting discussed ways of resolving this ongoing challenge against a backdrop of reduction in NHS funding and agreed that it may be better if a smaller group has a more detailed discussion.

1. No provision is made for those at work to be seen at convenient times (first thing or late in the day …. or on other days)

1. The practice works within its NHS contract and provides appointments from the start of and at the end of the day. What patients were asking for in the survey were for appointments outside these hours. Dr Britton explained that until this was a contractual requirement and /or funding becomes available we are unable to offer such appointments.
2. There are other categories of patients who want early and late appointments: e.g. some parents with young children who have to wait for a partner to return from work may need late appointments too.
3. When the practiced offered late in day appointments (until the funding was reduced by the then PCT) the experience was that we were unable to differentiate between workers and non-workers[JM2].

1. Getting through to the practice by phone takes too long
2. Martin explained that we have a finite(even without absences through holiday or sickness) resource and a very busy front desk and large volume of incoming phone calls both sometimes peaking at the same time. Our objective is to reduce the number of face-to-face and telephone interactions with staff rather than employing additional, unfunded resource. This will inevitably be through greater use of technology: on-line bookings and touch screen check in.

Possible resistance to these changes will need to be managed sensitively: but are unavoidable and eventually able to offer a better level of service.

Increasing use of technology could take pressure off the phone system. However the practice must continue to accommodate people who don’t have internet accessthrough computers or smartphones.

1. The reception experience ranges from very helpful to brutal: with more negative comments than positive

1. The meeting expressed the view that if all the other problems were resolved this would improve matters as reception staff would feel less stressed.
2. Martin stated that there is no reason why anyone need be rude – this view was in the main endorsed by the meeting. However, it was pointed out that sometimes patients themselves are the cause of rudeness through their own behaviour and unreasonable demands– unfortunately provoking strong reception responses.
3. Martin said that if action is to be taken against individuals then he needs to know who was involved (current requirement is that everyone should wear name badges). Disciplinary action may need to be taken and without the means to identify the individual(s) involved in displaying rudeness (verbal brutality)then we can’t manage the situation properly. HR legislation requires us to follow a strict process that provides for training, observation, support and ultimately disciplinary action. We have CCTV cameras and voice recording in the reception area and we can use this for training if we only know who was and who they were involved. Martin
4. Dr Davis confirmed to the meeting that receptionists had received many patient care training course / sessions during the last 20 years. More may be appropriate but they are not always beneficial to all individuals.
5. It was pointed out as our receptionistshave to deal with the full range of human emotion. Sometimes they are g giving positive messages to happy peoples but often enough they have to deal with people who are upset, angry or feeling ill and anxious: unlike receptionists in a hotel who are usually either making a booking for or checking someone in who actually wants to be there.

Martin concluded his report on the results of the survey by making the point that, despite the negative comments of a relatively small number of patients; over 90% of our patients would recommend the surgery.

Supplementary Questions(the PPG had previously asked for a question about patients being asked , when they booked appointments, the reason for their request and some members had strong views that it was not acceptable for a non-clinician to ask.

The practice also had an additional question relating to the action / sanction that could / should be taken when patients fail to attend their appointments without notifying the practice (DNAs).

The results were presented by Martin:

1. Our GPs find it useful to know in advance why you are attending and have asked our receptionists to ask you for a very brief reason for your appointment. e.g. Stomach pain, coughing for several weeks, high temperature, sore rash, personal.

Are you willing to provide this information to help you and your doctor?

YES 160

NO 15

If NOT, why? Privacy, embarrassing, do not want receptionists to know; don’t want the waiting room to know; happy to do if appointment booked on-line

Dr Britton confirmed this information was very helpful to clinicians as it enabled them to be better prepared for the consultation. With limited time available this extra indication enables the clinician to quickly scan the patients’ clinical notes to see if, for example, similar events had occurred. There was a very significant majority in favour of patients being asked the reason. The practice agreed to take further steps to ensure confidentiality is not breached and that patients are asked for this information in a way that allows them to feel comfortable in declining to give it.

1. Currently the practice loses 10 – 15% of all available appointments through people failing to show up (DNAs – Did Not Attend). This is approximately equivalent to losing one full time doctor. What action, if any, should the practice take with such patients?

Remove from practice list after 1 instance 3

Remove from practice list after 2 instances 43

Remove from practice list after 3 instances 73

None 25

Other: please suggest alternative sanctions (remembering that the NHS does not allow charges

for NHS services) 14

Send text reminders 24/48 hours before (we do 24 hours before); remove patient after 5 times; phone up to find out why; explain the costs/damage done to everyone.

The meeting was generally unaware of the high number of DNAs. In the survey there was a large majority of those in favour of removing patients from the list, with the majority after the third time. The meeting also suggested that the reasons (e.g. mental health) be considered on a case-by-case basis and that patients be warned before any such action was taken. The chair asked about other ways of dealing with DNAs. Research indicates that charging if appointment were missed works well in other countries, but cannot be done in the NHS

AOB

1. Communications: Robin Sharp started a brief discussion about confusion between the Kilburn Locality PPG and the Lonsdale PPG, which is sometimes just called ‘the PPG’ so it’s difficult to know which PPG is being referred to, He suggested that our PPG is always given its full title of ‘Lonsdale PPG’ As the Chair of the Kilburn Locality PPG and a Lonsdale patient, he described how he found some communications confusing e.g. the Locality patient survey and the Practice survey were too close together and should have been better coordinated and the in-practice notice boards for the locality and the practice need to be more clearly differentiated.

Others agreed with this and said that many practice and NHS messages were confusing as they appeared inconsistent. The practice was asked to ensure that its website and noticeboard were in synch and gave clear messages that patients could understand. The practice will try to do better..

1. Robin asked members to make note of the next Kilburn Locality PPG meeting 23 April 2014
2. Martin posed a question for the group to consider: he presented two charts one showing the vastly different patient age profile of the practice compared with the UK as a whole. The practice has almost twice the national average of patients in the 30 -39 age group and half the national average of 65+ patients. It also has 2,000 new registrations each year and an almost equal number of leavers; creating a huge churn and increased clinical and registration workload.

Martin then showed a chart of disease prevalence showing that the practice is significantly ‘healthier‘ than Brent as a whole, London, England and the UK (with only two disease areas slightly higher – asthma and mental health).

His question was: if our patients are so healthy: why are we so busy – why do so many ‘well’ people want to see a doctor?

1. Jill was thanked for being chair for the evening and nominated as the permanent chair. This was seconded and accepted by the meeting after Jill stated she was prepared to take the role on. She was duly unanimously elected.
2. The next meeting of the Lonsdale Medical Practice PPG was agreed for Monday, 16 June at 7pm – 8pm in the practice. The subsequent one will be in in September 2014. Notices for the June one need to go out now, and be displayed on the practice notice board

Minutes by Martin Chernick: 25 March 2014

Practice Manager

Reviewed by Jill Mortimer: 26 March2014

Lonsdale PPG Chair

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[JM1]Don’t remember saying this, and don’t know what I meant if I did say it!

[JM2]Not sure why you needed to do this