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
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Patient Participation Group

First Report
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Delivered March 2012
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


THE LINKS MEDICAL PRACTICE
Aim of PPG
The Patient Group will work with the doctors, other clinical healthcare workers
and administrative staff at the surgery in order to improve services wherever
possible.
We will try to address the question of how to best deliver primary healthcare in
this time of austerity: providing good “value for money”. In addition we hope
to foster good relationships with the local community and engender an
understanding by those on our patient list as to the pressures that the surgery
is under. We seek to involve patients with decisions as to how the surgery
operates and to seek their views in deciding which services to provide and
how they can best be delivered to suit. Furthermore, it is important the
members of the group have not only the patient population welfare at heart,
but also the welfare of the future survival of the practice itself. We have
communicated these ideas to the members upon recruitment.
In order to involve seek views from a broader cross-section of practice
patients we will run a local practice survey and engage with the Patient
Participation Group to develop an action plan taking into account their views
and opinions. Lastly we will collate the outcomes into a report that we will
publish on our website.
However, the GP partners have the final sanction regarding any changes that
may be put in place as we are subject to contractual obligations with the PCT
regarding the service we provide, as well as being limited by the funding
available.
Description of content and method of dissemination
This is the Links Medical Practice’s Patient Participation Report, which has
been published on our Practice website at www.thelinksmedicalpractice.co.uk;
circulated to members of the PPG; advertised in the waiting room on our
patient callboard and on the noticeboard as a poster; and also supplied to the
South London Healthcare Trust, London Medical Council and Bromley
Healthcare Community Interest Company.
The full link address is:
http://www.thelinksmedicalpractice.co.uk/website/G84003/files/survey_report.
doc.
A description of the profile of the members of the PPG
In this section we aim to demonstrate the validity of the patient group by
calculating how representative it is in terms of our patient population. We
have performed the following quantitative analysis by calculating percentage
differences between our practice population profile and the Patient Group
profile.
Our patient Group currently has members. However, it must be stated that
response from patients to this initiative has been very muted, even
withstanding the intensive recruitment drive we have pursued (outlined in the
following section.) It seems that many view the PPG with an element of
suspicion (despite assurances as to its anonymity and how it will not be taken
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into account directly when providing their care) and also are concerned with
the time that it may take to be a member. For this reason we have decided to
make the PPG a virtual group as only three members expressed an interest in
convening at meetings when asked at the outset in the new joiner’s
questionnaire. We found that this was the only way we could ensure a
healthy number of members.
We take the confidentiality of our members very seriously so will not publish
data on individual members. However, we have made every effort to be
inclusive, especially in incorporating hard-to-reach groups in the decision
making process. As such we do have at least one member who is
housebound, who is a carer, who has made a complaint about the surgery,
who has a disability and/or access issues, who is unemployed, who is
currently employed.
All are registered patients currently on the practice list.
None are related to members of practice staff.
The Group currently has 14 members
1.)Gender
PPG profile
Difference %
Male
Practice
population
profile
5042
2
36
Female
5033
12
As above
PPG profile
Difference %
Under 16
Practice
population
profile
2420
0
23
17 - 24
1076
0
11
25 – 34
1584
2
15
35 – 44
1510
4
14
45 – 54
1422
1
6
55 – 64
1036
2
4
65 - 74
701
2
7
75 – 84
523
3
5
Over 85
289
0
3
2.) Age
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3.)Ethnicity
PPG profile
White
Practice
population
profile
10133
Difference %
Irish
21
0
0
White & Black
Caribbean
38
0
0
White & Black
African
31
0
0
White & Asian
5
0
0
Asian or Asian
British
7
0
0
Indian
44
0
0
Pakistani
2
0
0
Bangladeshi
12
0
0
African
386
0
4
Chinese
9
0
0
& Any Other
0
0
0
14
The steps we took to ensure that the Patient Participation Group (PPG)
is representative of our registered patients and where a category of
patients is not represented, the steps we took in an attempt to engage
that category
We have outlined the differences between the practice population and
members of the PPG in the tables above. It can be seen that the differences
between the profiles of PPG and practice population members are mostly not
greatly significant, especially when taking into account the fact that some
groups not analysed separately are also included as “hard to reach groups.”
We have least one member who is:
 Housebound
 A carer
 Who has young children (under 18)
 Who has previously made a complaint about the surgery
 Who has a disability and/or access issues
 Who is unemployed
 Who is currently employed (Perhaps has difficulty attending the surgery
during normal working hours.)
 Who is retired
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 All are registered patients currently on the practice list.
 None are related to members of practice staff.
 Unmarried and at least one who is married
However there is variation seen between the groups, especially the
following can be identified as showing a small difference:
1.) Gender – it has been difficult to recruit male patient group participants.
We have therefore written and telephoned a random section of the population
asking them to join, in addition to the recruitment drive below. We have also
asked receptionists to ask male patients to join nut the response has been
muted and we continue to look at this issue. Please see below for further
information as we have tried to recruit more male patients to our PPG group
and the Receptionist have been trained to continue to advertise the PPG to
patients of different ethnicities.
2.) Age – Younger age groups in particular are not well represented, we have
attempted to address this by recruiting members with young children up to
those with teenage children. We have also sent randomized letters to these
age groups and tried telephoning but to no avail. We have a very siginificant
number of infant patients (0-4 years old) who lack the capacity to become a
member of the PPG. Therefore we have attempted to engage with their
parents. As such we currently have three parents with young children on our
PPG.
3.) Ethnicity- we have tried to recruit black African PPG members (our second
largest population ethnic group) by telephone, letter and by approaching
patients in the surgery by have had no luck securing any joiners.
Receptionists continue to advertise the PPG to patients of different ethnicities.
Although this is so small as to be largely insignificant, we have
nevertheless attempted to engage with any groups underrepresented by
the following means:
 Displaying the Patient Group recruitment poster on patient chairs in the
waiting room
 Having patient recruitment leaflets displayed and available in the
waiting rooms – which receptionists have also distributed
 Having a patient recruitment posters displayed in the waiting rooms
 Asking receptionists and office staff to ask patients to join and handing
out PPG literature, especially to under-represented groups such as
those from the under-represented ethnic and age range groups listed
above. Staff have been asked and trained in this and understand its
importance to good patient relations.
 Sending PPG recruitment information to patients’ addresses which
were randomly selected and also those who were from underrepresented groups or who fulfilled certain criteria (ages, gender or
ethnicities)
 Advertising our PPG on the practice website and encouraging all to
join.
 PPG membership was highlighted as both confidential and anonymous
to both reassure and protect patients and so encourage more opinions.
 The practice manager has actively sought to include all sections if the
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






population in terms of age, gender, ethnicity and has also handed the
recruitment literature to those who may have sought a meeting with her
or had cause to complain. This has included attempts to be as
inclusive as possible by contacting patients by post or by telephone
who are from different ethnic groups, gender, age ranges, who are
carers, who have young children, who are disabled, have been affected
by psychiatric illness, who have or who are currently being treated for
addictions or who are drug users, and who are housebound. We have
attempted to encourage those contacted to join the PPG if they can
and informed them that their views are valued. In total we have made
around 40 telephone calls and sent letters to this end, as well as
distributing literature to targeted groups in surgery, but the uptake has
been extremely limited.
We have advertised the PPG on the patient waiting room callboard to
encourage more joiners from a wider cross-section of our population.
We have asked those joining to complete a short questionnaire as to
their gender and ethnic group so that we are able to monitor the
inclusiveness of the group.
We have placed a poster in the window by the opening times at either
site advertising the fact that we are accepting new joiners.
We have now made it standard practice to issue new patients with an
information letter at registration to encourage greater patient
involvement.
We have discussed the issue of involving residential care home
members with the staff of the care homes we visit and the care home
managers, where possible. However, there has been a consensus that
this is not currently advisable as patients in these care homes are
either there for too short a time following their registration (home
provides end-of-life care) or are elderly mentally ill home patients who
may not be able to consent to involvement and who are not currently
capable of participating. We have stated to patient group members the
need to include all groups of patients in any decisions we make,
including those with additional needs. In spite of these impediments,
we shall continue to engage with patient care managers and patient
relatives at these homes regarding surgery development issues.
Asking PPG group members to disseminate information to others
whom they know who may be interested in joining our PPG.
The manager has identified long-standing patients who have had much
contact with the practice to invite them to participate, and has
attempted to be as inclusive as possible in selecting patients from as
many different groups and sections of society as possible, for example:
contacting our patients who are registered blind, registered as having
hearing difficulties or with learning difficulties.
Sadly, it must be stated that the response has been very muted from the
practice population, even when receptionists have handed out PPG joining
literature very few patients have actually responded to the offer and interest in
it can be described as weak at best, even having a virtual PPG without
requiring participants to attend meetings in person. Nevertheless we have
kept all members informed as to the decision-making process and taken on
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board all comments received by post, e-mail (by way of our secure NHS net
e-mail address which is checked every weekday at least once), telephone or
face-to-face conduct in surgery.
This is a genuine attempt to listen to patient ideas and concerns. In fact
several of the patients have been approached to join the group precisely
because they have had recent complaints with the Practice. This illustrates
that as a practice we are not afraid to listen to constructive criticism and this is
an important point to note.
Details of the steps taken to determine and reach agreement on the
issues which had priority and were included in the local practice survey
We have allowed the PPG to decide upon the areas that we to focus on for
our survey as it would be too difficult to focus on more to start with. Those
areas most consistently highlighted were:
1. Appointment system.
2. Prescriptions
This was decided by asking the PPG members at initial registration as a
member of the group(on the new joiners form) to state the areas they
would like to focus on first for development and improvement. Two
thirds of those replying stated the appointment system should be looked at,
and 5 members also felt the prescription service was an issue that could be
reviewed.
They are both recurring themes not just in the PPG members’ views, but also
taking in account other patient population members who have complained (we
have analysed the complaints log and found these to be the most common
themes) and in general day-to-day running of the practice contact with
patients. In the comments and suggestions box in the waiting room we have
also received comments focusing these areas. The National GP Patient
survey also showed that our patients were interested in improving the access
to doctors and being able to book appointments more easily.
In the welcome letter sent out to patients who expressed an interest in joining
the patient group we also included a brief rundown of information and ideas
that patients may wish to highlight or discuss, and then waited for their
response.
Some of our members responded with excellent suggestions and ideas by email and letter and also to the manager whilst in surgery at brief one-to-one
meetings, especially regarding access and discouraging “Do Not Attends”
(where patients so not attend a pre-booked appointment), all of which we
have discussed thoroughly in the action plan.
The manner in which we sought to obtain the views of our registered
patients
We then undertook a patient survey based on the issues highlighted by the
PPG as being of particular importance: prescriptions and appointment
availability and system.
Initiation plan:
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Recognize to ensure a good a healthy number of responses that the survey is
short and simple to complete.
Patient priorities- Appointment issues/prescription service highlighted by the
group as they have signed up to the group
This includes: Accessibility to book, Telephone lines busy. Open surgery, nonattenders, On-line booking capability
Survey drawn up and circulated to members for comments- Version 2 and
then 3 of the survey drawn up. Version 3 final circulated to patients at both
sites and to members of the group based on patient forum members
comments. Each version of the survey was sent by e-mail or post to PPG
members to obtain their comments and suggestions, these were taken on
board when replies were receives, again by post and e-mail and incorporated
into the final version of the survey (version three.)
Next phase - Obtain sufficient responses- 100 target agreed as being
appropriate to be conducted over Autumn-Winter 2011-2012.
Then to be analysed and reported back to the group for comments with a view
to their proposing and agreeing an action plan
Objectives and focal points of the survey
The survey was designed to focus on two key areas of practice policy: patient
access to appointments and demand by patients to be seen on the day. Our
surgery faces considerable pressures in both of these areas as demand is
extremely heavy and is indeed increasing. These two areas have also been
highlighted through discussion with the PPG. The PPG were consulted at
each stage of the survey’s design and their insights were invaluable to its
development.
It was decided after discussion with them that the survey would be too
cumbersome and thus unlikely garner many responses were it to be about
additional issues. The most pressing matter according to them, which also
frequently crops up in complaints and during discussions between waiting
patients and the Practice Manager (as well as that mentioned by GP Partners,
locum staff and receptionists) is that of access to appointments. Appointment
availability was also selected as the area for investigation for these reasons
but also as Do Not Attends (DNAs) are so high at our surgery, a fact the PPG
found particularly worrisome.
By focusing specifically on these areas we hope to make real beneficial
changes that will have a measurable impact (for example in terms of reduced
DNAs and increased number of people cancelling appointments if they are not
needed per month).
Patient Survey Aims
This report provides a detailed assessment and breakdown of responses
gathered to the Patient Survey conducted in Autumn-Winter 2011-2012. They
will, together with the views of our Patient Participation Group (PPG), be used
in the development of our service. If appropriate and necessary we will
implement changes to our operative procedures to best meet these patient
demands.
Ensuring Credibility
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THE LINKS MEDICAL PRACTICE
The local practice survey questions can be asked by paper or electronically, in
the surgery or by mail depending on what is considered the best way locally to
canvas the particular population. It is the responsibility of the practice to
demonstrate to its PRG that the proposed survey or methodology it chooses
as the vehicle for undertaking the local practice survey is credible.
Criteria for assessing credibility include an assessment by the practice that
the processes used for sampling and analysing are sufficient to provide “the
reasonable person” with confidence that the reported outcomes are valid.
This assessment and other evidence supporting the credibility of the survey
process should be included in the report of the practice results.
Survey Delivery and methodology
In addition to consulting with our PPG, we have attempted to ensure our
survey is as easy as possible for patients to complete by using a simple and
short paper-based questionnaire with a choice of responses to circle. By this
means we have made it as easy as possible for patients to respond and
thereby increased the likelihood that they will do so.
We have stated clearly at the top that responses should be made by placing a
circle around the number applicable to their choice. Ample space has been
provided on the survey for patients to make notes or suggestions if they so
wish. Instructions as to how to complete the survey have been included on
the front page, as has information regarding the survey’s purpose and how
the date will be used. This has been kept as brief and clear as possible. The
font used is large and clear with good contrast ink and paper. Pens are
provided by reception for those completing the survey in the Surgery. On the
other hand, no pressure is placed on patients to respond if they do not wish
to.
Objectives and focal points of the survey
The survey was designed to focus on two key areas of practice policy: patient
access to appointments and demand by patients to be seen on the day. Our
surgery faces considerable pressures in both of these areas as demand is
extremely heavy and is indeed increasing. These two areas have also been
highlighted through discussion with the PPG. The PPG were consulted at
each stage of the survey’s design and their insights were invaluable to its
development. The Survey was initially drawn up and circulated to members
for comments - Version 2 and then 3 of the survey drawn up. Version 3 final
circulated to patients at both sites and to members of the group based on
patient forum members comments. This version was approved and garnered
appreciative remarks as to its quality.
It was decided after discussion with the PPG that the survey would be too
cumbersome and thus unlikely garner many responses were it to be about
additional issues. The most pressing matter according to them, which also
frequently crops up in complaints and during discussions between waiting
patients and the Practice Manager (as well as that mentioned by GP Partners,
locum staff and receptionists) is that of access to appointments. Appointment
availability was also selected as the area for investigation for these reasons
but also as Do Not Attends (DNAs) are so high at our surgery, a fact the PPG
found particularly worrisome.
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THE LINKS MEDICAL PRACTICE
By focusing specifically on these areas we hope to make real beneficial
changes that will have a measurable impact (for example in terms of reduced
DNAs and increased number of people cancelling appointments if they are not
needed per month).
Usage of results, method of communicating report and plan of action
The next phase was to obtain sufficient responses (100 being the target as
agreed with PPG members) which we could then analyze and report back to
the group for comment with a proposal of plans to improve the appointment
system
We hope to use the survey results to assess how best we can meet these
requirements through liaison and feedback with the PPG. This report and its
conclusions are to be communicated to patients via the Patient Participation
Group (PPG) who will be e-mailed or sent hard paper copies in the post
(depending upon their chosen method of communication). Any subsequent
adaptations made to our practice will be formulated and delivered by way of
an action plan devised and approved by the PPG. The results, any ensuing
changes and subsequent achievements stemming from it will be announced
on the Practice website: www.thelinksmedicalpractice.co.uk.
Disseminating and advertising the survey
Inclusiveness has been promoted through the following means:
 Displaying the survey on patient chairs in the waiting room with
receptionists on hand to assist if necessary
 Sending copies to patients’ addresses which were randomly selected
 Advertising our survey on the practice website.
 The views the patients canvassed were confidential and are
anonymous to protect patients and so encourage more opinions. The
survey displayed this information prominently so as to reassure
patients as to this fact and guarantee that it will not affect their care.
 The practice manager has actively sought to include all sections if the
population in terms of age, gender, ethnicity and has also handed the
survey to those who may have sought a meeting with her or had cause
to complain.
 This has included attempts to be as inclusive as possible by contacting
patients by post who are from different ethnic groups, who are carers,
who have young children, who are disabled, have been affected by
psychiatric illness. We have also attempted to encourage these groups
to join the PPG if they can and informed them that their views are
valued.
 We have advertised the survey on the callboard to encourage more
responses from a wider cross-section of our population.
 Receptionist and administrative staff have handed out surveys to those
attending surgery, especially those from diverse ethnic groups, age
ranges, with disabilities or those with access issues.
 The advertising began before the surgery was initiated
Of the PPG members who responded, all were able to use the survey and
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THE LINKS MEDICAL PRACTICE
understand its questions and layout. The suggestions made were followed
and involved including a passage in the survey stating clearly that it was
anonymous and how to indicate responses.
Questions were specially selected and considered so as to provide the most
reliable, therefore most valuable, results possible. This involved a vigorous
checking procedure developed in consultation with a statistical sampling
method outlined on the website: “Principles of Questionnaire construction”
found at the web address: http://www.analytictech.com/mb313/principl.htm
and in consultation with the DES booklet on: “Patient participation directed
enhanced service (DES) for GMS contract: Guidance and audit requirements
for 2011/12 - 2012/13 (April 2011).
Prior to sending out the survey for initial checking by the PPG, the
assessment of all questions involved checking that each satisfied the
following criteria:
 Questions were not ambiguous – No questions were vague and where
possible offered only clear, discrete options. For example yes/no
responses and were close-ended. This made the survey easy and
quick to answer and analyse.
 Questions were not leading – any hint of partiality and emotional
rhetoric were removed from responses to leave them as clinical as
possible. A balance was sought between ensuring patients knew what
was being asked (i.e. describing what a telephone appointment was so
they could say if they knew what one was) and keeping the questions
clear and concise (not “advertising” the availability of such
appointments)
 All possible responses were included – ample space given and notes
provided to the effect that suggestions were all welcome
 Lacking bias – The questions tried to avoid prestige bias by removing
as many mention to doctors or clinical staff as possible. Language was
carefully vetted including omitting Descriptions (adverbs and
adjectives)
 Questions were specific, only addressing one issue at a time so as to
avoid any confusion of topics. This was further enhanced by splitting
the survey up into four clear sections of clearly numbered questions.
 We tried to stop reference to past events that people may not
remember (i.e. not asking if they had missed an appointment or
booking).
 We have avoided negatives in each of the questions so as to ensure
that people are not confused, especially when ill in the waiting room,
pressurized, or pressed for time.
 We have avoided medical terms, professional language, slang or
jargon but have kept to commonly used, standard English words. This
survey will be translated or transferred to another format if necessary
as are all practice documents. Publicity on this is on the DisabledGo
website, online at our website, on the NHS choices website and is
placed on a poster on the surgery notice-boards at reception.
 We have tried to be friendly and approachable in the survey to put
respondents at their ease and gather more responses. This includes
thanking them for their contribution with a personalized message and
11
THE LINKS MEDICAL PRACTICE

signing off with the practice manager’s own name. We have been
polite throughout all questions.
We had included information in a short welcome letter, but this was
dropped as PPG members found it to be off putting and more likely to
discourage responses if they had to read a great deal beforehand.
This view was taken into account and an opening welcome paragraph
was preferred.
The Links Medical Practice Patient Survey
2012 (V.3)
We appreciate that most of our patients attend their appointments. However
we are looking to try and reduce the number of patients who book and then
fail to attend appointments. In order to do this we need to know why patients
do not attend, and what systems we can put in place in order to reduce the
number of wasted appointments.
If you would kindly take a few moments to complete this survey it would help
us with this greatly.
Please circle the response that you agree with.
Section A - Wasted appointments
1. How would you prefer to be able to cancel an appointment that you no
longer require?
1. By telephone- leaving a message on a cancellation line.
2. Via Internet using Practice website.
3. By text message
2. If you have failed to attend for an appointment without cancelling it
what was the reason?
1. Felt better – appointment no longer necessary.
2. Forgot all about it.
3. Appointment was made by the Practice and arrived by post – the time and
date were not convenient or I did not want it.
4. Other- please state reason below
3. If the answer to the above question was number 2, would a text
reminder message have helped?
Yes
No
12
THE LINKS MEDICAL PRACTICE
4. If you failed to attend for an appointment did you make another
appointment?
Yes
No
5. Did you keep that appointment?
Yes
No
6. Telephone appointments - Did you know that we have doctors’
telephone appointments available for queries regarding ongoing
medical conditions and results queries?
Yes
No
7. Would you consider using telephone appointments for some queries?
Yes
No
Section B- Open Access Surgery.
8. Have you used Open Surgery?
Yes
No
9.If you have never used open access surgery, please let us know your
reasons why here:
Reason 1.
Reason 2.
9. If you have used Open surgery what was your experience?
Good
Bad
13
THE LINKS MEDICAL PRACTICE
10. If your experience was bad please list two ways in which we could
improve the service.
1.
2.
Section C - Extended Hours Service
Extended Hours appointments are available some Saturday morning and
late evenings. These pre-booked appointments are primarily for patients
who work and are unable to attend the surgery in the day or for workers who
wish to bring patients with disability and mobility issues to the surgery in the
car after work.
1. Did you know that the surgery have extended hours appointments
available?
Yes
No
3. Have you tried to book an extended hours appointment?
Yes
No
4. If the answer to question 3 was yes was there an appointment time
available to suit your need?
Yes
No
5. If you feel we could improve this service please let us know the
changes we could make here:
Change 1.
Change 2.
Section D – Practice Web Site www.thelinksmedicalpractice.co.uk/
Were you aware of the Practice website and the information it includes
(prescription request services, details of appointments, practice
services, breaking news and health information)?
14
THE LINKS MEDICAL PRACTICE
Yes
No
Do you or would you use this website to request repeat prescriptions?
Yes
No
If it were possible would you use this website to cancel appointments?
Yes
No
If you have any other suggestions as to how we can improve our
appointment system do please comment below.
1.
2.
This anonymised information will be used within the practice in an effort to
improve patient services. The results of the survey will be released to the
Practice population and Primary Care trust.
Thank once again for taking the time to complete this survey.
Julie Miller
Practice Manager
15
THE LINKS MEDICAL PRACTICE
Details of the steps we took to provide an opportunity for the PPG to
discuss the contents of the action plan
The action plan was published online at our website address
http://www.thelinksmedicalpractice.co.uk and PPG members e-mailed and
sent postal letters advising them on how to view it and asking for suggestions
and comments. All suggestions resulting from the survey were included and
discussed in this Action plan.
At each of the following stages, in addition to e-mailing and sending letters to
PPG members, we have posted advertisements on the practice website and
on the waiting room callboard advising patients on how they can access the
action plan, survey results and participate in the discussions and join the
PPG.
The PPG were initially consulted on the proposed action plan through asking
for feedback on the survey results, which were posted to all members, and a
mixture of postal contact, e-mails, face-to-face brief meetings and telephone
discussions were held to devise the action plan. The results were also used
to generate graphs and pie charts to enable easier understanding of their
import. Patient Participation Group suggestions received were ALL included
and discussed in this plan, even where they could not be agreed to and
reasons given as to why this was so.
The final action plan was agreed by e-mailing the website link to the action
plan to the PPG members and sending them an information letter by post
outlining how they can access this action plan and how to respond. We asked
for comments by telephone, e-mail or by post. We have also met with some
members on an ad hoc basis briefly to take suggestions when they have
attended surgery and taken any comments on board.
Generally the response to our action plan has been very positive and we have
received many comments including:
1.) How much open surgery has improved – the experience was so much
easier and better; especially when one is not feeling well.
2.) How thorough and inclusive the action plan is
3.)How pleased they were with the hard work that has gone into it
4.) Looking forward to seeing the new nurse, especially at open surgery to
help deal with some minor illnesses
5.) Glad that views are being looked at by practice and see that the where
changes cannot be made it is not the practice’s fault
6.)How friendly the receptionists and doctors are and how great the care by
the doctors is.
7.) Fabulous service at open surgery
We have not currently received any negative feedback
Details of the action plan setting out how the finding or proposals
arising out of the local practice survey can be implemented and, if
appropriate, reasons why any such findings or proposals should not be
implemented
We have tried to link the information on the actions taken as a result of the
16
THE LINKS MEDICAL PRACTICE
survey and all subsequent achievement directly back to the original
suggestions and survey outcomes as well as feedback from patients.
Where we have not been able to take up the PPG’s suggestions on proposed
actions, we have highlighted this along with our rationale for not following
these suggestions at this time: we have taken the ideas on board, it is just that
they are not currently feasible and we have explained why clearly.
There are not currently any contractual considerations to the agreed actions.
Action plan discussion
The Action plan we developed has been agreed in consultation with the
Patient Participation Group (PPG) and their agreement has been given to
implement the changes through e-mail discussion.
1.)Wasted appointments:
A number of solutions were proposed by respondents:








Charge patients- after all dentist’s do- at the present time GP
Surgeries are unable to charge patients who fail to attend for their
appointment.
Remove persistent defaulters from the Practice list.
Currently patients who frequently do not attend (DNA) are written to or
contacted by telephone and warned that they will be removed from the
Practice List if they fail to inform the surgery if an appointment is no
longer required. Certainly there are some patients who just to do not
bother to contact the surgery and these patients can be written to and
educated, however it is clear that some of these patients including
families with young children lead chaotic lives and the very nature of
their health problems are the reason that they fail to attend.
Have a telephone cancellation line on which messages can be left.
This is a facility that we are looking into.
Text messaging reminder service- This is a possibility that again we
are exploring. There will be the questions of patient confidentiality ( a
matter that we take very seriously) and cost to be considered.
Confidentiality in text may be overcome by leaving a very unspecific
message e.g ‘A reminder that you have an appointment on ‘date’ ‘time’
without specifying what the appointment is for or where it will take
place. One would have to assume that this would be enough
information to jog the memory.
Practice website cancellation of appointment facility.
Many patients are still unaware that we have a practice website - This
will be advertised more heavily via Flyers, Waiting room call board and
information leaflet.
This option is currently being explored as an option and would certainly
be more convenient for patients as opposed to hanging on the
telephone for some minutes.
2.) Open surgery
 Patients experience of open surgery remains poor.
17
THE LINKS MEDICAL PRACTICE





We have tried the following in an attempt to improve this service:
We have given patients an approximate time to come and sit and wait
in surgery . This has reduced the length wait that patients have had to
endure and we feel has given patients who want to go home and wait
in the comfort of their own home with cup of tea rather than the
unhealthy atmosphere of the waiting room.
In the past when we have had packed waiting rooms with patients
feeling unwell and children running around bored. Now the waiting time
is reduced although some patients preferred the former system!
There may be an issue that patients fail to understand the fact that
different doctors are working at different rates and even more
importantly that health care is not an exact science. Generally the
doctors will try and deal with the patient’s problem even if the
appointment time overruns. If patient has a number of interrelated
issues that it is impossible to separate these will have to be dealt with.
Most patients I am sure would appreciate this if they were in the
consultation but are less understanding of this while sat in the waiting
room.
We do state one appointment one problem to try and contain the
breath of the consultation but sometimes the doctor will halt the
consultation and ask the patient to rebook for another time but this is
not always acceptable. For example patients sometimes state the real
reason for their appointment as they leave the room. For example the
patient may be embarrassed or very anxious about their problem and it
takes courage to raise the issue with the doctor. If once raised that
problem is urgent and cannot be left for any length of time without
investigation then of course the doctor will invite the patient to sit back
down and continue the consultation. Of course a patient may be
receiving bad news which cannot be hurried.
3.)Capacity of appointment system
 The number of appointments that can be offered are limited.
 The doctors have other commitments which are just as important a part
of patient care as the face to face consultations.
 Examples of this work include: Nursing Homes to visit, Home visits for
the very ill or housebound, specialised Team meeting for example
Palliative Care (terminally ill) planning, Child protection meetings, baby
immunizations and baby checks, Minor surgery clinics and diabetic
clinics.
 There is also a vast amount of paperwork that the doctors have to deal
with and if necessary respond to and act upon For example- reviewing
results, hospital reports, discharge summaries, patients clinic letters
making referrals to hospital, prescriptions (a vast area ) child
safeguarding rand medical reports and certificates.
 Striking a balance to allow all of this work to be completed as well as
enabling enough consultation time for patients is very important to the
Partners of the Practice.
4.)Other suggestions to improve the appointment system included
18
THE LINKS MEDICAL PRACTICE


Patient education: An appointment fact sheet ‘ Is your appointment
really necessary?’ explaining options that may be available that do not
require a doctors appointment.
This could include a paragraph on what a telephone consultation can
be used for.
Once again the PPG members are all thanked most sincerely for their kind
assistance in looking into the matter of wasted appointments.
The Action plan was also discussed at a meeting of Practice staff, at which
also considered all PPG patient member feedback
Action Plan – see next page
19
Patient Participation Group Action Plan agreed in response to Practice survey, Patient complaint themes
and other service user suggestions
Unfortunately it is not possible to implement all of the PPG member and service user suggestions and comments (as much as we
would like to!) due to limited staff and funding resources but we hope that the action plan response will help to set out our first
targets in order to improve our service to you. We will be beginning a new round of the PPG discussions in April 2012 when new
suggestions and comments will be considered and proposals we have not been able to implement at this time can be reconsidered.
Just to confirm that this an ongoing exercise and we are constantly reviewing and improving it so as best to serve our patients.
Where we have not agreed with a proposal we have outlined clearly why this is not a feasible option.
REF PROPOSAL
1
Initiate a system
whereby patients
can book
appointments
online
BASIS OF
PROPOSAL
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL

The main problem with this is that it
Practice
would have to be Site specific. As we Manager
are a two site practice it will be difficult
to ensure that patients go to the
correct site and there will be a risk that
they will travel (whilst unwell) to the
wrong site, especially if they wish to
see a specific doctor


Members of
the PPG have
suggested this
Survey results
indicated this
would be
popular service
Previous
comment to
this effect by a
patient made in
the past year
Also some appointments are reserved
for specific health requirements i.e.
diabetic clinic, baby clinic, minor
surgery. There is a danger that
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
NA
Keep in mind for
future
development.
We do hope to
offer this facility
in the future
when the system
is in place to vet
and check
requests more
comprehensively
– patient safety
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
patients may book appointments at
the wrong time or day or with an
inappropriate member of staff
The Triage system is lost therefore we
cannot assess the urgency or patient
requirements of appointments –
human contact is lost potentially
endangering patients. (GPs
themselves have expressed concern
over this – for example of a person
has chest pain and needs to be seen
urgently)
A significant proportion of patients
have no access to a computer or
cannot or do not use the internet,
therefore would be at an unfair
disadvantage in booking these
appointments.
Concern over security as passwords
and logins would be required and the
surgery cannot guarantee a safe
connection at the patient’s end.
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
must be
paramount. We
agree it would
be good to offer
this service and
will look into how
other surgeries
run it and into its
success. We do
expect to move
to a new IT
system –
EMISWeb
shortly in the
next year,
maybe with the
advent of this
new system and
when this is up
and running and
in place we will
reconsider if
there is still
demand.
Loss of human contact when booking
21
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
(receptionist stating date and time and
confirming that an appointment has
been made) may mean that patients
are more likely to DNA (not attend
appointment).
Prohibitive cost, this is an additional IT
cost which we cannot fund at the
moment.
Dedicated staff required to be trained
and employed – must be especially
careful to monitor its implementation
at first so that mistakes are not made
in appointment allocation. Then it
must be verified regularly all of which
requires staff time and training
(including employing dedicated staff),
which we cannot finance currently.
Patients may make appointments at
times that are not appropriate – for
example late evening appointments if
they have persistently not attended at
such times or have been aggressive
to staff or other patients in the past
22
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
Practice
Manager to
consult
Practice IT
Lead liaising
also with
information
governance
Hopef
ully
within
the
next
two to
three
month
(health and safety issues).
Fairly new system so cannot compare
with other surgeries to see how the
system has fared (learn from others’
mistakes!)
System must be complex to account
for doctors nursing and care home
visits as even when doctors are at
work they are not necessarily seeing
patient on surgery premises.
Some patients have good working
relationships with certain doctors and
it would be a shame to disrupt the
care they receive if they were to book
into another doctor.
2
Initiate a text
reminder service

PPG members
have
suggested this
both prior to
survey and
after viewing
survey results
To draw up consent form for patients
and place it on the website
Ensure that this is secure and that all
information gathered is kept secure
and is verified
Ensure all people who have access to
Hopefully
reduction to
DNAs or more
patients
remembering to
cancel
appointments if
not needed,
23
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL

Patient survey
results
indicate this
would be a
popular choice
for patients
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
the phone sign consent form
lead (patient
security and
data
protection
issues)
s
Draw up a disclaimer
Draw up an information section for
patients to refer to and understand
how the system works
therefore more
appointments
available.
Ensure patients no to update details
and that they can opt out at any time
Research any other significant
information to be included so as to
protect and inform patients
To ensure this complies with
information governance
Test system to ensure it works and
monitor its function and reliability
regularly
Confidentiality in text may be
overcome by leaving a very unspecific
message e.g ‘A reminder that you
have an appointment on ‘date’ ‘time’
without specifying what the
24
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
Practice
Manager
NA
appointment is for or where it will take
place. One would have to assume
that this would be enough information
to jog the memory.
3
Publicise patient
survey more by
placing it in a
more prominent
place

PPG member
suggestion
We would love to be able to put
surveys, comments boxes and leaflets
in a more central position in the
waiting rooms. However it is an
unfortunate fact that these objects can
be used as missiles or be used
threateningly be patients towards staff
or other patients. So to safeguard the
wellbeing of staff and other visitors
and patients at the surgery we have
had to move them to a less
conspicuous position. We do
apologise for this though and have
tried to remedy it by advertising their
presence with colourful signs and
advertising their presence on our
website by stating that we are happy
to receive comments, suggestions or
complaints.
Encourage more
patient
involvement
through
advertising on
website and in
patient waiting
room by way of
posters
25
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
4
5
BASIS OF
PROPOSAL
Remove some
notices from the
waiting room

Publicise website
more


ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
PPG member
request
Previous
complaints
and comments
made over the
past few years
We agree that there are an awful lot of Practice
notices on the walls at either site and
Manager and
the Practice Manager and
receptionists
Receptionists do attempt to keep them
updated and to a minimum. However,
it is a contractual obligation from the
PCT that we have certain notices
displayed on our walls in order to
continue to satisfy their requirements
and to be eligible to continue providing
a GP service and receive funding. We
are inspected to ensure that we
comply. The Practice Manager has
asked other managers if they have
any solutions. They have also have
requests to remove some posters as
patients and PPG members feel it is
cluttered but currently we cannot
remove many from the walls as they
inform patients of their rights or
provide important health information
and advice.
Ongoing
Patient survey
results
indicate more
Many of the following suggestions
were from PPG members – thank you
Within More patients
next
making use of
coupl the website and
Practice
Manager with
reception
Hopefully keep
the walls tidy
and only
required or
relevant posters
displayed
26
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL
people would
use the
website had
they known of
it’s existence
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
for your ideas-
team,
prescription
clerk and
office
administrators
e of
its services such
month as fewer DNAs
as patients
s
register for text
message
reminders
Practice
manager
Next
coupl
To draw up an advertising flyer and
place it on chairs in the waiting room
to encourage patients to make use of
this service
Flyer to be placed in waiting room
leaflet holders and advertised with a
large notice above it
To place a notice outlining this facility
(briefly) on the patient callboard
Receptionists/office staff/prescription
clerk to tell patients of this facility if the
opportunity arrives bearing in mind
they are often very busy
Draw up a newsletter with the website
address displayed prominently
Display website address on all
practice literature and documents
6
Educate patients
so as to use

PPG member
suggestion
GPs will try to ensure patients who
attend appointments for more than
Appointments
used more
27
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
appointments
appropriately
BASIS OF
PROPOSAL


GP partner
and Practice
Manager
suggestion
from day-today contact
with patients
Note on
patient survey
as patient
suggestion
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
one problem are not able to come with
a “shopping list” of complaints.
Hopefully this will also help surgery
times to be more regular and
appointment times to be more
accurate
liaising with
GP partners
and with
reception and
administration
staff
e of
wisely
month
Free up more
s
appointments for
genuine
appointments
Less wasted
appointments
GPs not to issue repeat prescriptions
in appointments if patient has
forgotten to put a request in on time
Text to be placed on the patient call
board advising patients on how to use
their appointment most wisely
Fact sheet drawn up advising patients
in how to use their appointment most
wisely and when to consider not
making an appointment if it is not
really necessary that they see a
doctor.
7
Reception staff/
Health care
assistants to triage
patients to
eliminate


PPG member
suggestion
Suggested by
a survey
We have been fortunate, after much
Practice
work and effort, to secure a new nurse Manager, GP
who we hope will be able to see some partners
patients to help the doctor at times
NA
NA
28
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL
unnecessary
appointments
8
Telephone
Patients prior to
appointment as
responder
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
when the surgery is especially busy.
Receptionists do triage calls currently
(they would be unable to do this if
appointments were to be booked
online) however they have not
received sufficient clinical training to
make more detailed judgements.
Likewise with HCAs, doctors have
many years experience (at least 8
years of qualifying!) and often further
medical training which cannot be
replicated by other members of staff
and would threaten patient safety - so
we cannot initiate this idea at this
time. However we would implement it
if we were to develop the role of a
nurse practitioner in the future, which
the manager and partners are
currently investigating and
considering.


PPG member
suggestion
Indicated as
popular for
Limited staff time and limited finances Receptionists
available to pay them in order to afford and office
administration
this.
– trained by
Conti
nue
To keep
reminding
persistent
defaulters and
29
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL
reminder

patients by
survey results
Requested by
patients at
receptionist
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
Could possibly be viewed as
harassment or as overly intrusive by
come patients. They may feel
targeted.
manager
We do already work a policy of
telephoning patients who are known to
us as having difficulty in attending due
to health / social issues or other
problems or who have not attended
their appointments in the past.
However, we cannot really afford to
employ dedicated staff to do this full
time all the time for every patient.
DATE PREDICTED
DUE
OUTCOME
those who have
trouble attending
appointments of
the date and
time of their
appointment
More phone lines required which we
cannot afford currently, do not have
the staff to answer them and do not
have the space to accommodate
them.
9
Do not send
patients prebooked
appointments:
send reminder

PPG member
proposal both
before survey
and in
response to
Yes we will change our policy to
request that patients book their own
appointment at a time to suit them and
advising them how to do this when we
send letters advising patients they are
Practice
Manager.
Within Hopefully
a
patients will
week attend
appointments
booked at times
30
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL
requesting
patients book their
own appointments
10
No pre-booked
appointments/ All
day open surgery
everyday. More
appointments to
be available


ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
survey results
due an appointment or check-up at
the surgery.
Patient
suggestion
and comments
made to
reception and
in comments
box
PPG member
suggestion in
response to
survey and
prior to survey
results
Unfortunately we only have limited
resources available in terms of the
clinical time available from GPs,
nurses and HCAs. We cannot afford
currently to employ any more medical
staff so our focus is on cutting wasted
appointments in the other manners
described in this plan. We have
considered only having open surgery
but the doctors feel this would be
extremely hectic and busy with long
waiting times and aggravation caused
to the people waiting, perhaps long
periods to see a doctor. They could
not see the doctor of their choice
which would disrupt the doctor-patient
relationship which is absolutely
integral to patient wellbeing (and is
therefore fundamental to the service
we provide). No choice as to gender
of doctor which is important to many.
Cannot book appointment in advance
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
to suit them.
Decision
reached by
Practice
manager and
partners
NA
Reduce wasted
appointments in
ways outlined in
this plan
31
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
Practice
manager
liaising with
GP Partners
Imple Hopefully
mente reducing
patients who do
d
not attend to
lower numbers
so cannot arrange transport or may be
unable book an appointment if the
doctor requests that the patient make
a further appointment to see them –
for example following test results or to
monitor a patient’s progress.
11
Educate patients
as to loss to
practice if they Do
not Attend (DNA)
appointments/
remove persistent
DNAs from list or
fine them (as do
some dentists)



PPG member
suggestion
GP partner
suggestion
from contact
with patients
Response by
patients
completing the
survey
indicates this
Place message on website, patient
callboards and on patient newsletter.
Advertise the number of appointments
lost to educate patients
We cannot remove persistent DNAs
as we do not have the authority to do
this unless the doctor-patient
relationship has broken down
substantially or there are other
pressing reasons for removal of the
patient from the list. Often, as some
of the PPG members stated, there are
underlying reasons (health problems
or social problems) underlying many
consistently-DNA patients (such as
memory issues) so we would be
reluctant to remove such patients as
32
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
Practice
manager to
keep this
chased up
When Hope to install in
more the future
fundin
g
availa
ble
they are precisely the ones who may
require our input and support. We
would instead hope to make it easier
for them to attend by way of reminders
as outlined above. We cannot fine
patients who do not attend
appointments as we are not a private
practice therefore cannot set our own
“rules” as some private dentists may
do.
12
13
Allow patients to
cancel
appointments on a
dedicated
telephone line / by
text message

Publicise
telephone
appointments


PPG member
suggestion
Results of
survey
indicate this
would be an
option patients
on our list may
make use of
This would mean installing a new
telephone line, which we do not
currently have the funding (or space)
for. However, in view of the popularity
of this proposal we will try to see if we
can access funding for this idea. In
the meantime we expect that by
publicising the website facility to
cancel appointments more patient will
make use of this facility.
Fact sheet on telephone appointments Practice
Survey result
Manager with
indicates more to be written and displayed in the
reception
waiting room
people could
be made
Next
More patients
month making use of
these
appointments
33
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL

aware of this
facility
PPG member
suggestion
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
Advertisement to be added to
callboard
team
Website to explain purpose and
availability of such appointments
DATE PREDICTED
DUE
OUTCOME
regularly for
certain problems
and queries.
Doctors may consider a telephone
appointment is not suitable in all
cases as it is not a substitute for a
face-to-face consultation.
14
15
More telephone
lines/ more
receptionists to
handle calls
incoming

Disabled access –
Lower glass
screen


Suggested by
survey result
PPG members
suggestion
and comment
in response to
survey
See above – funding not currently
available but we will consider this as
and when funding is available. We
wish we had the funds and space and
staff hours to offer this at once! In the
future, were we to install a new
system and were the funding available
we would make more lines available.
Member of
PPG
suggestion
prior to survey
Currently prohibitive in terms of cost
but a notice is displayed in the waiting
room and on the website alerting
patients with different needs to ask for
help if they require it. Staff to be
reminded of disability training and
Practice
manager
Next
Better staff
staff
awareness and
trainin understanding
g day
34
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
Practice
manager,
reception
team
NA
awareness of different needs at the
next staff training day to be held this
year – this will include a part on better
communication. Staff training manual
on disability awareness will be
reviewed and changes made if
necessary. Any patient who feels they
have more needs can ask at any time
for more assistance. We are also on
the disabledgo website listing our
disabled access provision.
16
Reserved
appointments for
doctor’s own
patients

PPG member
suggestion
All doctors have access to patient
medical records including test results
and medication in addition to full
medical history so if a specific doctor
is not available for that day another
may be seen without jeopardising your
care. We will always attempt to let
patients see the doctor of their choice
if at all possible. Doctors have the
facility to block appointments off in
order to review patients.
Other measures
should free up
more
appointments for
such patients
use.
Not currently viable as this could be
too disruptive since some doctors may
35
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
Practice
manager
liaising with
GP partners
NA
end up only having reserved slots and
no appointments available for that day
to be booked or indeed there may be
unfilled appointments. This could lead
to an uneven or unfair work allocation
and cannot guarantee that slots will be
filled or that patients will use them.
Hopefully the other measures outlined
in this action plan will help free up
appointments for this purpose.
17
Share care plans
with patients

PPG member
suggestion
Wherever possible and time permitting
doctors will share and discuss their
care plans fully with patients and will
try to explain the steps they are taking
to inform patients fully as to the outline
their care will take. These are devised
and based on certain criteria as well
as their own clinical expertise and
judgement. It is a practice
requirement to complete care plans
for certain patients meeting certain
criteria (for example, to help prevent
hospital admissions.)
NA
36
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
18
E-mail contact
with doctors
BASIS OF
PROPOSAL


PPG member
suggestion
Other
practices do
run this
service
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
As well as concerns over security of e- Practice
mail address, which would need to be manager and
verified it would also be necessary for IT Lead
each person who has access to the email account to sign a consent
agreement, which may present
problems. Our NHS mail is designed
to be secure but there is no guarantee
that the patient’s e-mail is subject to
the same safeguards or protection.
Patient information (often confidential
medical information) may be put at
risk.
DATE PREDICTED
DUE
OUTCOME
On
going
Possibly to
implement in the
future with new
EMISWeb
system later this
year.
Feedback from
other practices
on success of
this scheme and
problems/concer
ns.
Patient safety concerns are
paramount as medical queries are
difficult to deal with if urgent by e-mail
– partners may not be on duty 24
hours a day 7 days a week so there is
a risk that urgent queries may not be
actioned or progressed.
We are having a new computer
system implemented later this year
which may allow these concerns to be
addressed. In the meantime we will
37
THE LINKS MEDICAL PRACTICE
REF PROPOSAL
BASIS OF
PROPOSAL
ACTION TO TAKE/ REASONS FOR
NOT IMPLEMENTING PROPOSAL
PERSON
RESPONSIB
LE
DATE PREDICTED
DUE
OUTCOME
Practice
Manager
Comp
lete
consider drawing up comprehensive
guidelines that advise patients on how
to use such a service as well as
liaising with other practices to see how
they are attempting to address this
issue.
Also the GPs are extremely busy with
care home visits, palliative care
meetings, paperwork, test results,
referrals, training etc as well as their
own surgeries!
19
Practice website
cancellation of
appointment


PPG feedback
Patient survey
Many patients are still unaware that
we have a practice website- This will
be advertised more heavily via Flyers,
Waiting room call board and
information leaflet. We have now
implemented this facility on our
website and hope that it is a better
alternative to hanging on the
telephone for some time.
Reduce nonattendances
38
A summary of the evidence including any statistical evidence relating to
the findings or basis of proposals arising out of the local practice
survey
To demonstrate that we have included the results graphs and survey results
that were circulated to PPG members for discussion by e-mail and by post as
part of our virtual patient group. Members were invited to respond with
comments and suggestions to add to the action plan by postal letter, dropping
a letter into the surgery, by e-mail or by telephone. We distributed 200
surveys and received 140 responses which is 14% of the practice population
and can therefore be seen as giving reasonably confident results.
Patient Survey results breakdown and analysis
These are to be referred to by PPG (Patient Participation Group) members in order to contribute to the development of an Action
Plan
We have ensured a balanced response from the entire cross-section of our practice population by canvassing responses from
patients in the waiting room, advertising the survey on the website, callboard and on notices in the waiting room, providing copies of
the survey to those contacting the Practice Manager with other queries or complaints and also by sending out questionnaires by
post to patients selected at random.
As well as randomised patients selected we have also sought responses from specific patient groups in order to represent a
diverse section of the practice population. We have posted questionnaires to those patients meeting certain criteria including: those
from different ethnic groups, different genders and age ranges, with different access requirements (hearing or visually impaired),
those with young children or who are pregnant, carers, those with disabilities, differing marital status or sexual orientation (where
known), different religions and beliefs. The practice manager and staff have also distributed questionnaires to patients they have
been in contact with (such as those who have made comments or lodged a complaint) and have invited at least five members of
each of the groups above to join the PPG although the uptake has been low. We are continuing our recruitment drive and will
attempt to address this throughout the year.
You can respond by e-mail to the following address: Bro-pct.linksmedicalpractice@nhs.net
Or alternatively by post to the Downham Site marking your envelope “PPG Survey Results” to the following address: The Links
Medical Practice Downham Surgery, 27 Brook Lane Bromley BR1 4PX
You are of course welcome to drop your response into the Surgery if you wish.
All responses will be dealt with in strictest confidence and will be anonymised.
THE LINKS MEDICAL PRACTICE
1. How would you prefer to be able to cancel an appointment that you no longer require?
1. By telephone- leaving a message on a cancellation line.
82
2. Via Internet using Practice website.
11
3. By text message
47
41
THE LINKS MEDICAL PRACTICE
2. If you have failed to attend for an appointment without cancelling it what was the reason?
1. Felt better – appointment no longer necessary.
45
2. Forgot all about it.
59
3. Appointment was made by the Practice and arrived by post – the
time and date were not convenient or I did not want it.
20
4. Other- please state reason below
42
THE LINKS MEDICAL PRACTICE
3. If the answer to the above question was number 2, would a text reminder message have helped?
Yes
63
No
27
43
THE LINKS MEDICAL PRACTICE
4. If you failed to attend for an appointment did you make another appointment?
Yes
46
No
24
44
THE LINKS MEDICAL PRACTICE
5. Did you keep that appointment?
Yes
63
No
27
45
THE LINKS MEDICAL PRACTICE
6. Did you know that we have doctors’ telephone appointments available for queries regarding ongoing medical
conditions and results queries?
Yes
41
No
69
46
THE LINKS MEDICAL PRACTICE
7. Would you consider using telephone appointments for some queries?
Yes
77
No
33
47
THE LINKS MEDICAL PRACTICE
8. Have you used Open Surgery?
Yes
84
No
26
48
THE LINKS MEDICAL PRACTICE
9.If you have never used open access surgery, please let us know your reasons why here:
No need as yet
3
Did not know it existed
1
49
THE LINKS MEDICAL PRACTICE
10. If you have used Open surgery what was your experience?
Good
64
Bad
20
50
THE LINKS MEDICAL PRACTICE
11. If your experience was bad please list two ways in which we could improve the service:
Remove people with non-urgent problems
6
Stop service being misused
1
Long wait/Too busy
8
Prefer booked appointment
2
51
THE LINKS MEDICAL PRACTICE
12. Did you know that the surgery have extended hours appointments available?
Yes
79
No
21
52
THE LINKS MEDICAL PRACTICE
13. Have you tried to book an extended hours appointment?
Yes
38
No
72
53
THE LINKS MEDICAL PRACTICE
14. If the answer was yes was there an appointment time available to suit your need?
Yes
No
21
9
54
THE LINKS MEDICAL PRACTICE
15. If you feel we could improve this service please let us know the changes we could make here:
Longer opening hours and more appointments
5
Regular advertised Saturday surgeries
1
Extended hours every day
4
See doctor of choice
1
Shorter waiting times
3
55
THE LINKS MEDICAL PRACTICE
16. Were you aware of the Practice website and the information it includes?
Yes
74
No
36
56
THE LINKS MEDICAL PRACTICE
17. Do you or would you use this website to request repeat prescriptions?
Yes
80
No
30
57
THE LINKS MEDICAL PRACTICE
18. If it were possible would you use this website to cancel appointments?
Yes
98
No
12
58
THE LINKS MEDICAL PRACTICE
19. If you have any other suggestions as to how we can improve our appointment system do please comment below.
A fair proportion of respondents said they had no access to a computer
10
Penalise those who do not attend appointments
9
Ability to book appointments online
4
Difficulties with memory cause missed appointments: a text/telephone
reminder would help
7
Book appointments by text
2
Publicise appointments and means to book them more
1
General positive comments about receptionists! (perhaps indicating we
should stick to a “human face” at the front desk to welcome patients
rather than machine to book in)
3
Extended evenings/more appointments
6
Fewer patients
4
No half day closing/more appointments
7
More telephone lines
1
Strike patients off list of they miss an appointment
2
Ration early and late appointments so they are only for those who can
not attend at other times
4
59
THE LINKS MEDICAL PRACTICE
Why is surgery empty but then told no appointments?
1
More nurse appointments
1
First come, first served system implemented
General positive comment about system
6
Worried about security of online website
1
60
Details of the action which we intend to take as a consequence of
discussions with the PPG in respect of the results, findings and
proposals arising out of the local practice survey
See comprehensive Action Plan above
Details of the action which we have taken on issues and priorities as set
out in the Local Patient Participation Report
See comprehensive Action Plan above where we have outlined the changes
we have already made to our service, for example: Place message on
website, patient callboards and on patient newsletter stressing importance of
attending appointments and also allowing patients to cancel appointments
online. We have also drawn up a mobile telephone and e-mail consent form
online where patients may submit their details to obtain reminders as to their
appointments and we are beginning to collect some responses. We are also
collecting these details as standard practice from new patients registering at
the practice (providing that they wish to take advantage of the service.)
The Links Medical Practice opening hours of the practice premises and
the method of obtaining access to services throughout the core hours
These are available via leaflets in the surgery, are advertised on posters in
the waiting room, are listed in the surgery booklet and are available on our
website at the following address:
http://www.thelinksmedicalpractice.co.uk/opening-times.aspx?t=1
Downham Surgery Normal Opening Hours
The opening hours are Monday to Friday 8:15 am to 12 midday (with the
doors open until 12:30 pm) & 1:30 pm to 6 pm except Bank Holidays when the
surgery is closed and Tuesday when the surgery closes at midday.
For details of what to do if you require a doctor please look at the ' what to do
when we are closed section' of our website.
There are out of hours appointments available to pre book for those patients
who are unable to attend during working hours.
The surgery telephones are off each day from 12pm to 1:30pm.
Monday
8:15-10:30am
Open Surgery
3:00-5:30pm
Booked Appointments
Tuesday
8:15-10:30am
Booked Appointments
Half Day closure from 12pm
Wednesday
8:15-10:30am
Booked Appointments
3:00-5:30pm
Booked Appointments
Thursday
8:15-10:30am
Booked Appointments
3:00-5:30pm
Booked Appointments
Friday
8:15-10:30am
Booked Appointments
3:00-5:30pm
Booked Appointments
Saturday
09:00-10:20am Booked appointment onlySurgery is not open for queries or script collection on Saturdays or during
evening surgery.
THE LINKS MEDICAL PRACTICE
Mottingham Surgery Normal Opening Hours
The opening hours are Monday to Friday 8:15 am to 12 midday (with the
doors open until 12:30 pm) & 1:30 pm to 6 pm except Bank Holidays when the
surgery is closed and Thursday when the surgery closes at midday.
There are a number of out of hours appointments available to pre book for
those patients who are unable to attend during working hours. Please contact
the surgery for details.
For details of what to do if you require a doctor please look at the ' what to do
when we are closed section' of the website.
The surgery telephones are off each day from 12pm to 1:30pm
Monday
8:15-10:30am
Open Surgery
3:00-5:30pm
Booked Appointments
Tuesday
8:15-10:30am
Booked Appointments
3:00-5:30pm
Booked Appointments
Wednesday
8:15-10:30am
Booked Appointments
3:00-5:30pm
Booked Appointments
Thursday
8:15-10:30am
Booked Appointments
Closed from 12pm
Friday
8:15-10:30am
Book on the day
3:00-5:30pm
Booked Appointments
Saturday
09:00-10:20am Pre Booked appointments only
Surgery is not open for queries or script collection on Saturdays or during
evening surgery.
Method of obtaining services when the surgery is closed - EMDOC
services in Bromley
EMDOC (or “Emergency Doctors”) is an out-of-hours GP-led service for you if
you become ill outside normal surgery opening times and need to see a
General Practitioner. Because we understand that you can become ill at
anytime, we use this as a “deputising service.” It is run by associated GPs in
Bromley to provide cover at all times and hours throughout the year. Please
be aware that calls at night should be reserved for serious or urgent cases
that cannot wait.
If you need urgent medical advice when your surgery is closed, during the
day, at night, weekends (including Saturday morning) or Bank Holidays, here
is what you should do.
Dial the EMDOC number given in your GP's answerphone message.
Currently the EMDOC number is: 0208 676 3263
Explain clearly what the problem is to the EMDOC clinician.
The EMDOC clinician will either:
 Advise you regarding a self-medication
 Advise you to attend a local A&E or Minor Injuries Unit
 Arrange for you to attend a local clinic
 Arrange for GP, nurse or paramedic to visit you
 Arrange to call an ambulance if necessary
62
THE LINKS MEDICAL PRACTICE
If you suspect a heart attack and if chest pains last for more than 10-15
minutes, possibly with nausea and sweating, dial 999 and let the
ambulance service know that you suspect a heart attack.
NHS Direct
If you require advice, and you are not sure if you need a doctor call NHS
Direct who will be able to help you.
NHS Direct is a phone service staffed by nurses and professional advisers
giving confidential healthcare advice and information 24 hours a day.
You can call NHS Direct on 0845 4647. Calls are charged at local rates.
You can also visit NHS Direct Online at www.nhsdirect.nhs.uk for advice on
healthy living, guidance on treating common health problems at home,
information about many conditions and their treatments, and details of NHS
services in your area.
The Links Medical Practice extended hours access scheme
We run an extended hours opening scheme to allow those who commute or
who cannot attend through normal working hours to have access to the doctor
at weekends and in the evening. We have Saturday morning (9am-12pm)
and evening weekday appointments (to 7:30pm on Monday at Mottingham
and to 7:30pm Wednesdays at Downham) available for workers convenience.
These appointments are bookable.
These are pre-booked appointments only and are with the doctor on the rota.
The individual doctor you see will vary as the doctors work on a rota basis
sharing the workload and our practice employs more than one doctor.
We currently only offer pre-booked surgery GP doctor appointments or
telephone appointments with a doctor throughout these hours, but look to
provide a nurse service in the future were there to be a demand for it.
63