COBBS GARDEN SURGERY
OLNEY
PATIENT SURVEY RESULTS
(year 2) 2012 -2013
NHS ENHANCED SERVICE : PATIENT PARTICIPATION
November 2012
INDEX
Page no.
1. SUMMARY AND OVERVIEW
2
2. ACTION PLANNING: YEAR 1 OUT-TURN
4
3. METHODOLOGY AND COVERAGE: YEAR2
7
4. QUANTITATIVE ANALYSIS
10
5. QUALITATIVE ANALYSIS:
11
6. ACTION PLANNING: YEAR2
12
1
COBBS GARDEN SURGERY : PATIENT SURVEY
YEAR 2012 - 2013
1. SUMMARY AND OVERVIEW
1.1 In May 2011 the N.H.S. Executive via its primary care trusts (P.C.Ts.) began an
initiative designed to further enhance patient involvement in the provision of primary
health care in G.Ps surgeries. The initiative was to run for two operational years;
2011 – 2013. This process was to demonstrate that G.Ps and their organisations were
encouraging greater patient involvement in the way primary care services should be
delivered and improved. Action undertaken was required to demonstrate, in a
measurable way, patient perceptions of the current service level, and take on board
how patients felt services could be made better.
1.2 The national perception of enhanced service/patient involvement envisaged a
number of “key steps”; briefly these were:STEP 1 Development of a structure to gain accurate involvement of patients.
STEP 2 Agree areas of priority.
STEP 3 Collect and measure patient views through two surveys, one for each
operational year, (2011 – 2013).
STEP 4 Use the structure achieved in completing STEP 1 to analyse and agree
action arising from survey results.
STEP 5 Agree a plan for implementing action.
STEP 6 Publicise actions taken and achieved to the P.C.T and the surgery’s
website.
2
1.3 During 2011 and 2012 Cobbs Garden Surgery took a number of actions with a
view to achieving the aims set out in the national initiative to enhance patient
involvement : These included: The formation of a representative group of patients to provide on-going input
to services from a lay perspective. This group, “Patient Participation
Group” (P.P.G.) is highlighted in the information booklet about the practice
and is contactable via the P.P.G. Secretary at the Practice.
 The P.P.G meets regularly with the Practice Manager and Doctors to highlight
and discuss priorities and action. (Patients are not discussed and individual
confidentiality is paramount.)
Overall trends and actions needed go on to form the substance of the agenda.
Recent initiatives from the P.P.G. include:



Set up and run a Carers’ Support Group, meeting monthly (in
conjunction with M.K. Carers).
Obtained replacement funding for a Nurse for the Elderly
(through Olney Town Council).
Responded to D. of H. White Paper on Primary Care.
Developed patients’ communication programme.
Last year (2011) in October and November the P.P.G. also undertook the first of the
Patient Surveys and the results of this review were published on
w.w.w.cobbsgardensurvey.gpsurgery.net
1.4 The survey highlighted areas where patients felt the service was good and made
suggestions for improvement. Again, these are available on the practice website.
1.5 What follows below is the result of the second survey together with an assessment
of progress made on suggestions from last year by the surgery’s patients.
Since the publishing of the second survey marks the final stage of the
“improving/assessing” care initiative, the report will provide a more comprehensive
outrun and future recommendations section, the aim being to ensure that the valuable
inputs provided by patients are not lost and are acted upon.
1.6 The substance of the report divides into 5 main sections, these are;1. Action planning for Year 1: Out-Turn
11. Methodology and Coverage
111. Quantitative data Year 2 and comparison with Year 1:- Trends
- Outstanding issues
1V. Qualitative data:- Positives
- Suggestions for improvement
- Action planning (Year 2)
V. Reporting to the P.C.T. and publishing the survey
3
N.B. Annexe of supporting data has been inserted into the narrative for each
main section.
2. ACTION PLANNING: YEAR 1 OUT-TURN
2.1 The overall survey results for the year 1 out-turn provided clear evidence
that the level of patient satisfaction was high. Nevertheless there were a number of
suggestions for improvement. Solutions to the issues that patients raised are covered
in Annexe 1 to this report below which revisits the suggestions made by patients,
numbers of patients raising an issue together with action taken by the Practice and the
P.P.G. to make progress.
ANNEXE 1
CRITICAL SUGGESTIONS FOR IMPROVEMENT : YEAR 1
COMMENTS
PATIENTS
ACTION UNDERTAKEN
Appointments
Kept waiting to see a GP
at the
Surgery.
9
Ask Doctors to be mindful of time
per patient.
Noted.
Need opening hours
outside office hours.
12
Want to see own doctor.
8
There is late night surgery on
Mondays and Saturday mornings.
Need for both to be better
publicised?
Second late evening surgery?
Needs re-emphasis.
Re-publicise G.P. specialities to
encourage use of more than
‘personal doctor’
Achieved.
Insufficient appointments
on the day.
4
Noted.
Appointments too far in
the future
4
Noted.
4
COMMENTS
Expensive 0844 number
PATIENTS
ACTION UNDERTAKEN
8
The 01234 number, re-instated
to reduce cost to patients.
21
Does physical structure/layout need
to be altered?
Noted.
Confidentiality
Lack of privacy in waiting
room/open plan/seats too
close to front desk.
More obvious notices showing
private room available?
Achieved.
Should receptionist ask patients if a
private room is required?
Arrival at Surgery
Booking-in screen broken
– very annoying and time
consuming.
11
Make sure screen is fixed and kept
in good working order?
Achieved.
Insufficient parking
spaces.
Background music
annoying.
2
Noted.
.
Noted.
Lack of drinks (hot or
cold) machine.
2
Want to bring buggies in,
very expensive if stolen.
4
Better seating (ie. higher)
for the elderly.
2
1
If required, could a drinks machine
be provided?
Noted.
Provided the secure, dry space
outside and availability of security
chains from the front desk.
Achieved.
Could some higher, more
supportive chairs be placed in the
waiting room?
Ordered – not yet delivered.
5
COMMENTS
PATIENTS
Desk sometimes
unattended.
2
Long queues at reception.
2
COMMENTS
Occasional mix-ups with
Cox and Robinson re
prescriptions.
Older patients do not like
to be called by their first
name.
Can doctors do blood test,
not send at later time to
nurse.
PATIENTS
ACTION UNDERTAKEN
Install a bell to summon a
receptionist and encourage patient
use.
Achieved.
See above, booking-in screen.
Achieved.
ACTION UNDERTAKEN
2
Noted.
1
Noted.
1
Noted.
2.2 As some of the actions suggested by patients were relatively minor concerns, once
identified they were able to be put into place without too much difficulty. Good
progress has been made. Despite this it is clear from the data gathered in the year 2
report that the same or similar complaints can be found as in the year 1 report. Where
this has occurred such issues need to be part of updated action by the Surgery. Some
of these issues can only be resolved by capital expenditure and this may not be easy
in the current economic climate when the Exchequer is currently concentrating on
reducing public expenditure and borrowing. The fact that there are matters unresolved
cannot be simply left but will need a clearer and focussed action plan. Suggestions are
made in the conclusion to this report.
6
3 METHODOLOGY AND COVERAGE : YEAR 2
3.1 In order to make a comparative analysis valid, the method tried to follow closely
the previous year’s process, eg. the actual survey (Annexe 2) is the same. Once again
the survey was carried out solely by members of the P.P.G. No practice staff were
involved at any stage. Any minor changes in method were to improve on last years
numbers of both patients and care organisations.
3.2 The year 2 survey is characterised by the following key features:- Quantitative data collection
- Qualitative comment by patients
- Random distribution of survey (only care homes were targeted).
- Anonymous and envelopes provided
3.3 Annexe 3 provides a comprehensive distribution/patient profile. Sample size of
470 patients was almost 20% greater than year 1. All residential homes were covered.
Sheltered accommodation and the sole chemist in Olney were provided with copies
for Cobbs Garden patients using the pharmacy service. The population (regular
patients) is included as part of Annexe 3 together with the ethnic mix of patients.
3.4 The combination of consistent research for both years, widely extended patient
coverage, care homes, sheltered accommodation and house-bound, also being
included have provided a representative data base which the practice partners should
be able to rely on.
7
ANNEXE 3
SURVEY DISTRIBUTION METHOD
The number of patients surveyed = 470
The Practice size
= 8500
% of Patients surveyed
= 5.5%
(1) SURGERY
The overall survey took place over 4 complete days and 2 Saturday mornings. The
rationale is set out below:-
DAYS AND TIMES
Monday
8.15am – 8.15pm
Tuesday
8.15am – 6.30pm
TYPE OF SURGERY
all doctors/nurses on duty
- normal surgery + out of
hours
-normal surgery and parent
and child clinic
REASONS
excellent spread of patients
in age and gender; ‘out of
hours’ patients
normal spread of patients
and good proportion of
young parents
good range of patients
Wednesday
8.15am – 6.30pm
Thursday
8.15am – 6.30pm
normal surgery
Saturday
9.00am – 1.00pm
Saturday
9.15am – 11.15am
Flu clinic
good range of patients and
good proportion of elderly
and those with ongoing
specific illness
as above
out of hours
(appointment) surgery
patients who cannot attend
‘normal hours’ surgery
normal surgery and flu
clinic
2 RESIDENTIAL HOMES
Four separate residential care homes were visited and the Senior Care
Worker/Manager responsible for dealing with Cobbs Garden was asked to comment
on their experiences with The Surgery. These four homes had a total of 68 residents.
(Bay House 11, St Josephs 12, Westland’s 17 and Broomfield’s 28).
8
3 SHELTERED ACCOMODATION
Clifton Court Sheltered complex was visited and 30 copies of the survey were left
with the Warden who agreed to distribute them to the residents. These were collected
one week later.
4 COX AND ROBINSON (CHEMIST)
Cox and Robinson agreed to help with the survey in two ways. Firstly they displayed
copies of the survey on the counter and asked Cobbs Garden patients to fill them in
whilst waiting. Secondly copies of the survey (with a stamped addressed envelope)
were included in their prescription deliveries, with a short explanatory note and a
request to post the completed form.
9
4 QUANTITATATIVE ANALYSIS
4.1 Numerical data is summarised in Annexe 4.
This is best understood as follows. It includes individual patients taken from general
surgery attendance and sheltered accommodation; questionnaires returned via the
chemist and the view of senior care officers in Olney’s four residential homes. No
answers were prompted.
4.2 In Annexe 4 each of the questions in the survey is covered. This includes Year 1
out-turn in parenthesis as well as, this year’s figures. Almost without exception the
overall satisfaction recorded by patients is outstanding. The impression created is
that of strong medical, nursing/allied professions, managers and administrators all
combining to provide a high quality primary care service. As with last years report
radical action would be unnecessary, and the staff of Cobbs Garden Practice is highly
regarded as an asset for Olney. No account of macro level factors eg., reduced public
benefits, has been undertaken by this analysis but it seems that even in straightened
times standards of primary care in Olney are well maintained.
4.3 It is appropriate to point out that the Practice is situated in what is still a relatively
affluent area and does not have any factors which might be problematic in other
primary care areas, from staff shortages, inner city or urban factors or high ethnic
populations with specific health needs. Some indication of structural problems may
need to be considered when examining the age profile (Annexe 3.2) where it seems
evident that Olney has a rapidly aging population. The Practice partners may conclude
that they will need to anticipate and plan for primary care services in the future
given this rapidly advancing problem.
4.4 In terms of areas of the questionnaire coverage, as was the case with last year’s
Report, most information of immediate use, both positives and negatives, are much
more evident in the following section of the Report, dealing with qualitative
analysis.
10
5 QUALITATIVE ANALYSIS
5.1 An extra caveat on the qualitative data is that significantly fewer patients chose to
make comments. Only 61% of patients commented, compared to last year when 73%
did so. Some explanation for this may be found in the higher coverage of patients in
care and sheltered accommodation but this is speculative.
5.2 Qualitative comments are grouped as in the case of last years Report. However, in
order to avoid limiting the analysis, new grouping of comments has also been
undertaken to record new issues raised by patients. Annexe 5 sets out the qualitative
analysis together with the number of patients making such comments. (These are
actual patients – not %). Last year’s figures (where a comment category is common
the both years) are included in parenthesis.
5.3 The comments made by patients are overwhelmingly positive and reinforce the
raw data demonstrated in the quantitative analysis. The Practice can take a good deal
of credit from the vast majority of these comments. All questionnaires have been
retained and the Practice Manager may again find it useful to consider these a
valuable source of patient perspective. Included in Annexe 5 is a separate analysis of
the care home management, who deal with the Practice on behalf of many of their
residents. These comments are given from a managerial/professional perspective on
Cobbs Garden, but have not been included in the overall figures as they did not come
directly from the patients. Again, the Practice staff can take good credit for their work
in responding to residential homes.
11
6 ACTION PLANNING; YEAR 2
6.1 The overall rationale for the national initiative is to listen to patients and act upon
their suggestions; necessarily, therefore this action plan has to concentrate on
providing solutions to critical comment made by patients. However, in doing this it
should not be lost that the Cobbs Garden Practice has provided another year of
excellent service. The Practice Manager, will no doubt want to ensure that she and the
Partners of the Practice provide good feedback to their staff and, indeed, take
considerable credit themselves. Within both quantitative and qualitative data
sets/comment, there are out-turns subtleties which again, the Practice Manager will be
in the best position to understand how individual performance has influenced the
outturns, both positive and constructive suggestions. What follows is the P.P.G’s
view on actions which they feel will benefit patients.
6.2 Suggested priorities for action planning derived from the qualitative data are
contained within the final annexe to this report, annexe 6. What are listed here are the
main outstanding issues for patients as drawn from the questionnaires. It is fairly easy
to see that some areas are common to Year 1 and Year 2. The best insight to areas
needing action can be found is by comparing last year’s out-turn with Annexe 6 in
order to see what particular trends might be.
6.3 For example, the issue of privacy at arrival in the waiting room, although
showing a welcome improvement was raised by 21 patients last year and only 11 this
year, requires further action. The improvement from last year was achieved by the
display of a notice enquiring if patients needed a greater degree of privacy at this
stage. Annexe 6 makes the simple suggestion that a more prominent emphasis of this
aspect is still needed. It may be that capital works would provide a longer term
benefit, but if not possible at the moment, some action still needs to be taken. Another
example can be seen in the time that patients are kept waiting at the surgery. This
has shown a marked increase and although still a relatively low figure, only 9 patients
out of 470 raised this. That was double the figure for Year 1. It may be that given the
particular demands on Doctors for a single day this can prohibit 100% achievement.
Indeed a linked factor drawn from the comments in Annexe 5 suggests a positive in
that Doctors are given credit by patients for not being rushed during
consultations.
6.4 Many of the concerns raised in Annexe 6, perhaps somewhat frustratingly, are
already covered in the existing practice handbook. A possible overall solution to
an apparent lack of awareness might be to adjust/amend the handbook. This perhaps
needs to be done annually and the handbook provided in sufficient quantities and
prominence to be easily available to patients, and not kept behind the front desk.
6.5 In order to help practice staff, Annexe 6, as with last year makes comment on how
the constructive criticism compiled from both years might be tackled and the P.P.G.
would indeed be happy to help in any way appropriate for the role of a patient based
group. At its next meeting the P.P.G, with the Doctors’ representative and the Practice
Manager will formally consider this report in total and discuss/accept the actions
recommended in Annexe 6, which itself needs to be considered in the context of the
overall and very favourable outturn evidenced throughout the Report.
12
6.6 It is recommended that the P.P.G. discuss/accept the findings of the survey and
formally commend the high level of achievement by The Practice to the Primary
Care Trust in Milton Keynes.
13
ANNEXE 4
QUANTITATIVE RESULTS AS %
KEY
G = Good
S
= Satisfactory
U
= Unsatisfactory
N/A = Not Applicable
S/R = Satisfaction Rate
(Those who answered good or satisfactory)
Last year 1 (2011) S/R figures in parenthesis.
SURGERY, SHELTERED ACCOMODATION AND CHEMIST
1) RECEPTION
a) Was your arrival well handled?
G = 430
S = 36
U = 2
S/R
(Year 2)
91.7%
7.6%
0.4%
99.3%
(Year 1)
84.5%
11.6%
3.8%
96.1%
b) Receptionist’s ability to answer question?
G = 321
S = 103
U = 7
N/A = 38
S/R
S/R = 90.4% (however for
those who did not ask
questions) = 98.3%
(100%)
68.3%
22.1%
1.5%
8.0%
90.4%
60.1%
7.8%
0%
32%
67.9%
2) CONFIDENTIALITY
a) Was confidentiality maintained at Reception?
G = 360
S = 105
U =
5
S/R
(Year 2)
77%
22%
1%
99%
(Year 1)
63.1%
34%
2.8%
97.1%
14
b) Was confidentiality maintained by your doctor?
G = 432
S = 37
U =
0
S/R
(Year 2)
92%
8%
0%
100%
(Year 1)
88.8%
11%
0.2%
99.8%
c) Was confidentiality maintained requesting Test Results?
G = 392
S = 72
U = 5
S/R
83.4%%
15.4%
1.1%
98.8%
81.1%
16.1%
2.5%
97.1%
(Year 2)
88.5%
10.6%
0.8%
99.1%
(Year 1)
83,5%
15,4%
1.1%
98.9%
3. PRESCRIPTIONS
a) How good do you rate this service?
G = 416
S = 50
U =
4
S/R
b) How do you normally request Repeat Prescriptions?
Website
Surgery
Chemist
N/A
78
200
183
8
16.6%
42.6%
39.1%
1.7%
23%
46.9%
26.1%
3.8%
c) If you use the website, how do you rate it?
G = 70
S = 7
U = 1
N/A = 392
S/R of those using
website, 98.1%
14.8%
1.4%
0.2%
83.4%
19.2%
3.3%
0.75%
76.7%
96.7%
15
4. APPOINTMENTS
a) How do you rate ease of booking an appointment?
G = 336
S = 125
U = 7
S/R
(Year 2)
71.7%
26.8%
1.5%
98.5%
(Year 1)
66.2%
29%
4.6%
95.2%
b) How do you rate the range of appointment times?
G = 280
S = 172
U = 17
S/R
59.4%
36.7%
3.7%
96.1%
52.3%
44.2%
3.3%
96.5%
c) How easy is it to change/cancel an appointment?
G = 380
S = 87
U = 2
S/R
81%
18.6%
0.4%
99.6%
70.5%
28.4%
1%
98.9%
16
ANNEXE 5.1
POSITIVE COMMENTS; YEAR 2
(2011 figures in parenthesis)
STAFF
helpful/friendly/welcoming
caring/attentive
shared professionalism
PATIENTS
60 (29)
24 (11)
12 (6)
Additional
whole team work together for good of
patients
access to all staff excellent
all excellent in dealing with children
4 (-)
13 (-)
2 (-)
APPOINTMENTS
always able to get an appointment
always able to fit in children
Additional
good at finding late/early appointments
43 (2.5)
10 (8)
2 (-)
PRESCRIPTION SERVICE
easy to use/efficient
9 (8)
Additional
website handy/easy to use
use of box at Clifton Court – good
6 (-)
4 (-)
ENVORONMENT
clean/comfortable/good seating
good variety of reading matter
good waiting environment for children
(eg. toys and books)
OVERALL
all aspect of surgery very good/excellent
Additional
flu clinic very efficiently run
23 (21)
5 (5)
75 (49)
5 (-)
17
CLINICAL STAFF
Doctors
sympathetic/knowledgeable
good communication (ringing
back/giving advice)
very patient with children
very patient with the elderly
give patients time/don’t rush them
“excellent”
Nurses
friendly/helpful/polite
put patients at ease
available to give advice
“excellent”
PATIENTS
26 (23)
18
14
12
14
35
(10)
(8)
(13)
(12)
(17)
24
8
5
17
(11)
(5)
(3)
(14)
Additional
nurse surgeries/times very good
5 (-)
RECEPTION STAFF
polite/welcoming/friendly/
helpful
good communication
“excellent”
81 (73)
11 (5)
39 (14)
ANNEXE 5.2
RESIDENTIAL HOMES
The four residential homes were visited by members of the P.P.G. (see Annexe 3.1)
The comments given by the Senior Care Workers follow;General Comments:- can always get an appointment for residents/visit from a doctor
- easy to order/collect prescriptions
- excellent at giving advice on the phone
- quick response in emergencies
- staff easy to talk to/sympathetic
- nurses helpful and understanding
- whole team flexible in approach to residential care patients
Direct quotes:Westland’s, “excellent all round, staff brilliant, don’t change”!
St Joseph’s Convent, “best GP’s ever, wish this was my surgery, you don’t know
how lucky your are”
Bay House, “the whole team are amazing, brilliant”
Broomfield, “can’t fault them, they are an amazing bunch of people”
18
ANNEXE 6
CONSTRUCTIVE CRITICISM; YEAR 2
SUGGESTED ACTION POINTS
COMMENTS
Number of
patients year 1
Number of
patients
year 2
POSSIBLE
ACTION
Appointments
Kept waiting too long
in surgery.
Need to open outside
office hours.
9
6
* Explain
dilemma in
revised handbook.
Ask doctors to
keep balance
between patients
where possible.
12
17
*Already doing
this on Mondays
and Saturdays,
again publish this
more clearly
8
6
*Already covered
in handbook,
patients are able
to book with their
own doctor or a
specialism.
4
3
*Bring to
Receptionists
attention. Do
patients need an
emergency
appointment?
(Not a widespread problem).
4
2
Want to see their ‘own’
doctor.
Insufficient
appointments on the
day.
Appointments too far
in future.
Difficult to get
appointment with
nurse.
0
3
*As above.
*During data
collection one
nurse was ill and
off work. Again
bring to nurse’s
attention
19
Number of
patients year 2
POSSIBLE
ACTION
0
1
*Upgrade systems
and report in new
handbook?
0
3
*No action.
21
11
Short term
*Increase size and
prominence of
notice advising on
possibility of
greater privacy.
*Advise
Receptionist that
this is seen as a
difficult problem.
Long term
*Small capital
works to re-design
reception.
2
3
*No action
possible.
Background music
annoying.
1
1
*Noted.
Better seating for the
elderly.
2
4
*Chairs on order
– chase supplier.
PRESCRIPTIONS
Fax machine does not
work.
0
1
*Blip – fax
machine is
working.
Prescriptions go
missing.
0
3
Mix-up between
surgery and Cox and
Robinson.
0
3
COMMENTS
Introduce web-based
appointments.
Phone engaged.
CONFIDENTIALITY
Lack of privacy at
reception desk.
SURGERY
FACILITIES
Insufficient parking
Number of
patients year 1
*Discussion with
Cox and Robinson
on improvement
to current
arrangement.
20
Unaware of ability to
order repeat
prescriptions on
website.
0
3
*This is possible
already, greater
emphasis in
handbook.
Unable to order repeat
prescriptions by
telephone.
0
4
Is website secure.
0
1
0
1
0
2
*Fence now
repaired.
0
1
*No action
needed.
1
3
Website crashed.
*Practice policy,
therefore no
change as safety
may be
compromised.
*Website is
secure, perhaps
re-check
quarterly.
*Blip – website
running.
GENERAL
Fence around garden
area broken.
Get rid of flower beds
to allow more parking.
Elderly patients need
more home visits.
*Bring to the
attention of the
nurse for the
elderly.
21