PARKHALL SURGERY
Patient Participation Report 2013/14
5.
1.
Our Patient Participation Group
1.2 If this is not your PRG’s first year, is the PRG still representative of the practice population? If
there are underrepresented groups, how does the practice try to engage with them?
We have two patient groups: a virtual group and a patient participation group that meets on a
monthly basis.
Virtual Patient Group – we have continued to advertise this in an attempt to increase numbers and
this year we are up to 122 patients (compared to 99 last year). As well as having information on our
website and posters in the surgery, we have included a sign-up form and information sheet in all the
new patient packs. We felt that this was the best way to encourage a range of patients to participate.
We have seen an increase in patients from different ethnic backgrounds and in the age range 17-34
years compared to last year (see breakdown of practice and both patient groups at Appendix A)
PPG – either the Practice Manager or a Partner attends the monthly patient group meetings. The
group has continued to promote itself at community events such as the carnival and they distribute
leaflets and sign up forms for both patient groups. In January the PPG arranged a health education
event focused on diabetes. Through this they managed to gain a new member to the group.
By increasing the number of males, patients in the younger age categories and those from ethnic
minorities we believe that the virtual patient group is representative of the practice population. Our
new approach of including information in new patient packs has helped us to reach a wider range of
patients including those that do not visit the surgery as often. By also including the information on our
website, patients that are working during the day or do not visit the surgery as frequently, can still sign
up for the group. In this way we have tried to ensure that all groups of patients are included.
Component 2. Method and Process for Agreeing Priorities for the Local Practice Survey
2.1 How were the views of the PRG sought to identify the priority areas for the survey questions i.e a
meeting, via email, website etc?
At the PPG meeting on 5th December 2013, the Practice Manager asked the group for suggested topics
for a patient survey. These included A&E costs and attendances, referral management, services
provided by the practice and medication prescribing. The main theme was the reduction in money in
the NHS and how to ensure funds are used efficiently.
It was agreed that the first draft of a survey included too many topics and could be quite confusing for
patients. As there is currently quite a lot of work around prescribing savings and ‘switching’ patient’s
medication it was agreed that this would be the main priority. A draft survey was emailed round to
the PPG and agreed at the January meeting (9.1.14).
2.2 How have the priorities identified been included in the survey?
The main topic of the survey was ‘medication prescribing’ as the Practice and PPG wanted to get an
idea of how patients feel about various ‘switches’.
Once a month the practice closes for an afternoon to attend HCP meetings / training. Although these
are publicised on the website and in the surgery, the practice had received some feedback from a
patient suggesting that more should be done to advertise the closures. It was agreed that there would
be a question regarding this towards the end of the survey.
Having recently arranged a health education evening the PPG are keen to organise more. Therefore
the final question in the survey asked for patient’s to suggest topics for future events.
Step 3. Details and Results of the Local Practice Survey
3.1 Was a survey carried out between 01.04.13 and 31.03.14?
The survey was carried out in February 2014 over a period of approximately 3 weeks.
3.2 What method(s) were used to enable patients to take part in the survey (i.e survey monkey, paper
survey, email, website link) and why?
All patients in the virtual group (PPG members are included in this group) were sent an email asking
them to take part in the survey. A link to the Practice website was included in the email
(www.parkhallsurgery.co.uk) along with instructions on how to find the survey. Our website
automatically collates and analyses the results into a report.
We also put up posters in the Practice advertising that the survey was taking place on the website.
3.3 Was the survey credible (was the response rate sufficient to provide ‘the reasonable person’ with
confidence that the reported outcomes are valid)?
43 patients completed the survey. We were slightly disappointed that more people didn’t fill it in but
as we had emailed the whole group and advertised the survey in the Practice we felt that we had done
all we could to encourage participation. The recent GP patient survey only had a response rate of 75
patients and that is a survey organised on a national level. Therefore we feel that our survey is
credible on a local level. We also discussed the results with the PPG and they felt that the results were
valid.
3.4 Please provide a copy of the survey and the analysis of the results of the survey.
See below
Parkhall Surgery
Getting the Best Out of the NHS on a Budget
MEDICATION PRESCRIBING
Financial constraints on the NHS are influencing medication prescribing. Every Practice is
advised to stick to the Cambridgeshire approved formulary (drug list). These drugs have
been approved by the Cambridgeshire and Peterborough Clinical Commissioning Group
(CCG) as being the most cost effective options available.
The cost of individual medicines can vary greatly depending on a variety of factors including
who they are made by and the ingredients.
GP practices are given a set allocation of money to cover the costs of the medication their
patients require, this is called the ‘prescribing budget’. Practices are tasked with staying
within this budget and in order to do this it is sometimes necessary to ‘switch’ a patient’s
medication to an alternative, but equally effective preparation. The Doctors consider all
these switches very carefully to ensure that patient care is optimised. These switches could
happen in a number of ways and we would like to ask your opinion on them.
1) Would you be happy for your medication to be ‘switched’ to another form e.g.
tablets instead of capsules?
Yes 67%
No 30%
No response 3%
2) Would you be happy for your medication to be ‘switched’ to an identical
product containing the same ingredients but with a different name /
manufacturer?
Yes 76%
No 20%
No response 4%
3) Would you be happy for your medication to be ‘switched’ to a similar product
within the same group of drugs, but with different ingredients or dose? The drug
would work in the same way and be as effective.
Yes 46%
No 48%
No response 6%
4) In general, if your medication was ‘switched’ how would you prefer to be
informed?
By letter 18%
Note on prescription 25%
At an appointment with the Doctor 44%
Not necessary to inform me 4%
Other, please comment below 6%
Comments:
A very relevant list of questions above as my latest prescription had a change to one of my pills
Metformin), totally different shape, larger and not so easy to swallow.
--email or text
--email would be preferred or at represcription time.
--I think it is essential to have a conversation with a doctor about this. It is not acceptable to just receive a
letter or note on a prescription. People need reassurance that their medication will remain as effective.
--I worry about the more senior patients who can get easily confused by repeated changes in packaging.
One prescription gives tablets with a calendar pack to enable you to see if you have taken your daily dose,
the next prescription does not have the calendar pack making it more difficult to check if tablets have
been taken. I know from experience that some manufacturers while selling the "same" drug, can use
differing ingredients which may not be suitable for some patients.
--Just to be told by the Doctor, in a two minute chat, when, what and why.
--or a call from the surgery
--or email
--This already happens as my tablets already vary between manufactures on a monthly basis and have
done for a long time, so I do not see the point of this survey
--
5) How do you usually order your repeat prescriptions?
By telephone 16%
Online via the website 60%
Complete the paper slip attached to the prescription 18%
Do not have repeat medication 4%
Our telephone system has changed and patients are now able to speak to a dispenser
directly between the hours of 9.30 am and 5.00 pm. The telephone number remains the
same (01487 740888) but there is a recorded message and two options. By listening to the
message and pressing option 2 you will go through to dispensary. If the line is busy you will
be redirected to the reception team who can take a message or try again for you.
6) As a member of the local commissioning group Hunts Care Partners, we have to
attend monthly meetings and training sessions. This means that the practice will
be closed for the afternoon on a number of dates in 2014/2015 (further details
available on our website). What do you think is / are the best method/s for
making patients aware of these closures?
Posters in the surgery 58%
On the Practice Website 46%
Notice attached to repeat prescription 67%
Other, please comment below 16%
Comments:
Also by letter
--Answer phone message
--email
--e-mail
--email and recorded option message on telephone
--Email or text
--Hunts Post Town Crier Somersham Voices Facebook Twitter
--Ideally by email for those patients whose addresses are registered with the practice.
--Just be advised when making an appointment, that it will need to take place the following day. As and
when. No need to spend time/money on mass information to the world. It will only affect those patients
who happen to choose the specific day when the Practice is closed. Ie a couple of dozen people maximum.
--Letter
--Notice as indicated above would in my case be more appropriate as we live out of the village in the Fen
and have to drive to the surgery. A couple of weeks ago I did drive to the surgery only to find it was
closed that day/afternoon for training. Whilst that is not a huge inconvenience, a note of regular
prescriptions would be good.
--Perhqps one doctor could remain in the surgery. This could be done on rotation. Then the surgery needn't
close.
Our Patient Participation Group (PPG) recently arranged their first health
information evening ‘Preventing and Managing Diabetes’.
If you have any suggestions for future topics please comment below.
Choice /Availability of voluntary services / groups within the Surgeries service area - Dementia Awareness
- Support for Carers: what services are available
--A well man clinic for men oer 50 as men do not like talking about illness that may affect them from this
age and onwards ie prostrate cancer and diabetes
--Arthritis management including diet,
--Avoiding heart attacks and symptom recognition Gout- causes and control Sciatic pain control
Supplements- are they useful? What is a balanced diet? Managing arthritis
---
Bowel Cancer Screening
--Dementia care
--Did intend coming to support, but apologies I didn't get there in the end !!
--Discharge Planning Managing Respiratory Disease Carer support with eg Carers Trust or rethink Mental
illness If you believe care isn't right how can you get something done about it? Understanding pressure
ulcers Events for teenagers - there is too much substance and alcohol use
--Evenings related to younger people e.g. STI's, contraception, alcohol, smoking. Importance of being
healthy and general wellbeing, Health checks for example. Self help Our PPG did a falls event for older
people. Looking at reasons for falls, prevention and helpful advice.
--Every patient to be informed, on collection, the actual cost of each of their prescribed medications. This to
increase patient-awareness of some of their costs to the NHS.
--First Aid in the Home especially if someone suffered a heart attack or stroke and signs to look for.
--HRT. Hysterectomy advice.
--It may sound obvious but telling overweight patients (all ages) - who respect and listen to doctors - they
must eat less/exercise more might get through to some. Ie in the same format as your 'preventing
diabetes' programme. Similarly, targeting those who still smoke and drink excessively, particularly the
young 18-35 age group, either rebellious in character, or brought up by irresponsible parents who still do
the same. While on the subject, discouraging the 'social use' of class C drugs - that the media glamourise
as fashionable for the young - which often leads to experimentation of class B and class A substances, and
then to dependance, could prove positive. Obesity, drug, tobacco and alcohol reductions would save the
Health Service many, many millions. Tough drink-driving laws have got the message across to the
majority. Health education along the same lines may make a difference, too.
--Managing cholesterol - I don't think most people (including me) understand good and bad cholesterol and
how to keep healthy.
Component 4. Discussing Survey Results with the Patient Reference Group (PRG)
4.1 How were the survey results discussed with the PRG and any proposed outcomes agreed?
The survey results, including comments, were emailed to the PPG at the end of February. Paper copies
of the results were made available at the PPG Annual General Meeting (AGM) on 6th March and the
findings were discussed. This was minuted by a member of the PPG. The members of the PPG that
were present agreed with the Practice Manager’s summary below:
Looking at the results it seems that:

The majority of patients (67%) are happy for their medication to be switched to another form (e.g. tablets
instead of capsules)

76% of patients are happy for their medication to be changes to an identical product containing the same
ingredients but with a different name / manufacturer.

When it comes to switching medication to a similar product within the same group of drugs but with a
different ingredient or dose the results are split almost half and half (48% said no and 46% said yes)
This suggests that any medication changes that fall within the latter category should definitely be discussed at an
appointment with the patient or at least over the telephone. For other switches a note on the prescription may be
adequate with a note to contact the Dr if there are any problems / concerns.
With regards to the monthly closure afternoons we were pleased to see that the methods we already use (posters,
website, notice on prescriptions) scored highly. We have since been attaching a list of all the dates to our repeat
prescriptions along with a notice in the front window.
Component 5. Agreeing an Action Plan with the Patient Reference Group (PRG)
5.1 What action plan was agreed and how does this relate to the survey results?
Following discussion of the survey results the action plan below was agreed. The Practice Manager
summarised the results of the survey and the group discussed the various actions that could be made
in response. The Practice Manager read back the action points to the group and all present agreed to
them.
PRACTICE SURVEY ACTION PLAN – MARCH 2014
FEEDBACK FROM SURVEY
ACTION TO BE TAKEN
Medication Prescribing
 The majority of patients (67%) are
happy for their medication to be
switched to another form (e.g. tablets
instead of capsules)


76% of patients are happy for their
medication to be changed to an
identical product containing the same
ingredients but with a different name /
manufacturer.
Medication changes that involve a similar
product within the same drug group but with
a different ingredient or dose should be
discussed with the patient at an appointment
or at least over the telephone. The group felt
that more explanation was needed for these
switches.
For other switches (different manufacturer /
form) a note on the prescription or a letter
may be adequate, with a note to contact the
Dr if there are any problems / concerns.
When it comes to switching medication
to a similar product within the same
group of drugs but with a different
ingredient or dose, the results are split
almost half and half (48% said no and
46% said yes)
Ordering repeat prescriptions - the majority
of patients that responded (60%) are using
the online ordering system.
Continue to promote online ordering of
prescriptions via the website, posters in
surgery and the practice leaflet.
Monthly closure afternoons. The methods
already employed by the Practice (posters,
website, notice on prescriptions) all scored
highly.
As well as the current methods it was agreed
that the Practice would publicise closures in
the following way:

Other suggestions were emailing or sending
letters to patients.



Attach a list of all the dates to repeat
prescriptions for a set period of time.
Possibly repeat this at ongoing
intervals
Put a poster with all the closure dates
in the front window of the Practice
Put a note on the home page of the
website on the day before a closure
Email the virtual group on the week
of a planned closure
Unfortunately the cost of sending letters to
over 4,000 patients is prohibitive, especially
for each closure. In addition we do not have
the manpower to do this.
Our current clinical system does not have the
functionality to allow us to send bulk emails
to patients. We would need to run a search
and export and then manually enter all the
emails into a distribution list. Again, we do
not have the resources to do this. Any
Health information events – various topics
suggested.
patients that join our virtual patient group are
added to an email distribution list so we can
easily email them regarding closures and will
start to do this from April when the next
closure is planned.
Also discussed how easy it is to find the
closure dates on the website. Discussed
possibility of PPG member sitting with
Practice Manager and reviewing website to
suggest ways that it could be improved /
made easier to navigate. There is a lot of
generic NHS information on the site as the
‘My Surgery’ company manage it. May be
better to remove some of this and make it
simpler and more Practice focused.
It was agreed that the Practice would work
with the PPG to develop ideas for future
events. ‘First aid at home’ was felt to be a
good topic for the next event.
5.2 How was the PRG consulted to agree the action plan and any changes?
As mentioned above, the survey results and a subsequent action plan were discussed at the AGM on
6th March 2014. The action plan was typed up and emailed to the PPG on 10 th March 2014 for
comments / suggestions. The group were given the deadline of 14th March to submit any amendments
/alterations. None were received and the action plan was finalised.
5.3 If there are any elements that were raised through the Survey that have not been agreed as part
of the action plan what was the reason for this?
See points in action plan regarding emailing / sending letters to all patients about closure afternoons.
5.4 Are any contractual changes being considered? If so please give details and confirmation that
these have been discussed with the AT.
N/A
Step 6. Publishing the Local Patient Participation Report
6.1 Are there any further actions that have occurred from the:
2011/12 Action Plan
The lines between the spaces in the car park have been repainted and are clearer now.
We have just carried out a three week trial of extending the Dispenser’s hours from 9-5pm to 9-6pm
Monday to Friday. The results are going to be discussed with the Doctors and then the wider practice
team.
2012/13 Action Plan
Receptionists are now trying to book patients in with the minor illness nurse instead of a doctor if
possible. They are also trying to ascertain the level of urgency to determine whether the appointment
could be booked for another day.
Due to changes in the NHS structure and new staff at the Practice there has not been time to run a full
appointment audit yet but this is something we still plan to do in the future.
6.3 What are the practices opening hours and how can patients access services during core hours
(8am-6.30pm)
The Practice is open between 8am and 6pm Tuesday to Friday and between 8am and 8pm on Monday.
During this time patients can access services via telephone or by visiting the Practice. The Practice
does not close for lunch. Between 6 and 6.30pm calls are diverted to Urgent Care Cambridgeshire
(UCC).
6.4 Do you provide extended hours? If so, what are the timings and details of access to Health care
Professionals during this period.
The Practice provides extended hours every Monday between 6pm and 8pm. Appointments are
available with a Doctor or Nurse between 6.30pm and 7.30pm.
7. Practice Declaration – this is only required as part of the report submitted to the AT
The Practice confirms that the above report is a true and accurate reflection of the work undertaken as
part of the Participation DES 2013/14 .
Signed and submitted to the PCT and published on the Practice website on behalf of the Practice by:
Name: Leanne Hurren………………
Surgery code: D81619
Website: www.parkhallsurgery.co.uk
Signed: LHurren
Date: 24th March 2014
APPENDX A – BREAKDOWN OF PRACTICE POPULATION & PATIENT GROUPS
Practice Population
Profile
Virtual Group
Profile
List size as of 10.3.14
4669
British/white british
4529
97%
Group size as of 10.3.14
122
British/white british
118
% of
list
16 and under
17-24
25-34
35-44
45-54
55-64
Over 65
1036
374
541
693
774
619
632
4669
22%
8%
12%
15%
17%
13%
14%
Male
Female
2318
2351
49.6%
50.4%
97%
% of
group
16 and under
17-24
25-34
35-44
45-54
55-64
Over 65
Male
Female
1
7
17
20
18
20
39
122
1%
6%
14%
16%
15%
16%
32%
39
83
32%
68%
PPG Profile
Group size as of 10.3.14
9
British/white british
9
100%
% of
group
16 and under
17-24
25-34
35-44
45-54
55-64
Over 65
0
0
0
1
2
2
4
9
0%
0%
0%
11%
22%
22%
44%
Male
Female
4
5
44%
56%
FOR AT USE ONLY
Date Report Received by the AT: _________________________________
Receipt Acknowledged by: ______________________________________
Report published and evidenced on Practice website by required deadline: ______________________________________________________________