PELTON AND FELLROSE MEDICAL GROUP
PATIENT REFERENCE GROUP MEETING
THURSDAY 17 SEPTEMBER 2015
MINUTES
Present:
JM
MC
DB
WE
SH
DC
TH
YF
SS
BH
AT
CL
CR
BJH
DW
Apologies:
ID
ST
BS
Friends and Family Test – Feedback
CR discussed how the practice has a contractual requirement to undertake the NHS Friends and
Family test. This allows patients to give their feedback on their experience of visiting the surgery.
The information gathered is then forwarded to NHS England on a monthly basis who then rate the
practice. The information is recorded and sent to NHS England through the CQRS website. The
results are also published on the practice website. It was stressed how the Friends and Family Test
was contractual and, therefore, the surgery cannot opt out.
“How likely are you to recommend our GP practice to friends and family if they needed similar
care or treatment?”
The Lavender Centre received 36 responses from 1 June 2015 – 31 August 2015
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11 Extremely likely
3 Likely
4 Neither likely or unlikely
3 Unlikely
8 Extremely unlikely
7 Don’t know
Fellrose Surgery received 23 responses from 1 June 2015 – 31 August 2015
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17 Extremely likely
6 Likely
0 Neither likely or unlikely
0 Unlikely
0 Extremely unlikely
0 Don’t know
“If you could change one thing about your care or treatment to improve your experience, what
would it be?
Comments from patients included:
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Friendly and helpful staff
Appointment on same day and got seen straight away
Doctors are good but you wait ages
Waiting time for appointment
Attentive and caring GPs who genuine want to improve the care of their patients
Wait too long for a GP appointment
Need a self-check in
More appointments
More private reception
Inability to see GP when needed, can you find people who do fail to attend?
Change appointment times – more late night appointments
It was discussed how the practice encourages patients to use the elephant kiosks. However, it was
noted that less patients appear to leaving feedback. It was agreed that this was potentially because
patients feel hassled to give their feedback each time they visit the surgery (it was discussed how
patients are asked to fill in a patient experience questionnaire when they have had minor surgery
etc.), that patients have difficulty using the kiosks or that it is not advertised adequately.
The following was discussed to try and improve the number of patients using the kiosks:
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Review the questions asked - It was discussed how patients seemed to be leaving comments
on the surgery rather than improvements which they would like to see be made.
Moving the kiosks – It was queried whether the kiosks could be moved to a new location in
the surgery where more patients may see it. It was, however, discussed how the kiosks need
access to wireless and, therefore, are unable to be moved.
Receptionists to encourage patients to use the kiosks and assist them in using the kiosks –
This is going to be trialled by the practice.
Advertise the kiosks – It was suggested that posters be displayed within the surgery to
encourage patients to use the kiosks. It was discussed how patients can fill in a post card
with their comments if they prefer rather than use the kiosks and it was agreed that this
could also be advertised. It was agreed that patients should also be informed that they can
give feedback via a link on the practice website.
Comments on NHS Choices
It was discussed how patients can also leave feedback on the surgery through the NHS Choices
website. Each surgery is given a star rating. Pelton and Fellrose Medical Group was initially at a
rating of one star but is currently at three and a half stars after publicising and encouraging patients
to leave their comments. A response is sent to all patients who leave comments on NHS Choices. It
was discussed how negative comments are looked in to but that it is sometimes difficult to follow up
as patients do not have to post their name when leaving a comment.
Two of the more negative comments on NHS Choices were discussed:
“I had an appointment and was waiting over 30 minutes before I then approached the receptionist
who only then told me they were running late... surely they could have told me this when I
arrived. Then 2 days later my 6 week old son was poorly and could hardly breath... I phoned the
surgery who told me they would triage the doctor and phone me back... I was phoned by
receptionist to bring him in for an emergency appointment... again got there.. surgery was full...
other people again complaining of waiting times.. I sat for 40 minutes before I approached the
reception to ask about waiting times.. again they told me the doctor was very busy and running
late.. again I was never told this on arrival..... what was the point in phoning me and telling me to
bring my 6 week old baby in straight away to see the doctor on an emergency appointment when
you allready know they wont see him for well over an n hour +. Very angry. Terrible service.
Would not recommend to anyone.”
“Weeks to wait for an appointment, they don't read secondary care letters, the current practice
management is out of their depth, and is always there to pull the abuse card to dismiss justifiably
angry patients 35 minutes to answer a phone on a good day. They promise 48 hour delivery on
prescriptions.......................................Best to order them a fortnight. earlier. End of life pathways
are abysmal at best, inhuman at worst”
It was discussed how, with regards to the first comment, that it is difficult for reception staff to
comment on how long patients will have to wait although it was acknowledged that patients should
be informed if the clinician is running late when they attend for their appointment and CL explained
that training had been done with reception staff with regards to communication during the
practice’s monthly PLT sessions. Complaints are also discussed during these training sessions to
discuss improvements for the future. It was agreed that when patients attend for emergency
appointments, it is difficult to know how many other emergency appointments are going to be
added to the Doctor’s screen and how long each appointment will take.
It was queried how long the comments stay on the NHS Choices website as there are comments
dating back from 2012.
North Durham Patient Reference Group
MC explained that she had applied to be a member of the group but decided against this as the
information she had received was confusing. CL queried with the group if they would be interested
in somebody from the North Durham Patient Reference Group to come to the next Patient
Reference Group Meeting to give a talk. The North Durham Patient Reference Group deals with
wider issues with regards to North Durham CCG (including ambulance issues etc.). The group were
interested in this going ahead and the necessary arrangements will be made for the next Patient
Reference Group Meeting in January.
Difficult Patients
AT explained that over the summer time, the practice has had a bad spell with difficult patients. This
involved patients who are abusing prescription drugs and requesting more, resulting in a lot of abuse
to the GPs and other members of the practice staff. There was an incident with one particularly
abusive patient which resulted in the police being called and AT running around an hour behind in
her surgery. It was discussed how the Community Drug and Alcohol Service has relocated from
Chester-le-Street and that now patients are required to be seen either in Durham or in Consett and
this may account for the increase in number of difficult patients as this is out of the way for a lot of
the practice’s patients.
AT explained that to help deal with these problems, new patients are put on a patient contract. They
will then have to sign weekly for their prescription at the chemist. It is stressed to these patients that
they will not get their medication early under any circumstances.
AT also discussed how there has been an increase in burglaries to homes of patients who have big
supplies of medication (e.g. Codeine) and, therefore, patients may find that their prescription be
amended to smaller amounts of tablets in order to protect these patients.
It was discussed how there are panic alarms in the consulting rooms but that it is still alarming for
GPs and other practice staff, as well as other patients. If the police have to be called to an incident or
if a patient is violent, the patient can be removed from the practice list immediately. If the patient is
verbally abuse, the patient is sent a zero tolerance letter informing them that if their behaviour is
repeated that they will be removed from the practice list. AT did explain, however, that if a patient
complains to an organisation regarding this, that we can be sent a letter requesting we accept them
back as a patient. Alerts are also put on patient records if a patient is potentially violent and some
patients can only been seen by a GP with a chaperone present.
It was queried whether the reception area could be adapted to make it safer for reception staff. AT
explained that it has been well researched and documented that having an open reception area has
proved to be the safest for reception staff. This makes it easier for staff to vacate the area if needed.
She also explained that glass screens could actually make the reception area less safe.
Chester-Le-Street Health
CL explained that practices within the Chester-le-Street constituency are coming together to form a
federation. This federation includes, alongside Pelton and Fellrose Medical Group, Bridgend Surgery,
Sacriston Surgery, Middle Chare Surgery, Great Lumley Surgery and Cestria Health Centre. As part of
NHS England’s five year plan, federations have been put in place with the aim of working better and
offering better patient care.
CL explained that the first service that the federation is working towards is winter pressure clinics.
This is a service which will run Saturday and Sundays from 8 am until 6 pm. Instead of working as a
lone practice, the service is run by the federation and based at Cestria Health Centre. The main aim
of this service is to identify vulnerable patients who will then be looked after by a GP over the
weekend period. This is to avoid unnecessary visits to A&E. On a Thursday afternoon, the GPs will
provide a list of any vulnerable patients who may need to be visited over the weekend. The GP will
then visit these patients at home over the weekend period. This service is due to start in October but
CL explained that once the practice knows more, this will be posted on the practice website and
publicised within the practice. DC queried whether patients could be emailed with the details and
the practice is going to look in to the practicalities of this.
CL explained that the winter pressure clinics are being trialled by North Durham CCG. Winter
pressure clinics were in place last year but when reviewed, it was found that the only benefit this
achieved was that patients who worked during the week were able to be seen on a weekend. It had
not reduced pressure on the A&E department which was the overall aim. It was also discussed how
an audit for people who attended A&E found that patients felt they would be seen quicker in A&E
rather than their GP surgery which is untrue.
CL also explained that more services will follow from the federation.
Patient Information Leaflet
BJH handed the group an updated patient information leaflet. It was discussed how the leaflet would
be beneficial but that it is difficult to continually keep it up to date. The group provided positive
feedback on the leaflet.
Online Services – Update
CR explained that 12.3% (855 patients) from the Lavender Centre and 14% (257 patients) from
Fellrose Surgery are now registered for online services. The amount of online appointments being
offered is being changed according to how many patients are registered. Patients can use online
services to book GP appointments, order repeat prescriptions and view their allergies and
medications. CR explained that by the end of March 2016, patients will also be able to view their
read code entries (medical conditions) from their records. Positive feedback was received from the
group regarding the online services. It was queried whether patients receive an email reminder for
an appointment. It was discussed how patients would not but that if they have a mobile number on
the system, the practice will send an SMS reminder.
BH expressed concern that patients had to re-register with the new online system when they had
used the previous online services. CL explained that, unfortunately, this was outside of the practice’s
control and due to information governance, this has to be done. It was agreed, however, that this
needs to be explained to patients.
Proposed Changes to the Appointment System
DW explained that in July there had been 323 appointments at the surgery which patients did not
attend. There were also 187 appointments in August and 121 in September which were also not
attended. He discussed how 46 % of these appointments were booked more than two weeks in
advance of their appointment and that 274 appointments which were not attended from April 2015
were booked three weeks in advance.
DW discussed how he and CL had visited Stanley Medical Centre to see how their appointment
system was working.
DW explained that presently there are 53 pre-bookable slots for a GP during a week with 10 slots
which are opened 48 hours before the appointment. The proposed new system would involve a GP
having 25 pre-bookable appointments with 30 appointments which would open the week before the
appointments. If a GP advises a patient that they require a review appointment, there will be slots
available for this but can only be used with the authorisation of the GP. Rotas will be added three
weeks in advance.
JM queried what would happen if a patient needs an appointment for a specific week for work
reasons etc. AT explained that the practice would not be able to make any exceptions but that
appointments are pre-bookable three weeks in advance.
If a patient needs to be seen as an emergency on that day, the receptionist will take the details of
why the patient needs to be seen and add their name to a screen for the GP on Call or the Nurse
Practitioner to work through contacting by telephoning. They will then decide whether the patient
needs to come to the surgery to be seen. AT explained that currently for Nurse Practitioner
appointments, they do not get screened and patients are using these appointments for conditions
which are not medical urgent for that day. This new system will mean that only patients that need to
be seen that day come to the surgery and that any problems that can be dealt with by a telephone
consultation are done this way. The aim is to avoid wasting appointments and reduce pressure on
emergency clinics.
The new system is going to be trialled from November. The last two weeks in October will be open
surgery so that the new system can be started in November. At the next patient reference group,
feedback can be given on how patients feel the system is working.
Any Other Business
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DNAs
It was queried whether patients can be removed from the practice if they do not attend
appointments. CL explained that the practice is unable to do this as it would be a breach of
contract.
Confidentiality
CL clarified with the group that receptionists have signed a confidentiality agreement, the
same as the GPs.
Jayex Board
There was concern raised that the jayex board is not presenting all of the information and
that certain words are being missed off sentences and that the number of DNAd
appointments has not been updated. It was also felt that the information changes too
quickly so patients do not have time to read. The practice is going to look in to improving
this.
Fundraising
BH explained that he had done some research in to setting up an association/charity for
fundraising for the practice, initially for a self-check in machine. He explained that this would
involve setting up a committee with a chair, treasurer, secretary and member of the
practice. BH has had a meeting with CR and CL. The practice is going to provide a list of what
they would find helpful and will feedback. BH was thanked for his hard work in researching
this.
Areas of Concern/Petitions
JM queried whether there were any areas of concern or petitions to the practice needed
assistance with. CL explained that at present there were not but that she would inform the
group in meetings if she feels there is anything to report.
Meetings
DC explained that there is a meeting coming up at Durham Town Hall. He has passed the
details to CL so that she can circulate these to the rest of the group.
Feedback
MC commented that she felt the practice had improved dramatically over the past two to
three years.
Next Patient Reference Group Meeting – Thursday 21 January 2016