The Priority Areas Agreed Are

BellinghamGreen Surgery

email: bgs.patientgroup

Opening Times

Monday, Wednesday, Thursday, Friday 07:55am – 18:15pm

Tuesday 07:55am – 20:15pm

Extended Hour appointments are book in advance.

Out of Hours Patients should contact SELDOC.

Patients can register online for repeat prescriptions and to join our patient group.

Patient Participation Group 2011 and Onwards

Introduction and History

The Bellingham and Downham estates were part of the “homes fit for heroes” building programme after the First World War, rehousing people from slum dwellings in Bermondsey and Rotherhithe. The Bellingham Green Surgery was started in 1924 by Dr Bill Walker, who also had a surgery on the Bromley Road. On his death in 1956 he was succeeded by his son, Dr Brian Walker.

Dr David Misselbrook joined Dr Walker in 1984. At that time the practice had 2,300 patients with a high proportion of elderly people, many of whom had spent most of their lives on the estate. When Dr Walker retired in 1987 Dr Janet McCredie joined, and Dr Nicholas Surridge joined also in 1989. In 1991 the practice became a training practice, taking G P Registrars.

In 1991 the three partners commissioned a large extension to the original house, building on what had been the garden. This opened in 1993 and the Bromley Road Branch Surgery was closed. This extension forms most of the current surgery and has allowed us to expand the practice and the services we provide. The last 20 years has seen a huge increase in diversity on the estate, and has also seen a great expansion in a wide range of health and social needs and also in the number of younger patients needing child health services.

Dr David Sharpe joined the partnership in 1994, Dr Wendy Gaskell joined in 2002 allowing the practice to expand further. A further small extension was built in 2003 enabling us to take 2 GP Registrars. Dr Sejal Patel joined in 2006. Dr Surridge retired in 2011 and in April 2012 we welcomed our new partner Dr Katherine Chan. Dr Janet McCredie also retired in 2012.

Bellingham Green Surgery Patient Group

Profile of the Practice Population

The practice has a population of 7252patients of which 3266 are male and 3489 female. Within that, we recognise we have a changing population, in that there are now a number of young patients and patients of many ethnic groups. In addition we are not only treating patient’s physical ailments, but health conditions resulting from social need

and vulnerability.

The following is our first ‘real ‘ steps towards developing a patient group for the future.

1. Steps taken to set up and ensure that the PPG is representative

We have tried various activities to engage patients across our demographics but the response hasalways been poor.

So far we have tried the following methods of recruitment;

Recruitment Methods

In House Circular

14 patients originallysigned up in house, despite distributing over 100 circulars.

7 male 7 female 9 white descent, 3 Caribbean and 2 Africandescents.

Age groups (14 members)

25 – 34 age group (3 patients)

35 – 44 x2 age group (2 patients)

45 – 54 x 4 age group (4 patients)

55 – 64 x 2 age group (2 patients)

65 – 74 x 2 age group (2 patients)

75 – 84 x 1 age group (1 patient)

Text Message

We selected 35 patients who have been treated due to drug misuse. We contacted 4 of them by text message but had no response. Of the 106 patients coded to alcoholism we contacted 6 by text and had nil response. There were 87 carers and we targeted 5 by text with no response.

Email

There were a number of people that expressed an interest in being a part of the virtual group. Of the 18 that expressed an interest, 9 were contacted but no response was received as a result of the email. The PM then selected a third of them for further investigation, and contacted them by phone. At that time one patient expressed a tentative interest, one was sick from work and was unsure whether it was ok for him to participate and one had his computer out for repair.

We have found the text process to have a high unsuccessful rate due to the frequency with which people change their contact numbers, and do not remember to inform the practice.

Telephone

Of the 7 that signed up in house, all were telephoned at various times on more than one occasion,with 3 agreeing to participate by telephone.

As a practice we need to continually push for patients to keep us up to date with their contact details.

Open Meetings

In April 2012 we made the decision to go ahead with an open meeting to try to generate ideas and interest in the group in view of the difficulties experienced as above. Meetings were held in November 2012, January 2013 and March 2013.

Leafleting for a first open meeting began in September 2012. Participants previously involved in the telephone and email group were contacted. The whole team was involved in making patients aware of the group by talking to them in consultations and at reception. The team have been aware of the need to encourage participation by all groups and have actively sought younger and more disadvantaged groups. At the first group meeting, the need to be representative was discussed and the group members offered to spread the word and be involved in leafleting and putting up posters locally. Clinicians proposed to target specific groups at postnatal/childhood immunisation appointments, mental health reviews and new patient checks.

Demographics of 2012-13 Members

The original group of patients who expressed interest were informed of the meetings, sent minutes and offered the chance to respond. Some made comments. Four patients attended some, or all of the meetings.

Age Group (15 members)

10 female and 5 male members

The majority of members are white British, but there are also African and Caribbean members.

2. Agree Patient and Practice Priorities

1. In 2012 we carried out an internal survey. We distributed 238surveys in total. The figure came from number of clinicians in the practice and sessions worked. The survey told us that patient’s ability to book appointments in advance came up as an area that we do not perform well. This has issue has been highlighted for the past 3 years in the National Patient Survey, and has in fact declined year on year in the from71% satisfaction in 2008 to 68% in 2009 and 60% in 2010. This has been somewhat perplexing for us as a practice, as there are plenty of appointments that can be booked ahead (except for occasions when more than 1 GPs is absent at the same time).

1. Another problem for the practice is how we strike a balance between appointments booked on the day and in advance, as the inability to achieve this balance results in some non urgent patients being seen as urgent, which adds additional demand on the GP, and is not satisfactory for reception staff, and in some cases the patient.

1. A review of the complaints for the year raised concerns about receptionist communication relating to appointment process and availability. This is a theme that has been highlighted from the internal complaints process as well. We know the practice receptionists are good at their jobs and polite to patients, but there are instances when we are not providing patients with all the information they need to make decisions. Neither are we explaining the book in advance process in enough detail, neither are we, at times, offering it appropriately.

1. Building access – This was another of the items that has consistently come up in the national survey as one of the top 3 areas of poor performance by the practice, and this was further endorsed during an observation session by Lewisham Link (our local involvement network), when they visited the practice last year. Of the 53 comments made about accessing the building, 34 (42%) were negative. As part of the Care Quality Commissions (CQC) drive, to ensure practice premises are fit for purpose, it is timely that we start to incorporate some of these requirements into our patient and practice plan. Although we did not include building access in our internal survey, we have scored low in this area between 2008-10 and we are sure this will be a poor performer again, in the 2011 national survey. Therefore we feel if it is an important issue for the patients, and is a CQC requirement, then it is an issue the practice must tackle as a priority.

3. Collate views through survey

We carried out a patient survey in February 2012 and asked many of the questions used in recent years. The practice results overall were good in areas relating to clinical care and communication with GPs, Practice Nurses and reception. See examples below.

Further to this, several priority issues were agreed in the first two open PPG meetings of the new year (Nov 2012 and January 2013). These were:

1. Updating of the practice website
2. Provision of the ability of book online and order prescriptions online
3. Access to appointments, particularly advanced access
4. Extended hours provision.

Questions based on these issues, were agreed for inclusion in our 2013 patient survey.Our survey was conducted in February and March 2013 and the PPG informed of the findings by letter and at the meeting on the 20th March 2013. Below is a summary of the findings;

Question 1. How often do you ring or visit the practice?

Question 2. How easy is it to get through to someone at the practice on the phone?

Question 3. How easy is it to book ahead at the practice?

Question 4. How well do the practice staff listen to you?

Question 5. Which additional hours would make it easier to speak to or see someone?

Question 6. How helpful are members of staff at the practice?

Question 7. How interested would you be in booking appointments via the internet?

Question 8. Overall, how satisfied are you with your experience of Bellingham Green practice.

The age range of respondents was:

The reception team handed out questionnaires randomly in the waiting room during a 2 week period, with 95 returned completed.

4. Provide PPG with opportunity to discuss survey findings and reach agreementwith change to service.

(Steps 4 and 5 are interlinked).

In early 2012, although the Patient Group wasnot yet in a position to meet as a formal group either virtually or in person, the PM has ensured she has some of the respondents engaged by keeping up telephone dialogue with them as individuals, in order to ascertain their views on the findings and to seek their approval with regard to any changes. As the virtual group did not take off on this occasion, the practice manager explored the possibility of conference calling, but unfortunately was unable to pursue this, as the practice phone system does not facilitate conference calling. It is an avenue to be explored in the future.

For this process, the PM spokewith 7 patientsby telephone and in person. Some had seen:

• the overall survey results
• a summary of the findings
• the items that the practice scored well
• the consistent areas of the practice that need improvement
• the priorities that have arisen from the survey
• the proposed action plan

In March 2013, the 15 patients involved in the PPG were sent the 2013 survey findings. These were discussed in the March PPG meeting – see below

5. Agree action plan and implement change

(Steps 4 and 5 have been linked together)

In 2011 the practice identified the appointment system and building access as a priority. Many months were spent discussing options, conducting surveys from other sources including the Primary Care Foundation.

A meeting took place with reception staff, the practice partners and the practice manager on 14th March 2011 to discuss the items that cause them problems as a receptionist. The appointment system was top of the agenda. There was a discussion about what would work best for them and patients. As a result of this meeting, and ongoing meetings between the Practice Partners and Practice Manager the following action plan was agreed.

Action

The plan was to try a new method of managing appointments

Introduce a template for receptionists to ask patients that will ensure they provide the patient with all the information they need to assist them in receiving the appointment they need, when they need it.

The main features of the new appointment system are;

1. Appointments opened in advance
2. Increased doctor availability for telephone consultations and urgent assessment.
3. Retained ability to see doctor without appointment if patient feels necessary (urgents list)

In terms of Building Access

Two major issues came into play that prevented us from proceeding with building works in 2012. First, the practice premises is shared with another agency. It came to our attention that they are moving to new premises in the next 6months which means there is now an unexpected opportunity to totally reconfigure the patient waiting area (with a view to improving the issue regarding confidentiality), and the reception including the front doors and lobby. Secondly, the recent CQC survey will provide us with a written report of building requirements and regulations that need to be met and so these recommendations can be incorporated into the plan.

Action

Our next step is to call in the practice architects for some design layouts in preparation for works to commence.

To survey the patients with views as to what they see with regard to how we greet and serve them from initial point of access, through to reception (confidentiality) and their views on how they visualise a new waiting area.

Moving on from these actions, in 2012, the appointment system was regularly discussed and reviewed in house. At the meeting on the 20th March 2013, the PPG commented on and discussed the practice survey findings.

In view of the survey finding that 49% of patients find it not very easy or not at all easy to book appointments ahead, the practice will put extra administrative time into ensuring appointments are put onto the system and monitor availability.

In 2012 the practice was able to secure Improvement grant monies for changes to the reception and waiting areas, andbuilding access, and the building work has been monitored with enthusiasm by the PPG, several reflecting on the fantastic ability of the practice to continue to provide services while work has been in progress. The new doors are DDA compliant and have vastly improved warmth and noise disturbance in the reception area. We also have a low level reception desk area for patients who are wheelchair bound.

The following additional actions came out of the 2013 survey and PPG work;

In view of the survey finding that 61% of patients are interested in booking appointments online, the practice will work on setting this up. It was agreed that initially only book ahead appointments would be available due to concern about disadvantaging the 39% who are not interested in online access.

In terms of extended access, the PPG had considered the possibility of restarting Saturday morning surgeries. The survey showed that 30% of patients were interested in this, while 45% were already being catered for by the current set up. 15% asked for early morning appointments and 10% for Sunday opening. In view of the scattered needs of the patient population, it was agreed that there would be no advantage in moving to Saturday access. The plan to retain current extended access arrangements was agreed and it was agreed that this should be re-publicised to ensure patient awareness.

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