Holborn Medical Centre
Patient Reference Group
Meeting Minutes
Thursday 6th March 6pm
In attendance: Dr Alex Moghissi, Natalie Cooley, Abjal Afrus, Michael Poutney, Ralph Wong
1. Introductions
Introductions from all in attendance. AM discussed the history of HMC, the reasons for this
meeting and why we are establishing a PRG. We are aiming to ensure that we have patient
feedback in order to make improvements that patients want.
2. Review of key findings and most positive/ least positive responses
Compared to previous years scores using the IPQ all of our scores had increased asides from
waiting time, in which we decreased by a few points.
When our survey results were compared to national results of all participating practices we
found that we did not reach the average benchmarks for any marker.
When compared to other practices of a similar size we were lower than all benchmarks
except for telephone access, in which we were slightly over. The markers in which we had
the most difference were comfort of waiting room, waiting time, see practitioner within 48
hours and seeing practitioner of choice.
These comparisons were seen to be of limited use. Since this meeting NC has contacted the
company running the IPQ for statistics for other Central London practices of a similar size.
The response is as follows:
“Dear Ms Cooley
Thank you for your email.
I can fully understand your patient group members interest in this type of information. However,
looking at our database we do not have sufficient recent data from this specific survey in the WC1
postcode area to make such data meaningful. The concern I have that if you extend this postcode
area to include other areas of London, this too may not be helpful as the socio economics between
different areas would vary and are known to play a part in the type of feedback received and
therefore probably not make the information representative of your particular location.
Although the benchmarks provided in your report encompass practices in a wide range of locations
with varying socio demographic characteristics, they will give you an idea of how other practices are
performing and the spread of scores achieved. We must stress though that all benchmark data is for
general guidance only and may not be representative of any practices particular situation.
With kind regards
CFEP UK Surveys Reports Team”
3. Main priorities
As a practice we felt that our main priorities should be seeing a practitioner within 48 hours,
seeing practitioner of choice and waiting time. In addition to this the patients in attendance
felt that confidentiality in the reception area was also an area in need of improvement.
4. Action Plan
a. See practitioner within 48 hours
Access was discussed at great length. Future plans could be to change opening hours but
this may have a large financial implication on the surgery, which is not currently viable. This
could potentially include opening on a Saturday/ starting surgeries earlier/ or having a
locum doctor on a Thursday afternoon.
Thursday afternoon sessions are vital for our staff as they are used for training purposes in
which clinicians are able to discuss patients’ complex needs and new clinical guidelines. Up
to date training can also be implemented. These sessions are essential and are of great help
to the staff, as we are a training practice.
Recently, during the survey period we chose to reassess the way appointments were made,
especially those, which are deemed urgent by offering the option of a face-to-face review or
telephone review. Whilst reassessing we chose to revamp the entire way patients calls are
handled on our clinical system, and how those who need immediate attention are managed.
Our previous system had one telephone triage doctor at a time, with this doctor changing
regularly throughout the opening hours each day. This meant that a doctor carrying out
telephone triage during lunchtime (1pm-3pm slot) was trying to balance their own morning
and afternoon clinics as well as assessing patients through phone calls, and then try and
squeeze urgent patients in any free slots on any available doctors surgery.
Our new system has two duty doctors a day. These doctors have specific sub-sections of
their surgeries for telephone triage and face-to-face appointments. Therefore urgent phone
calls (or patients who simply want telephone advice) are responded to as soon as possible,
and patients who need to be seen (or prefer to be seen face-to-face) are seen on the same
day.
There are also ‘book on the day’ appointments with other GPs, and patients are triaged
directly into these face-to-face appointments with GPs by the reception team. The reception
team have easy access to discuss a case with the duty doctor such that, where there is any
doubt as to the urgency of a patient’s problem, the GP can either telephone that patient
back urgently or they can be booked in for an urgent (on the day) face to face appointment.
This new system has opened up a large amount of clinic time, where urgent patients are
seen sooner and are assessed over the phone in a more immediate manner. We hope that
over time this new system will be much favourable to patients, as there should not be a long
waiting time for immediate problems.
We also have embargoed appointments (blocked deliberately for a purpose), which are
freed 48 hours in advance, available to be booked by patients. However these appointments
do go very quickly. We have recruited more GPs such that we can offer even more 48hr and
advanced appointments.
Furthermore, considering feedback we have very recently introduced online access via our
practice website, such that patients can book appointments online, once they register with
the online tool.
For routine problems we have bookable appointments up to one month ahead. Due to the
large practice population these can sometimes get booked up quite far in advance,
regardless of how many doctors have surgeries available.
b. See practitioner of choice
It makes good sense to see the same clinician if you are having on-going treatment for a
chronic medical condition and continuity of care is key to patient satisfaction. Although, in
an ideal world patients would always see the same doctor all the time, it is not always
possible, especially if a patient needs to be seen on an urgent basis. However, we do try and
offer ‘book on the day’ face-to-face slots with all our GPs every day for urgent problems.
We must also be more pro-active at informing our patients that we are a GP training
practice and often our GP registrars (trainee GPs) move on after they complete their
obligatory 1-year training. We include this information in our newsletter. We managed
however to retain the services of our popular GP Registrar Dr Eleana Bibb (currently on
sabbatical), who will re-join us in May 2014.
Patients in attendance felt that email updates to our mailing list on our website would be
helpful. This could include advising patients when a specific doctor is leaving or if a new
doctor is to join the surgery, details of changing policies and systems such as our reception
triage. This would allow patients to understand why continuity of care is sometimes difficult
in large surgeries in central London, especially in training practices. This would also allow
patients who do not attend regularly (and therefore would not see the practice newsletter
that is available on the premises) to stay engaged with their GP services. These email
updates will be advertised within the surgery and on the website.
We also discussed ensuring more patients have access, particularly those who are elderly
and do not use the internet. A suggestion was that if elderly patients or patients who do not
have English as a first language can ask family members to sign up to the email updates on
behalf of them so that they can also share information. Alternatively we could post hard
copies of the newsletter to all who are over 75.
c. Waiting time
When doctors overrun it is generally because their patients have needed more time, have
been late or do not have adequate translation service to hand. We try to accommodate
people who do not speak English, by offering a translation service and double
appointments. When the new Registrars start they also have longer appointments too - so
they can familiarise themselves with the patients' needs. We understand it can be
frustrating expecting the patients to attend on time and then have to wait in the waiting
room for long periods.
Dr Moghissi highlighted that specific doctors at this surgery, himself included, are very
patient centred during appointments, and therefore appointments may run longer than
planned. Boundaries may be an issue here where doctors should say ‘we should stop now’
rather than continue on longer than the specified appointment length, as this then makes
any following patients late for their appointments.
This becomes a bigger problem when patients turn up late for their appointments,
especially if they feel that their doctor may be running late. If the doctor is running on time
and a patient is late but is still seen then this also makes all other appointments run late.
Our policy in regards to patients who are delayed for their appointments is as follows: If a
patient arrives within their 10 minute slot then they can still be seen. If they are any later
than this they should wait until a gap or until the end of the surgery.
Often patients come in with several problems and GPs have their agendas too in terms of
chronic disease management, health promotion and screening for chronic disease.
We try to ask patients the nature of the reason(s) they would like to see a GP/Nurse/HCA in
order to book appropriate appointment lengths to cover their needs. We appreciate that
this sometimes feels intrusive but it is done in the patients best interest to ensure that we
book appropriately.
We will continue to offer double appointments for patients that simply require more time
thus reducing the waiting time for others in the waiting room.
We will also remind patients to attend their appointments on time e.g. via text reminders
and appointment cards to ensure the clinician can see the patient on time, as it can be very
difficult to ‘catch up’ if a patient arrives late.
d. Privacy in the reception area
Patients in attendance also discussed the issue of privacy in the reception area. This has
always been an issue due to the way the layout of the building is. Suggestions to improve
this would be to have a screen across the seated area of the waiting room to separate the
reception desk. Another idea would be to have a ‘confidentiality hatch’ to ensure that other
patients cannot hear what is being spoken about.
Since the PRG meeting this has been discussed with the deputy practice manager, who will
be looking into this to try and implement this idea.
Patients would also like to give their input on design changes within the building.
Patients have also found that reception staff have not always given patients their full
attention at the reception desk. AM and NC reiterated that reception staff do not fulfil other
duties whilst patients are at the desk. The reception staff are been trained to acknowledge a
patient’s presence and apologising if they are in the middle of finishing a previous task.
5. AOB
In October Dr Moghissi stated that there may be changes where patients can register to
doctors near to where they work. If this is the case then many staff members from Great
Ormond Street Hospital may wish to become a patient at Holborn Medical Centre. Dr
Moghissi reassured that there would still be control of the list size.