‘VIRTUAL’ PATIENT PARTICIPATION GROUP AND PATIENT SURVEY 2013/14
The current Lennard Surgery has been based in the Bedminster Down/Bishopsworth area since 1984. It moved from smaller premises in Bishopsworth Road and prior to that had started in the Hartcliffe area when that estate was being built. It is situated in a predominantly ‘White British’ community, with some areas of deprivation in the Withywood and Hartcliffe fringes. The practice population includes a higher than average number of elderly patients and a small number of nursing home patients. There are patients who have one or more chronic diseases due to the industries that used to be based in South Bristol (e.g. Wills Tobacco factories) and an increasing number of patients with diabetes, linked to insufficient Healthy Living promotion in the past.
Over the past year, the surgery has seen an increase in patient numbers to 7811. This would have been 7924 but a ‘list cleansing’ exercise by the local Primary Care Trust reduced this by 113. With a combination of more small developments of flats and houses in the area and the purchase of large family homes as members of the older population pass on, we expect the list size to continue increasing. This requires a close look at our current services, the expectations of a changing population in the area and the demand on the premises, the appointments and the skills mix in the practice team.
THE ‘VIRTUAL’ PATIENT PARTICIPATION GROUP
This survey was answered by 33 of our members, a reduction of 9 from our original group of 42. 78% of this group attended the practice more than twice a year.
The majority of respondents were aged between 45 and 75 but there was representation from across the whole practice adult age range:
17 to 44 = 15% (practice population 36%)
45 to 64 = 48% (practice population 26%)
65 to 74 = 27% (practice population 9%)
75+ = 9% (practice population 11%)
‘vPPG’ RESPONSES TO QUESTIONS
The thrust of the vPPG questionnaire was to try and identify the areas that could be improved beyond the usual problems with appointments and GP choice. Regular monitoring of the standard GPAQ survey on the practice website and from comments on both the website and NHS Choices seemed to show an improvement on those perennial issues since the introduction of the 50/50 appointment system. There were, however, other aspects that needed tweaking or improving and those were the ones of most interest in this questionnaire.
Getting access to appointments – the reasons for not getting an appointment were quite evenly matched. These were a combination of the telephone being engaged, appointments not being suitable or they had all been taken by the time the patient got through. This question was repeated for the main practice survey.
Seeing the doctor of choice – It was encouraging that 45% of the respondents had been able to see their doctor of choice. The main reason for not seeing that particular doctor was that they had all been taken by the time the patient contacted the surgery. Again, this question was repeated for the main practice survey to compare results.
The remainder of the questionnaire was deliberately left quite open ended to allow the respondents to freely express their views. These questions enquired about the good things that we did and how we could improve. The following ideas were taken from these responses:
· Staying consistent with appointment systems and times. If there is a need to change then this should be better communicated (especially for people who don’t attend that often).
· Shared care to further ensure continuity of care – either between 2 doctors or between other clinicians.
· Look at better appointment booking and times for workers.
· Electronic prescribing for repeat medication.
· Access to test results and aspects of medical records for patients – to aid them in form filling, etc.
· Contacting patients by email.
· Making ‘follow up’ appointments easier, without going to the ‘back of the queue’.
· Increased amount of appointments available online.
· Better parking facilities for mobility scooters.
THE PATIENT SURVEY
The 2014 Patient Survey was distributed electronically to the registered users of the online Repeat Prescribing, available on the Lennard Surgery website and offered in a paper form to patients visiting the surgery. 204 people responded to the survey = 2.6% of the practice population.
Demographically, the mix was as follows:
36% Male (practice 49% – attend 40% of appointments)
64% Female (practice 51% - attend 60% of appointments)
Age breakdown –
16 to 44 : 25%
45 to 64 : 49%
65 to 74 : 20%
75+ : 5%
68% of respondents stated that they had a long standing health condition
Ethnic group responses – 97% White and 3% No answer
Employment status -
Employed (full or part time, including self-employed)52%
Unemployed / looking for work1%
At school or in full time education0%
Unable to work due to long term sickness8%
Looking after your home/family3%
Retired from paid work29%
No response 7%
76% of the respondents visited the surgery more than twice a year (17% on a monthly basis)
The survey repeated the 2 questions about accessing appointments and doctor of choice.
Getting an Appointment
37% stated that they had trouble accessing the surgery by telephone as the lines were engaged first thing in the morning.
42% stated that when they did get through, then the routine appointments for that day had already been taken.
27% of patients had no trouble getting an appointment.
A lot of the patient comments indicated that they had less problems with the online system but it was recognised that these people were willing to be more flexible with the length of wait, the timing and the GP required.
Patients who are working and either at work or commuting at 8.30am found it extremely hard to get appointments. There are ‘Worker’ appointments available – mainly early evening and Saturdays – plus the option of online booking but this does still seem to be an issue.
It was commented that we had created a system where the more ‘tech savvy’ were likely to have an advantage over other patients.
Seeing a doctor of Choice
39% said that the doctor’s appointments were all gone by the time they needed it.
23% said their doctor was not working on the day they wanted
28% had not experienced any problems
15% did not know which day their doctor worked
Despite information on the website and on the GPs individual appointment cards, it seems that patients are not aware of their doctor’s working days.
There also needs to be more education around the 50/50 appointment system and the opportunity to access a patient’s ‘usual GP’ on the day.
85% of respondents used the Repeat Prescribing facility on the practice website
38% used the online booking system for appointments
This is encouraging and highlights that we need to do more work on promoting the other available online services. Test results would be a good area to start – see next section.
Test Results – preferred method
39% of respondents would like an email with their test results
19% wanted us to phone them, 18% would prefer texts and 17% would continue to phone us
There isn’t a facility in place within the surgery to email patients with results but it is something worth considering. One respondent suggested an online access to the appropriate information, similar to accessing your bank account 24/7.
Quality of Other Services
Patients were asked to comment on the quality of any other services that they may have used. These included Specialist Clinics; Dressings and Wound Care; Health Checks; Baby Clinics/Immunisations; Support to Stop Smoking and Travel Clinics.
Although responses to each of these varied, the majority of the results showed them to be Excellent or Good.
Patient comments highlighted individual problems with certain aspects of the clinics, e.g. follow on appointments, getting results etc, but there were no over arching issues.
“What one thing would make your life easier if you had to access any of our services?“ This question reinforced the message that getting access to appointments was still a high priority, especially for patients who work. Telephone access was difficult for them because they were either commuting to work or actually at work when the surgery opened the lines.
Other interesting comments or ideas from the patient survey included:
· Different approaches to medication reviews
· Communicate more clearly on the appointment system
· Communicate more clearly on the Travel Clinic – content and possible costs involved
· Greater privacy in the Treatment Rooms – storage issues
· More information about GP working hours
Patient Survey items of consideration
Action to be taken by the Surgery
Staying consistent with appointment systems and times. If there is a need to change then this should be better communicated (especially for people who don’t attend that often).
o Visual Powerpoint explaining appointment system to be developed and played at regular intervals on the waiting room digital screen
o Same Powerpoint display to be available on the surgery website
o Update practice leaflet for new patients
By end May 2014
Shared care to further ensure continuity of care – either between 2 doctors or between other clinicians.
o Medication management project underway to proactively identify suitable patients for shared care between nurse Practitioners and GPs
Starts 1st April 2014
Look at better appointment booking and times for workers.
o Use additional funding from HM Safeguarding to target resources for appts up to 6.30pm
Starts 1st April 2014
Electronic prescribing for repeat medication.
o Work with local practices to implement EPS2
By end October 2014
Access to test results and aspects of medical records for patients – to aid them in form filling, etc.
Contacting patients by email.
o Work with EMIS to find suitable and affordable solutions to access records remotely
o Develop ideas and protocol around email to patients, with guidance on data protection, confidentiality and security
By end October 2014
Making ‘follow up’ appointments easier, without going to the ‘back of the queue’.
Increased amount of appointments available online.
o Develop project to review the appointment supply and demand
By end July 2014
Better parking facilities for mobility scooters.
o Use Prescribing Incentive Scheme money to create a hard standing area at curve of front entrance ramp
By end May 2014
Treatment room privacy
o Investigate ways to reduce the need to access treatment rooms during consultation times or to enhance privacy
By end May 2014