Dr D J Sinclair & Partners
Jubilee Surgery
Patient Participation Report 2013-14
How the Patient Participation Group (PPG) has been developed
Jubilee Surgery has a current patient population of 9325. The age/sex breakdown is shown below. (Fig1)
800
600
400
Female
200
Male
0
Total practice population Fig 1
Our Patient Participation Group (PPG) is made up of a small core group of 14 individuals who meet with one
of the doctors and the practice manager every three months, and a “virtual” group of 450 patients who can
be contacted by email, text, phone or post (Fig 2) As you can see from the graph we have a higher
percentage of female patients in most age groups, they are more likely to visit the surgery for routine
screening and therefore be more aware of the issues.
We invite other members to the core group as required or when patients express an interest.
Two of our core group members are also on the Fareham & Gosport Patient Representative Locality Group
which includes members from all local practices.
60
50
40
30
Female
20
10
Male
0
PPG population Fig 2
All new patients, over the age of 16, are asked if they would like to join the virtual group, we also have
posters and leaflets in the surgery advertising the group, and information and a form on our website for
patients who may wish to take part. In addition we have mentioned the group on a recent article in the
Titchfield Parish Magazine along with other information about the surgery.
Ethnicity
Jubilee Surgery does not have a high minority ethnic (Fig 3) but we have virtual PPG members from this
group as shown in Fig 4.
6.00%
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
Practice Population
PPG Population
Total Ethnic Population Fig 3
6
4
Male
2
Female
0
African Chinese
Irish
Asian
Virtual PPG Ethnic Population Fig 4
At a meeting on 17th March 2014 the core group considered that we had good representation from all areas,
and that the current strategy for recruiting to the PPG was working.
PPG meetings were held at Jubilee Surgery on the following dates:
6th March 2013
14th May 2013
6th Aug 2013
12th Nov 2013
14th Feb 2014
With an additional meeting to discuss the findings for the report on 17th March 2014.
In August 2012 the practice had the sad loss of their practice manager Jan Bell, This role was not filled until
March 2013 and so there was no published survey or PPG report for 2012-13. However the results of survey
for 2012-13 were collated and discussed at the PPG meeting on 14th May 2013, and a poster summarising
the results displayed in the waiting room.
At this time the virtual groups had not been set up although we had received over 350 applications forms.
These were collated into 4 groups all covering a range of age and sex. The resulting groups now form our
virtual PPG. As we get more applicants they are added to the groups up to a total of 100 per group, we
anticipate that we will exceed 500 virtual members over the next year.
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Patient Surveys
We are required to carry out at least one patient survey each year, this helps to shape and improve our
services to patients, and gives our patients the opportunity to share ideas and comments. In 2012-13 the
survey was developed by the small PPG group and the practice manager. Responses were received from
90 patients, results from this were collated in 2013 and the following actions taken. The information below
was displayed in the surgery.
Jubilee Surgery – Patient Survey 2012-13
From the 2012-13 survey we have made the following changes;
Updated telephone system
PA System
Appointment changes
Toys and magazines
Text alerts
We had our existing phone system updated in
the summer 2013 to help direct your calls to
the best person to deal with your query.
There is a new PA system for the doctors to call
you in, and we have a hearing loop in reception
for those who have hearing aids.
We have made new slots available that can be
booked one week, or two weeks ahead for
routine appointments – these become available
at 8:00am and 2:00pm each day. We have also
added telephone follow up slots, 24 hour
appointments, and increased the number of
slots available to book on-line.
We have reinstated the children’s play table
and try to keep a regular supply of clean
magazines for you to read – if you have
magazines you no longer need we are always
glad to have them to replace any which are
getting worn.
We are using texts to remind patients about
appointments, or when flu vaccinations or
Blood Pressure checks are due. Please make
sure you keep us updated with changes to your
mobile phone number.
Jubilee Surgery – Patient Survey 2013-14
The practice undertakes an annual Patient Survey to monitor and improve our services. This is developed
with input from our PPG group, who decide on the areas to audit. We try not to repeat questions used in the
previous year, and include questions on both the staff and services.
The core PPG group discussed the possible questions to include at our quarterly meeting on 12 th November
2013. We had around 20 questions which had not been used in the past 2 years from which they chose 9
questions which looked at the appointments system and how it was used, the clinicians and whether the
patients felt that they were involved in their care, prescribing and the ease in obtaining repeat medication
and the overall experience when attending the practice.
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The survey was offered to patients attending the surgery for 4 weeks, some members of the PPG spent time
in the waiting room handing out survey forms and answering questions about it. There was also a notice in
the waiting room and a box for the return of completed questionnaires. We received 222 paper survey forms
from patients.
In addition the survey was posted on the internet through Survey Monkey, and the link sent to all our virtual
PPG patients and any other patients who had consented to receive emails from us. We also put the link in
our newsletter and on posters. At this time we had not completed development of our new website so were
unable to add a link to it. We received a further 187 responses to the on-line survey.
All responses for the questions were collated and discussed at the PPG meeting on 11th February. The
results are as follows:
Questions and answers
Q1. 411 patients responded
How do you usually book your appointments?
3.9%
10.5%
By telephone
Booking online
14.4%
In person at reception
79.8%
When attending a previous
appointment
Q2. 411 patients responded
Are you usually satisfied with the day and time of your appointment?
4.4%
Very satisfied
9.2%
31.9%
12.9%
Fairly satisfied
Neither satisfied or
dissatisfied
Dissatisfied
41.1%
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Very dissatisfied
Q3. 356 patients responded
Have you used any of the following - tick all that apply?
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
58.4%
31.5%
Telephone follow
up appointments
14.3%
14.0%
Early morning
appointments
(Wednesday)
Late evening
appointments
(Monday)
Telephone triage
appointment with
the nurse (Monday
or Friday morning
Q4. 409 patients responded
Do you feel that the doctors and nurses address all your
concerns?
6.1%
4.4%
32.0%
Q5. 405 patients responded
5
1.0%
56.2%
Yes, completely
Yes, probably
Not sure
Not really
Not at all
How much do the doctors and nurses you have seen involve you
in decisions about your care?
5.4%
2.5% 1.2%
39.8%
49.6%
Completely
Most of the time
Sometimes
Not much
Not at all
Q6. 406 patients responded
Do you understand what the doctor or nurse has told you?
1.5%
18.7%
Yes, completely
Yes, probably
Not sure
Not really
Not at all
75.9%
Q7. 407 patients responded
Do you feel you can ask for more information when you are
seen?
4.2% 0.7%
3.4%
Yes, completely
Yes, probably
Not sure
25.3%
Not really
64.6%
Q8. 397 patients responded
6
Not at all
Do you find it easy to get your regular medication?
3.3%
2.5%
Very easy
8.6%
Fairly easy
Neither easy or
difficult
Difficult
28.5%
55.7%
Very difficult
Q9. 407 patients responded
Overall how would you describe your experience at Jubilee
Surgery?
3.9% 1.5%
Excellent
9.3%
Fairly good
Neither good or
bad
Fairly poor
34.6%
72.5%
Very poor
Additional comments
In addition to the results of the questions, Dr Karen Postle one of the PPG members collated all the
comments from the survey for a qualitative analysis. We have used these to formulate an action plan for the
coming year. A core group from the PPG met on Monday 17th March to discuss the actions, and comment
where it may not be possible to implement change at present. Where possible we have discussed and
included expected time frames.
Once compiled the report was sent to all members of the main PPG group for review before publishing and
sending out to 100 members from the virtual group to request further comments.
The qualitative analysis is based on grouping “like with like” responses.
103 respondents did not make any comments at all.
Comments from the practice giving further information are shown in italics.
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33 patients commented positively about staff saying they were
pleased with the service.
There were 21 positive comments about GPs
5 positive comments about nurses,
6 positive comments about receptionists.
Comments about
staff
Appointment System
Action – priority for all staff:
There were 24 negative comments which dealt with specific
incidents or individuals, usually about abruptness or unhelpfulness,
which have highlighted a further need for training in customer
service for all staff.
The staff have regular training meetings and customer service is
always part of the session. All staff are reminded that patients are
often worried or feeling ill and need to be treated with compassion
and empathy. We are going to undertake further training by
July2014 with external trainers to raise awareness of this very
important issue.
There were a number of comments about the appointment system
(number of patients with this comment are in brackets):
 Lack of future appointments (11)
 Future appointments too far ahead (22)
 Difficult to get appointments when you work (32)
 Hard to get an urgent appointment (4)
 Online booking too hard to use/fails (4)
 Too many different methods to book appointments
(1)
 Want online booking (1)
 Unaware of extended hours (1)
 Didn’t like triage system (1)
 Didn’t like telling the receptionist what was wrong
(1)
This is a priority action.
From April 2014 a new system will be introduced, each day the
duty GP and a nurse will triage all requests for appointments. It is
hoped that this will help relieve the pressure on the system, and
that some patients will have their problems dealt with by a
telephone consultation. A similar system is used successfully at
other local practices.
The comments also highlighted the need to further publicise the
new appointment system, on-line booking and extended hours and
this will be done by April 2014, using newsletter, website, posters,
emails, texts and another Parish Magazine article.
Receptionists do ask for some idea of the problem for patients
needing treatment urgently, or for nurse appointments, this is to
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assist us in giving the patient the correct type of appointment.
Patients can decline this information, and will then be put through
to the clinician doing triage who will be able to give them an
appropriate appointment.
Waiting times
22 patients commented on the length of time they were waiting
for booked appointments. - GPs will where ever possible give
patients the time they need to resolve their problem and
investigate issues fully, this can lead to delays.
2 patients felt their wait was longer while the doctor had a chat
and a coffee – Doctors will sometimes take a comfort break during
their 3 1/2 hour surgery and catch up with colleagues to discuss
patients they have seen.
There were useful comments about how we could advise patients
on the likely length of wait including using the check in screen.
Action:
The practice used to add comments to the electronic check in
screen, but this had stopped working. As we now have a new
screen we will endeavour to set this up again before the end of
March 2013.
Telephone System
6 patients reported problems getting through
4 complained that they were kept waiting on the phone for a long
time – The receptionist dealing with your call will often have to get
further information which can delay her completing one call and
answering the next.
2 patients would like to see more receptionist answering the phone
and on the desk. –We currently only have 4 phone lines. In the
morning and other peak times we have three receptionists
answering the phone and one on the front desk, at present we
don’t have space to increase this – although this is something we
are considering to change in the future.
1 patient wanted a text phone system for those who are deaf or
have a speech impediment – We offer on-line booking of
appointments for those who struggle to use the telephone. We can
send text messages as reminders but do not currently have capacity
to monitor incoming text messages although this may be available
in the future.
Action:
We are still aware that the current phone system may not coping
with demand, nor meeting our requirements. We are looking at
changing to a new supplier who may be able to offer us a better
system, we expect that this will be changed during the summer
2014.
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Issues with GPs
6 patients always want to see the same GP – where possible we will
give the patient a routine appointment with the GP of their choice,
however, if it is an urgent problem we will always offer an
appointment with one of the triage nurses or GPs on the same day.
We hope that our new appointment system will make it easier to
be able to offer patients the GP of choice.
3 patients would like to have more female GPs available. – Dr
Naylor is currently our only lady GP, although Dr Nicola Wood will
re-join the practice at the beginning of August for a year. When we
have to book locum doctors we try to use females to give patients
more choice.
Action:
We will be reviewing our GP hours in 2015 and may consider
increasing our female GP sessions then.
1 patient wants to be able to see the doctor about more than one
problem. – At present most of our GP slots are 10 minutes, in some
cases they can deal with more than one acute problem, but many
chronic problems can take a long time. If the doctor feels it
necessary they will arrange for the patient to have longer
appointments.
Ordering
prescriptions
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A number of comments related to repeat prescriptions; we have
included explanations for each one.
Some patients wanted to:
1. Order and collect on the same day – We are contracted to
do repeat prescriptions in 48 hours. This is to allow time for
the prescription to be issued, checked and signed by the GP,
and to allow for any queries that may arise to be dealt with.
As we receive requests for around 200 prescriptions each
day, working through the whole process on the same day
would be impossible.
2. Order medication for 6 months at a time – the only
medication issued for 6 months at a time is the
contraceptive pill. All other medication can require
monitoring, give side effects and needs to be reviewed to
ensure that it is not being over or under used. If medication
regimes are changed issuing large quantities can lead to
costly wastage and it is everyone’s responsibility to try to
reduce waste and keep costs under control in the NHS.
3. Order by telephone – the reason that we do not accept
requests for medication over the telephone is one of patient
safety. The names of many medications sound the same,
but are used to treat very different conditions. If the wrong
medication was requested and issued it could lead to
serious health problems. In addition patients often ask for
their heart pills or yellow capsules – the prescribing clerks
who prepare the prescriptions for the GPs to sign do not
possess the clinical knowledge to identify the correct
medication described by patients . Asking for the request in
writing or on-line helps prevent mis-prescribing and gives an
audit trail if there are any queries following the request.
There were also some very positive comments:
1. It is very good to be able to collect the medication from the
local chemists.
2. Ordering on-line is easy and convenient
Action:
We need to publicise the on-line prescriptions more widely as
some patients were unaware of the ability to order this way, this is
on the website, and publicised in practice, but will be added to the
repeat slip on prescriptions, the newsletter and mentioned again in
our next Parish Magazine article – May 2014
There were a number of comments on the environment of the
surgery.
1. 4 patients felt that the waiting room needed updating.
Action:
The practice has a 5 year rolling programme to update the
public areas. Since 1 Jan 2014 we have replaced the central
heating boiler and also refurbished consulting room 5. We
plan to have decorated all areas in the next 5 years.
Surgery Environment
2. 4 patients said that disabled access needs to be improved
Action:
We have installed a bell at the front of the surgery for
disabled patients who need help, and are currently looking
at options to change the entrance and reception area. This
will be a large structural undertaking which will lead to
significant disruption and so can not be undertaken without
considerable planning. It is also likely to be costly, and for
the past 12 months there has been no national funding
available for practice improvements. We are going to
review this again in 2014-15.
3. 1 patient mentioned cars sometimes park by the dropped
kerb.
This is a public thoroughfare owned by the Highways
Agency and as such the surgery is not able to impose
parking restrictions. However, people do park there to drop
of elderly patients, for deliveries etc. We also need access
here for emergencies when we may have to call an
ambulance. We do ask patients to move cars if we are
aware that they have parked there.
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4. 1 patient wanted a water dispenser.
Past experience of water dispensers in waiting rooms has
shown that there will be spills, cups left around half full of
water and that children will often press the buttons, this
leads to wet carpets and extra work for the reception staff
in clearing up. However, if patients would like water the
receptionists will always be happy to get them some.
5. 1 patient said the seats re uncomfortable.
Action:
The chairs are quite old, and we will be replacing them over
the next 5 years as part of our refurbishment programme.
We plan to obtain 3 new chairs with arms during 2014-15 to
assist patients in rising.
6. 1 patient said that the tannoy system is impersonal.
We tried a period of 6 weeks when the GPs went to the
waiting room to call patients, however, this added on
significant time to each consultation especially for Dr Naylor
whose room is furthest away. This was discussed at length
at PPG meeting last year and as a result a new tannoy was
obtained, as this was considered to be the best option.
7. 2 patients asked for music to be played, and for better or
newer magazines.
We reviewed this with the PPG last year, the practice had
tried playing music in the past but received more complaints
about it as some patients didn’t like it at all, or didn’t like
the type of music being played. We agreed at the time and
during subsequent discussions that most people who want
to listen to music will have their own personal player and
that it is better not to have it played generally.
The magazines are changed regularly; any that become
worn are removed. We are always grateful for donations of
new reading material to allow us to do this change.
There were also positive comments about the electronic check in
screen – 2 patients mentioned that they found it very easy to use.
Other Comments
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Out of Hours:
1 patient would always like to see their own GPs when they call the
Out of Hours service.
This would not be possible, our GPs do not have capacity to provide
this service 24 hours a day, and the Out of Hours service covers the
whole of the locality not just for our patients.
1 patient mentioned that they would like the out of hours GPs to
access their records.
This is possible. The practice feeds patient records to the
Hampshire Health Record, and will be sending information to the
National Summary Care Record. Locally the Out of Hours team do
have access to the local record so can see patient medications,
problems and allergies. Some patients have opted out of one or
both of these initiatives and so their data is not available to the Out
of Hours team.
Action:
We need to do more publicity around the various record sharing
initiatives, which are already shown on the website, on posters in
the surgery and mentioned in our leaflet. We will update the
information and include it in newsletters, and Parish Magazine
articles.
Health Promotion:
1 patient asked for more focus on health promotion.
We already have themed notices in the waiting room which are
changed regularly. Patients are offered blood pressure checks, and
seasonal vaccinations at every opportunity, and we have a
programme of recall for anyone missing their regular checks.
1 patient asked for specialism in older patient medicine.
In Primary Care we offer General Medical Services and as such are
unable to offer specific specialists, although we have access to
locally commissioned services which patients can be referred to.
There is further information on NHS Choices website:
For women over 60
http://www.nhs.uk/LiveWell/women60-plus/Pages/Women-60plus.aspx
For men over 60
http://www.nhs.uk/LiveWell/men60-plus/Pages/Men60-plus.aspx
This report was shared with the core Patient Participation Group, and 100 virtual patients for comment prior
to publishing.
March 2014
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