Tel: 01494 782884
Dr Peter Boast
Dr Rachael Morrell
Dr Katherine O’Brien
Gladstone Surgery
Chess Medical Centre
260–290 Berkhamsted Road
Chesham HP5 3EZ
OPEN: 8am to 6.30pm Monday to Friday
OPEN LATE: Wednesday and Thursday evenings please enquire
at reception
GLADSTONE SURGERY
PATIENT PARTICIPATION GROUP (PPG)
Report February 2015 (2014/2015)
INTRODUCTION
Many surgeries are beginning to introduce Patient Participation Groups as a means of improving the services
they offer to their patients and allowing patients a chance to have their say. Gladstone Surgery is one such
practice and our first patient group was formed in 2012. For an explanation of how the group was formed
please see Appendix A. This report gives a summary of how the group has improved services during its 4
meetings over the last year and how it hopes to change the face of the surgery over the coming months.
RECENT DEVELOPMENTS (JUNE AND OCT 2014 MEETINGS)
REVIEW OF PREVIOUS YEARS REPORT AND ACTION POINTS (JUNE 2014 MEETING)
During the June 2014 meeting the group reviewed any action points from the last meeting and previous years
patient group report. An exert from the minutes of this meeting is included below and shows the developments
the group had made at the start of the financial year:
-
The surgery now has an automated BP machine next to main reception – potentially location
needs a rethink so that patients do not feel intimidated or ‘on display’ when using the equipment,
ideally either small area next to New Surgery play area or in the corridor by the GP rooms if
there is room.
-
Practice Manager and one group member have had a meeting with the council and the Chiltern
CCG to discuss moving the out of hours service (OOH) back to Chesham (within the spare suite
of rooms at the Chess Medical Centre on the 1st Floor). The council (who have taken the lease
on the spare suite of rooms) were fairly keen on the idea and have invited the patient
representative to partake in the steering group focusing on developing the Chesham area.
Practice Manager also listed the other services that will be offered by the Council in the vacant
rooms.
-
DNA (Did Not Attend) policy – Practice Manager circulated the new DNA policy for the
surgery. Analysis showed that since 1st January 2014 x 521 patients have DNAed, of which
there is a fairly equal distribution between males/females. Highest offenders are children aged
up to 9 years (specifically boys) and females aged 30 to 39. All felt this was probably because of
the huge demands on working mums and the fact that children can be ill one minute and
miraculously improve the next and parents are not cancelling appointments.
During the meeting with the council mentioned earlier, there was a suggestion that recent
research showed putting DNA notices up encouraged people to DNA as it becomes normalised,
so all agreed no need to continue with the DNA notices.
All felt happy with the new DNA policy and accompanying letter, review in Dec 14 and see if
DNAs have reduced from the 521 in the first part of the year.
-
Bogus NICE Alerts displayed on website and in sub waiting.
-
The grey Exit sign has been replaced by a more prominent green sign in the corridor between
New and Gladstone consulting rooms.
-
A list of PLT (training afternoon) dates have been put up in sub waiting and on the website.
-
Sign to turn off mobiles is now in sub waiting.
-
Catch it, bin it, Kill it poster in sub waiting.
-
The group nominated a member (who had recently become a carer herself) to become the
surgery’s patient carer champion since she would have ‘hands on’ experience of what issues
carers face. Practice Manager explained the current options for carers at the surgery including
carers break scheme and carer identification protocol including self referral form. Practice
Manager had also recently received a poster and booklet listing care choices for the locality –
poster to be displayed and more copies of the booklet to be obtained for sub waiting.
SURVEY (OCT 2014 MEETING)
Back in the June 2014 meeting the group felt a patient questionnaire was still the best method to obtain patient
feedback. It should be A5 in size, available on the website and consist of only 4 or 5 main questions. 1 – 5
scaling measurement to be used if question desires it eg 1 for poor, 5 for excellent. It is also to be called an
Improvement Survey rather than questionnaire.
The patient participation enhanced service re quires the group to focus on 3 core area’s for improvement and the
group hopes to find these core areas through this survey. The group previously decided back in June that
‘Carers’ was to be a key area as it was felt more work could be done to support this group of patients, hence the
meeting with Carers Bucks earlier in the year (see next section ‘Focus on Carers’). Practice Manager and group
carers champion discussed the type of questions to use with the Carers Bucks representative and put the ideas to
the group in October 2014.
There was some further discussion on what other area’s to concentrate on and as well as reviewing last year’s
internal patient survey, the July 2014 National Patient Survey was considered and one particular result stuck out
– 25% of patients questioned said they didn’t like the fact they could be overheard in reception. Therefore it
was a unanimous decision to include dignity and respect in terms of confidentiality within the questionnaire.
The complaints received so far in 14/15 were also considered. Luckily there had not been many and certainly
not sufficient for a pattern to develop. In previous questionnaires problems with prescriptions had been an area
the patients seemed to focus on and indeed today a couple of group members had had problems in obtaining
their prescriptions, therefore this was to be our third and final area for improvement.
Practice Manager to finalise the questionnaire and distribute during the flu clinics in October 2014.
The final questionnaire can be found in Appendix B.
FOCUS ON CARERS
The second key focus of the October 2014 meeting centred around carers in the locality. The Practice Manager
and the patient group carer champion had recently met with Carers Bucks following which various actions
emerged and are summarised below:
-
-
A ‘Carers Event’ in November 2014 (shared with New Surgery) allowing patients to meet with
Carers Bucks and speak to other carers and surgery staff. They will be able to sign up to Carers
Bucks and the flexible break scheme on the day, as well as complete forms enabling the surgery
to log them as a carer on their medical record.
After this event monthly carer group meetings will be put into place, again shared with New
Surgery patients.
A ‘carers corner’ will be establish within Gladstone Surgery enabling carers to find all the forms
they need easily within the surgery.
The Carers Bucks team will be attending the flu clinics to try and ‘pick up’ carers during the
sessions.
More carer information has been installed on the practice website.
Flexible break scheme forms are now available to pick up on reception along with the carers
bucks referral form and carer consent forms.
ANALYSIS OF SURVEY RESULTS (DECEMBER 2014 MEETING)
The focus for the group’s third meeting of the year were the results of the patient survey and actions arising as a
result. 101 surveys were completed in all and a summary of the patient survey results can be found in
Appendix C. The following action points were a direct result of feedback from our patients and discussion with
the group as to what should be implemented.
Carer Awareness
- Only 6 patients knew of a carer not registered with Carers Bucks. This either indicates that uptake of
carer support is very good in our surgery or the patients questioned just do not know any carers. On
reflection this question could have been worded better.
- Many of the comments regarding carer awareness centred around friendly support for carers and
information sharing. The surgery has recently run a Carers Event in conjunction with New Surgery
which picked up a lot of new carers – in the New Year a regular carers group meeting will also be held
at the surgery which will be an ideal time for support initiatives and the sharing of information. Also in
the New Year the surgery hopes to instill a ‘Carers Corner’ housing an abundance of information for
carers and their loved ones.
- Practice Manager and one member of the patient group noted that the flexible break scheme funding
had come to an end for this year. All were concerned that this important initiative may be stopped or
funding cut so Practice Manager to initially find out more details as to the situation and then Practice
Manager/group carer champion to write to the relevant bodies on behalf of the patient group to explain
why we think it should continue and list the various benefits it has to carers and their families.
- One suggestion was that more consideration should be given to carers when trying to book themselves
an appointment, so Practice Manager to remain the staff that a carer would quality for one of the
evening extended hour appointments usually reserved for commuters and the like.
- In terms of the support for carers, Practice Manager to investigate Silver Line and the existing
Befriending Service and report back at the next meeting. This type of information could then be added
in to the Carers Corner
Dignity and Respect
- It surprised the group that more patients did not know about the small side room where patients can
speak in private to a member of reception. Only 17 out of 101 patients questioned knew this was
available 10 patients had concerns about confidentiality. Possibly a lack of advertising since the only
poster is found in main reception and most of Gladstone Surgery patients reside in the small sub waiting
area. Therefore Practice Manager to put another poster advertising this service in the sub waiting area.
- Again with regards confidentiality in reception, Practice Manager suggested for patients waiting in a
queue to speak to reception a bollard could be placed a few feet away from the desk in order to respect
privacy as per New Surgery. However these are expensive so the group conceded that a yellow line of
tape for patients to wait behind might prove a better initiative. This was later agreed by the doctors so
Practice Manager to implement.
Prescriptions
- Only 6 patients out of 101 were not happy with the prescription service which was very encouraging.
Of those that were not happy a couple of suggestions mentioned being able to order prescriptions online,
a service the surgery has been offering for quite some time now and which is publicised well
throughout. There were 2 personal comments regarding depression medication review and a
prescription incorrectly remaining at the surgery for collection which would need to be discussed with
the patients themselves. Therefore all felt no further action on this topic.
General comments
- One patient mentioned a poorly copied travel vaccination request sheet. Practice Manager had already
been notified of this some weeks before the questionnaire results were analysed and this had already
been rectified.
- One patient requested a first aid/minor injury service which is available from our nursing team if they
have appointments or immediately if it is immediately necessary care.
- All felt the comment relating to waiting 2 weeks for a GP appointment and other similar threads
referred to patients who wanted to see one particular GP – patients that are happy to see any clinician
generally do not wait that long for a routine appointment.
- One patient would like to see his/her GP out of hours which is not possible at present.
- Most comments regarding the receptionists were highly appreciative and very complimentary, all of
which have been passed on to the team.
- One comment regarding magazines implied that these were far too out of date. Reception staff to
regularly go through the issues and get rid of those that are old/tatty.
- The comment regarding a water dispenser was picked up on by a group member, who also felt strongly
about this issue. Initially it was suggested a sign could go up in sub waiting telling patients they can ask
reception if they require a glass of water, but subsequently the group wanted the Practice Manager to
investigate whether it would be possible to have a free standing water dispenser linked to the mains and
only dispensing tap water. Costs would be to install/maintain plus for the cups and the group felt this
would be a good use of the Friends of the Surgery Funds. However there is only £81 in the account.
Practice Manager to discuss with GPs.
- Group member mentioned the pictures on the walls again, but the group discussed why this had been
rejected in the past and this suggestion was put on hold.
- Group member felt the seating in the main reception was too ‘blocked’ and intimidating for new
patients walking in. Practice Manager to discuss with New Surgery a solution, possibly breaking up the
seating into smaller areas.
- Blood testing at the youth centre was brought up again on this years questionnaire, but since the
surgery had entered an agreement for the majority of bloods to be taken here there was not a lot which
can be done. Having recently visited the youth centre, group member felt there should be better signage
for the car park and possibly more information/map on the patient information leaflet.
- With regards supplying more toys for the children, this has previously been discussed but decided to
be a health and safety risk. Books/childs table were provided instead.
- Also the request for specimen drop off times to be extended is impossible since they need to go via the
brake at lunchtime in order to get to the lab in time to be analysed.
REVIEW IMPROVEMENTS AFTER SURVEY
(MARCH 2015 MEETING)
Completed action points resulting from the analysis of the patient survey were discussed during the March 2015
meeting. Summary:
- Automatic Blood Pressure machine has been moved from the front desk to a more secluded area at the
back of reception to improve patient confidentiality, dignity and respect.
- A ‘Wait Here’ bollard/sign has been placed at reception to stop patients crowding at the desk and
improving confidentiality.
- After researching the support options available to carers, the practice manager established the flexible
break scheme is due to resume in April 2015.
- The surgery’s reception team have been reminded that a carer would qualify for an extended hour
appointment in the evening.
- Practice manager and patient group carer champion researched Silver Line (helpline for older people)
and various befriending services – all to be made available to patients in the new carer corner.
- Practice manager has installed a poster in sub waiting area informing patients if they require a drink of
water this is available from reception – more plastic cups purchased for this purpose.
- Practice Manager contacted the phlebotomy team at the youth centre and has asked for better
information and possibly a map on the patient leaflet and better signage in the car park.
CONCLUSION
It has been a very worth while exercise involving our patients in the direction the surgery is heading. The
survey and patient group meetings have identified many areas for improvement, some of which have already
been implemented. It is hoped going forward many more improvements will be made ensuring the surgery
performs to an optimal standard.
Many thanks to everyone for their participation in this analysis, especially the patient group who have
given up their time to help improve their surgery.
APPENDIX A
FORMING THE GROUP
Gladstone Surgery has approximately 5350 patients and wanted to establish a patient group reflective of as
many demographic sectors as possible (*). Initially the surgery encouraged potential members to join by
advertising on our website, within our practice leaflet and on posters dotted around the surgery. Unfortunately
this produced a fairly limited response, so the Practice Manager met with the GPs and discussed which patients
they felt would have greatest impact on the surgery as a whole ensuring coverage of as wide a base of patient
sectors as possible. Once a selection of patients had been identified the Practice Manager contacted each
patient individually to explain what the surgery was trying to achieve and how they could help.
An initial patient group of 11 patients was established and our first patient meeting was held at our new surgery
premises towards the beginning of last year. Additional members are continually joining our group, whilst
previous members no longer have the time to attend meetings.
* Demographic areas covered within our existing patient group: Various clinical areas, disability,
multicultural, care homes, learning disabilities, age/sex, social, Punjabi/Urdu language barriers etc. A
detailed breakdown is available on request.
GLADSTONE IMPROVEMENT SURVEY 2014/2015
APPENDIX B
CARER AWARENESS
Do you look after someone who through illness, disability or frailty cannot manage without you?
If so you are a CARER. Please inform reception as we would like to help and support you in this role. The first
step is completing a carers identification form which can be found on the front desk.
1)
Are you a carer (or do you know of any carers) NOT registered with Carers Bucks? Yes
2)
Thinking of these carers, what additional support do you think carers need?
No
___________________________________________________________________________________
___________________________________________________________________________________
DIGNITY AND RESPECT
1)
Are you aware that the surgery has a small room to the side of reception
where you can speak in private to a member of reception?
Yes
No
2)
Do you have any concerns about confidentiality in the reception area?
Yes
No
3)
If you do have concerns regarding confidentiality, what do you think we could do to improve it?
___________________________________________________________________________________
___________________________________________________________________________________
PRESCRIPTIONS
1)
Are you happy with the prescription ordering service at the surgery?
2)
Yes
No
If no, how do you think it could be improved?
___________________________________________________________________________________
___________________________________________________________________________________
COMMENTS
1)
Please list any other comments/feedback on our service or idea’s for improvements at the surgery:
___________________________________________________________________________________
___________________________________________________________________________________
THANK YOU FOR COMPLETING THIS QUESTIONNAIRE – RESULTS WILL BE PUBLISHED ON THE
SURGERY WEBSITE (www.gladstonesurgery.co.uk) AT THE END OF MARCH 2015
QUESTIONNAIRE RESULTS 2014/2015
APPENDIX C
(A total of 101 questionnaires were completed)
CARER AWARENESS
1)
Are you a carer (or do you know of any carers) NOT registered with Carers Bucks?
YES:
NO:
6
95
100
No, 95
80
No of
Patients
60
40
Yes, 6
20
0
Response
2)
Thinking of those carers, what additional support do you think carers need?
‘Financial and emotional support. Guidance, classes etc to enable them to do the job.’
‘Practical advice and support, respite advice.’
‘Respite.’
‘Respite at least 3 times weekly.’
‘A course maybe to support.’
‘Yes they need it.’
‘Breaks or coffee mornings.’
‘Time.’
‘More consideration when trying to get appointments as work shifts and long hours.’
‘Time to themselves, respite care for the person they look after.’
‘Awaiting result of assessment for care homes.’
‘Social groups? Coffee catch ups with people in same situation?’
‘Financial.’
‘One to one support, additional support groups, counselling.’
‘Respite.’
‘They need a person who can talk with them. A few of them feel very lonely – they need a chat
with someone.’
DIGNITY AND RESPECT
1)
Are you aware that the surgery has a small room to the side of reception where you can speak in
private to a member of reception?
YES:
NO:
17
84
No
90
80
70
60
No of 50
Patients 40
30
20
10
0
Yes
Response
2)
Do you have any concerns about confidentiality in the reception area?
YES: 10
NO: 91
No
100
90
80
70
60
No of
50
Patients
40
30
20
10
0
Yes
Response
3)
If you do have concerns regarding confidentiality, what do you think we could do to improve it?
‘Tell people about small room to the side of reception.’
‘Provide more standing distance between patient at desk and queuing patients.’
‘Not enough privacy when checking in.’
‘Not a lot without re designing the reception and spending money.’
‘Just feel it is not private enough sometimes.’
‘I do like privacy, sometimes there are people listening.’
‘I think the reception staff are discreet as required.’
‘Everyone can listen to what you say, no privacy at all.’
‘Not sure re layout – make visitors aware of privacy room option.’
‘Never had any concerns before.’
‘Make people more aware of side room.’
PRESCRIPTIONS
1)
Are you happy with the prescription ordering service at the surgery?
YES:
NO:
N/A:
92
6
3
Yes
No
N/A
2)
If no, how do you think it could be improved?
‘Seen the new online service which seems like a good, practical idea.’
‘The prescription forms could be clearer ie back to the tick box – had 3 incorrect prescriptions.’
‘Sometimes have a problem getting repeat prescriptions for my regular anti-depressants. Need to
see doctor to review often and it takes a while to get an appointment in time.’
‘Sometimes even when printed PLEASE SEND TO PHARMACY it is still at reception.’
‘On several occasions items I’ve ordered are missed off the prescription sent to the chemist.’
‘Cannot register online.’
‘FMY and register online.’
PATIENT COMMENTS
‘First aid/minor injuries service’
‘All fine’
‘Receptionists very friendly’
‘I would like the ability to see a doctor from this surgery out of hours. I am not sure if this is part of the
surgery system’
‘I think 2 weeks is far too long to wait to see the doctor. I have had this a lot.’
‘Shorter waiting times to see GPs.’
‘Water dispenser and updated magazines in waiting area. Reception staff are much more friendly and
accommodating in last year. Shorter wait times for appointments.’
‘I am very happy with the service and staff at Gladstone Surgery.’
‘Well done to reception, all good.’
‘No problems with staff or doctors at surgery.’
‘All good!’
‘Old magazines – depressing literature to read, waiting room walls too bear.’
‘I received information on a very poorly photo copied sheet, which had been photocopied many times before.
Much of it was difficult to read. Black and white printed information is fine, but quality needs to be as good as
this sheet. The vaccination questionnaire was scrappy, scruffy and did not reflect a professional or customer
focused service. A 2 sided laser printed form, properly copied/printed would be a better reflection of your good
service.’
‘The font size of the print on this questionnaire is too small. Increasing it by 1 or 2 points would make it easier
for everyone to read and still keep it on one side of an A4 sheet. ‘
‘Could be more toys for children I think.’
‘Unfortunately due to the size of the building the surgery has lost its friendly atmosphere. Also phoning for an
appointment seems to take longer than it did.’
‘I am always impressed by the service received at Gladstone Surgery.’
‘Gladstone have wonderful receptionists who will always do their upmost to help and the doctors give you the
time to help you get better. I don’t know where I would be now if it wasn’t for the care and support they have
given me. I always highly recommend you all. Thank you.’
‘They give appointments very easily and good services.’
‘Good service’
‘Fine’
‘The booking screen when working saves waiting in the queue and helps desk staff.’
‘Longer hours for bringing in specimens.’
Blood tests – one usually has to go to the youth centre, only open on Thursdays which seems inefficient and
slow.’
‘All ok.’
‘Very happy with my doctor’s surgery.’
‘Can’t get appointments very easily.’
‘I do think sometimes it seems too long in seeing your own doctor.’
‘All ok’
‘Seems fine to me’
‘Good service’
‘Possibly slightly larger waiting room for Gladstone as it gets quite cramped,’
‘None – I always manage to get an appointment’
‘Make more appointments available – it’s hard to plan one’s illness 2 weeks in advance!’
‘Too much waiting – if a person has to pick up children from school, how can he or she manage?’