FAIRFAX GROUP PRACTICE
PATIENT PARTICIPATION GROUP REPORT
Establishing the Patient Participation Group:
In July 2011 we set about establishing our Patient Participation Group. We
had tried to do this in the past but unfortunately had not been successful in
recruiting an adequate number of interested patients. We therefore decided
to go about it in a slightly different way on this occasion. We advertised on
the website, by displaying posters in the waiting room and with information in
patient newsletters but we also asked all members of the practice team to try
and identify patients who they thought may be interested and would represent
the practice population in terms of age, sex, ethnic background, patients with
chronic illnesses, nursing home representation, carers etc.
As a result of this ‘recruitment’ campaign we received expressions of interest
from a total of 12 patients who represent the following groups:
Sex
Age
16-24
25-44
45-64
65+
Sex
Male
Female
Male
Female
Male
Female
Male
Female
0
1
1
1
2
3
2
1
This group represented patients from different ethnic and cultural
backgrounds, patients with long term chronic illnesses, a carer, a young single
mum and a member of the nursing team from one of our residential nursing
homes. (See Appendix 1)
First Meeting:
Our first meeting was held in October 2011 but unfortunately less than half of
the patients who had agreed to attend were actually able to do so.
Nevertheless, along with practice representation from the Practice Manager,
Practice Administrator and Lead GP for Patient Liaison, we went ahead with
our first meeting. We discussed the purpose of the group, frequency of
meetings and the areas we should focus upon.
Practice Priorities
Information had been prepared for the group to give them some background
information about the practice in terms of practice list size, the appointments
system used, repeat prescription ordering and the number of prescriptions
generated in an average week, as well as some general information on
staffing, nursing home involvement etc.
We then looked at previous surveys we have conducted and the areas where
we felt we could concentrate on which would give us the greatest opportunity
for improvement. It was agreed that the following areas should be the focus
of our attention and these should form the basis of our next patient survey:
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Appointments
Telephone Access
Reception/Waiting Times
Satisfaction with GP and Reception Staff
Following this meeting, a suitable patient survey was designed and circulated
to members of the group via e-mail. At the suggestion of one of the members,
an additional question was added and the survey was then conducted during
the month of November when all patients attending for a GP appointment
were asked to complete a survey (Appendix 2). We did consider running the
survey on-line but decided on this occasion not to do so.
Following the conclusion of the survey period the results were collated
(Appendix 3) and a summary of the findings drawn up for discussion at the
next meeting of the Patient Participation Group in January 2012 (Appendix 4).
Second Meeting and Review of Survey Results:
Appointments: - Just over half of patients thought it was fairly easy or very
easy to get an appointment at the time they wanted and only 22% of patients
felt they had not been able to see the specific GP or nurse that they wanted to
see. We discussed our appointments system and agreed that it was always
going to be fairly difficult to see specific doctors at certain times because we
are a large group practice with 7 doctors, most of whom are part-time.
However, the group agreed that the triage system was useful and means that
anyone wishing to speak to a doctor or nurse on the same day is able to do so
by utilising this service. We have recently altered the way we open prebookable appointments so that patients can now book only 2 weeks ahead in
an effort to cut down on the number of patients missing appointments. The
group suggested it may be useful to introduce a text reminder service and this
was qualified by the fact that approximately half of the patients surveyed had
thought this would be a good idea. The group felt it is useful to advertise
surgery times for individual doctors in the waiting room and up-to-date
information should always be available. This information is also available on
line.
Telephone Access: - Patients continue to tell us that they have problems
getting through to the surgery on the telephone. As a result of a recent
capacity and demand survey which showed that the majority of calls coming
through are in the first hour of opening, we have adjusted shift patterns of staff
to ensure that we have as many lines as possible operating in that first hour.
We are also encouraging patients to register for the on-line appointments
system which avoids them having to ring the surgery and means they can
book a convenient appointment via the internet at any time of the day or night.
This is something we are hoping will continue to expand. We also discussed
the new electronic prescription service which we will be offering in the next
month, along with the facility to order repeat prescriptions on-line. With the
introduction of more on-line services it is hoped that pressure on the phone
lines may in turn be reduced.
Reception/Waiting Times: - 59% of patients stated that they waited for more
than 15 minutes for their appointment. This is a high proportion and we need
to look at ways of addressing this, as well as realising the importance of
keeping patients aware of any delays in appointment times. We discussed
the reasons for this and part of the reason is that patients regularly attend with
more than one problem which takes up more than the 10 minutes they have
been allocated. It was suggested we put up posters or information in the
waiting room to inform patients that they should not attend with a list of
ailments or problems in a 10 minute slot as this means delays for subsequent
patients. It was also suggested that an LED screen in the waiting area would
be useful to inform patients of any expected delays. 30% of patients were not
happy with the design of the reception area from a confidentiality point of
view. This is a difficult area to address given that we work from a PCT
building and are limited in the space available but we will try to make sure
there is as big a distance as possible from the queue waiting to be attended to
and the reception desk itself. We have recently installed piped background
music to help and another suggestion has been to have a TV screen installed
which could inform patients of new developments within the practice or
topical/seasonal health related issues. We discussed the layout of the seating
area in reception and this is something we can look at to improve things.
There are also signs in reception pointing out that patients can ask to speak to
a receptionist in private if they particularly want to do so. The group also
asked if the practice had considered electronic check in. This is something
we have discussed in the past in order to speed up the process for patients
simply checking in for an appointment. At that time, cost was a big factor but
it was agreed that we will look into this again as anything to improve waiting
times should be considered.
Satisfaction with GP and Reception Staff: - Overall, 91% of patients said
that they felt the receptionist had dealt with their request for an appointment
very well or quite well and 78% said that the appointments system had been
explained to them or they were already familiar with the system. Customer
service training is ongoing in the practice and we will continue to ensure
patients are informed of any changes or improvements to the booking system.
Over 90% of patients also said they were happy with the outcome of their
consultation with the doctor, that they fully understood the advice given to
them and that they felt they had been listened to adequately during the
consultation.
Summary of Actions to be taken:
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Practice to consider introducing text messaging service for
reminders of appointments and recalls.
Advertise surgery times for individual doctors in the waiting
room and on the practice website.
Leaflets and posters in the waiting room to encourage patients
to register for on-line services.
Make information available for patients regarding the
importance of keeping 10 minute appointment slots to 10
minutes only!
Consider installation of a TV screen to advertise new
developments within the practice or to provide information on
topical/seasonal health related issues.
Consider an electronic check-in station.
The Way Forward for the Patient Participation Group.
We discussed that it was useful to meet up as a group but it was disappointing
that we cannot recruit more members to give their input and to gain a wider
range of views, suggestions or comments. We would like to explore the
possibility of developing a virtual Patient Participation Group with an e-mail
community whom we can consult with on a regular basis. We will do this by
advertising both in the practice and on the website and will collect e-mail
addresses wherever possible from patients who are willing to take part.
Finally and most importantly, we would like to thank those patients who have
given their time to the group so far. Their input has been greatly appreciated
and some valuable feedback has been gained from them.
Establishing the Patient Participation Group:
Appendix 1
The Fairfax Group Practice is determined to ensure patient involvement in decisions
about the range and quality of services provided by the practice and to promote the
proactive engagement of patients through the use of an effective face to face Patient
Participation Group.
PRG application process:
We advertised in the practice by displaying posters and notices, in the practice
newsletter and on the website, inviting patients to express their interest in joining this
group. We also decided that in view of the poor response previously, we would
actively try to identify patients who could contribute and who would represent a cross
section of our practice population. We did this by asking all members of the practice
team to invite individually identified patients. We also contacted our local nursing
homes for representation and looked at our carers and young parents to try to
encourage them to join the group.
This resulted in us recruiting 11 members to the group. We contacted all members to
notify them of the date of the first meeting and asking for up to date mobile numbers
and e-mail addresses so that we could keep in contact with them.
Demographic representation:
We realise that the PRG will never be truly representative of the practice population
as a whole but we endeavoured to establish the age/sex distribution, ethnic minority
groups, carers, nursing home residents and patients with chronic illnesses.
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Age/sex distribution – the practice has an almost equal split between male
and female patients with slightly more females. 19% of our patients are under
16 and we have an increasing number of patients over the age of 65; this
group currently forms 15% of the patient population. The largest group of
patients at 29% are between the ages of 25 and 44.
Minority ethnic groups – the practice has a growing group of ethnic minority
groups with a fairly large proportion of patients from the Jewish population.
Nursing home residents – we have a relatively high number of patients in
nursing and residential homes. Over 15% of our patients are over the age of
65 and of these patients, 15% reside in a nursing or residential home. The
largest proportion of these are at Heathlands where we have a total of 150
patients and this utilises a significant amount of clinical resource.
Carers – the practice has a relatively small number of registered carers but it
is acknowledged that we will undoubtedly have more who have either not
registered as a carer or do not consider themselves as such.
Chronically ill patients – a significant proportion of patients have a chronic
illness and are on one of the practice’s disease registers.
Current PRG:
Age/Sex Distribution
AGE
16-24
25-44
45-64
65+
SEX
Male
Female
Male
Female
Male
Female
Male
Female
PRACTICE
6%
6%
14%
15%
13%
13%
6%
9%
PRG
0%
9%
9%
9%
18%
27%
18%
9%
Minority Ethnic Group
2 members of the PRG fall into this group.
Carers/Nursing Home Representation
2 members of the PRG fall into this group - one of them being a member of staff at
one of the nursing homes.
Jewish Representation
2 members of the Jewish population were represented on the group.
Chronic Illness
5 members of the PRG have a chronic illness
Others
One member has a hearing disability and another a learning disability.
Fairfax Group Practice
Appendix 2
Patient Survey
Dear Patient
Many thanks for taking part in this short survey to help our practice understand how we can improve.
Please answer all the questions by ticking the appropriate response.
Patient Experience
Q1.
How easy was it to get an appointment for the time you wanted?
Not very easy
Fairly easy
Very easy
Q2.
Were you able to see the GP/Nurse you wanted to see?
No
Did not want specific GP/nurse
Yes
Q3.
Quite well
Not at all well
Not very well
○
○
○
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Did the receptionist fully explain the appointments system to you?
No
Yes
Already familiar with the system
Q5.
○
○
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How well did the receptionist deal with your request for an appointment?
Very well
Q4.
○
○
○
○
○
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How easy do you find it to get through to the surgery on the telephone?
Very easy
Fairly easy
Not very easy
Not at all easy
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Q6.
Would you be interested in receiving an appointment reminder via text?
Yes
No
Q7.
In the reception area, can other patients overhear what you say to the
Yes, but I don’t mind
Yes and am not happy about it
No, other patients can’t overhear
Don’t know
Q8.
Between 5 to 15 minutes
Between 15 to 30 minutes
More than 30 minutes
Can’t remember
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Did you fully understand the advice given to you by the Doctor during your
consultation?
Yes
No
Q10.
receptionist?
How long after your appointment time do you normally wait to be seen?
I am normally seen on time
Q9.
○
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Did you feel that you were listened to by the Doctor during your consultation?
Yes
No
○
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If you have any further comments/suggestions as to how we can improve, please note these below.
Fairfax Group Practice
Appendix 3
Results of the Patient Survey – November 2011
Methodology
The survey was held over a 4 week period in November 2011. All patients attending for appointments
were invited to complete a questionnaire. 157 completed forms were returned.
Results
Q1.
Q2.
Q3.
Q4.
Q5.
Q6.
How easy was it to get an appointment for the time you wanted?
Not very easy
74
47%
Fairly easy
61
39%
Very easy
22
14%
Were you able to see the GP/Nurse you wanted to see?
No
35
22%
Did not want specific GP/nurse
48
31%
Yes
74
47%
How well did the receptionist deal with your request for an appointment?
Very well
78
50%
Quite well
65
41%
Not at all well
8
5%
Not very well
6
4%
Did the receptionist fully explain the appointments system to you?
No
34
22%
Yes
57
36%
Already familiar with the system
66
42%
How easy do you find it to get through to the surgery on the telephone?
Very easy
12
8%
Fairly easy
59
38%
Not very easy
43
27%
Not at all easy
43
27%
Would you be interested in receiving an appointment reminder by text?
Q7.
Q8.
Q9.
Q10.
Yes
67
43%
No
90
57%
In the reception area, can other patients overhear what you say to the
Yes, but I don’t mind
84
54%
Yes and am not happy about it
48
30%
No, other patients can’t overhear
9
6%
Don’t know
16
10%
receptionist?
How long after your appointment time do you normally wait to be seen?
I am normally seen on time
3
2%
Between 5 to 15 minutes
55
35%
Between 15 to 30 minutes
74
47%
More than 30 minutes
19
12%
Can’t remember
6
4%
Did you fully understand the advice given to you by the Doctor during your
consultation?
Yes
153
97%
No
4
3%
Did you feel that you were listened to by the Doctor during your consultation?
Yes
20
91%
No
15
9%
Patients were also invited to make any other comments and these are detailed on the following pages:
Comments received from patient survey – November 2011

One particular doctor is always busy typing as you are talking to him and often
over-talks you when trying to describe your problem. Apart from him, all
other doctors are very good. Recently, one receptionist refused to give my
wife blood results saying she was not a doctor. My wife phoned the following
day, asked a different receptionist and was given the results.

Dr Colter is a star!!
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Overall very happy. At times of real concern you are extremely helpful.

The new system of not being able to book an appointment on the actual day is
not satisfactory.
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I would like to book appointments that are not urgent more than one week in
advance to fit in with a very busy diary as one week is too limited. I find it
impossible t see a doctor at short notice when it is really urgent.
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Appointments system is terrible.
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Sometimes the radio station is a bit much, especially if anxious and just want it
to be peaceful and quiet. Also usually too warm! Is this very healthy in a
surgery?
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A doctor for just children’s appointments. A doctor for old people. Old
people seem to take up all the appointments and every time I come in there is
always someone asking to register with a doctor. Stop taking new people
on!!!!
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Provide TV and newspapers for waiting patients. Also a cup of tea would be
nice.
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Please, the sound of the radio is quite high and irritating.
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Would like to say how good Dr Dixon is (not patronising, open and honest).

Please – some sort of online system for booking long term/regular/routine
appointments. The current on demand and limited telephony system is
inefficient and frustrating if all you want to do is make a regular/advance
appointment. Admin staff could easily respond to confirm online requests for
these sorts of appointment needs, surely?!
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Please listen to patient’s requests over the phone. Please open triage telephone
lines for longer and with more than one doctor to make it easier to be dealt
with.
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Poor appointments system.
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Changes are made often and I do not come very often so I am not always
aware of a new procedure. The receptionists expect me to know.
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I think it is very bad that you can wait over 30 mins for your appointment. We
all have busy lives, not just doctors, and this affects peoples’ schedules badly.

Difficult to get through on the phone in the mornings.
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Two weeks for an appointment is too long.
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We wait too long at reception. Why not invest in an electronic appointment
check in screen?
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Evening/Saturday morning to help those at work.

When told by the receptionist that there is nothing available on the day, call
back tomorrow when some slots will be released and then find they have all
gone, surely it would be much easier to have given an appointment on one’s
first call than have to ring back the following day and find they have all gone
again, which only causes stress to the patient.
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Excellent! Just telephone is a problem – always engaged. Otherwise,
excellent service, very good bedside manner all doctors!

You can never get through in the morning, it is always engaged then all
appointments have gone. The queue for the reception desk is often very long –
there should be extra staff manning at busy times. This time it was easier to
get my appointment but normally it is extremely difficult, made more so by
the attitude of some of the receptionists. Today it was nice to be greeted by a
smiling face. It is not easy getting to see the same doctor so there can be
continuity of care.
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On-line repeat prescription ordering and booking appointments makes it much
easier. Value the triage system.
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Find it hard to get an appointment – sometimes up to a week later.

You could do with a poster and take away leaflet in the waiting room,
explaining simply the appointment system, ie web, phone etc. I know
appointments are released at certain times but I’m not clear on it. I know you
can book appointments via the web but again not 100% clear. Variety of
methods – not clear on them all.

Because I only get one day off a week, I cannot pre-book an appointment with
my doctor. The last time I had to wait 6 weeks.

Revert to appointment booking and prescription ordering by phone and
employ more staff to take phone calls.

To understand a patient’s needs and not be giving advice as they are not
doctors. Also to be briefed that children with asthma and reduced immune
systems need to be prioritised for flu injections and not ignored until over 65’s
are dealt with.

I feel as though I am being rushed through the appointment. Told about the
budget for tablets, mine apparently cost £140 per month for one of them. I felt
a bit guilty for being in pain.

As stated, privacy when speaking to a receptionist is very poor – not sure how
to improve it? A radio in reception area not overly loud.

Not easy to get an appointment, doesn’t matter what time it is. Just wanted to
see a GP. If no appointments left on a day to day basis, patients who feel they
need to see a GP should be able to wait in a queue.

On the occasion I’ve needed an emergency visit to the doctor, I have been told
the earliest appointment would be 2 weeks and I should visit the WIC which I
feel is unacceptable.

I must say in the main the receptionists do their best. But it is a little
frustrating when you can’t get through on the telephone. You can be ringing
from 8.30 to get an appointment, only to find that when you do get through
there are no appointments left. (PS You all do your best)

Trying to get an appointment is a joke and waiting times are even worse. Why
are there only telephone consultations in the morning?

Re telephones – it depends what time one rings. More cover at busy times
would be good.

Problems with prescriptions. Often get ‘lost’ even when e-mailed.

Impossible to get an appointment when ill. Always told have to ring on a
certain day.

The receptionists should have a smile on their face and be more helpful.

I have overheard patients in the waiting room discussing how they make
appointments without needing them because it is so hard to get an
appointment. One woman said she always had an appointment and would
cancel it on the day if it wasn’t needed.

Should be able to book appointments for a few days time, at a time required to
fit. Should not have to wait a week and still not get a convenient time.
Service is good but it is the booking system that is not. If wanted an urgent
appointment, do not think system is acceptable – can never get through early
in the morning.
Appendix 4
SUMMARY OF FINDINGS
PATIENT SURVEY CONDUCTED DURING NOVEMBER 2011

Just over half of patients thought it was fairly easy or very easy to get
an appointment at the time they wanted.

Only 22% were not able to see the specific GP or nurse that they
wanted to see.

91% of patients thought the receptionist dealt with their request for an
appointment very well or quite well with 78% saying that the
appointments system was explained to them or they were already
familiar with the system.

54% of patients felt it was not easy to get through to the surgery on the
telephone. Although this still shows there is much room for
improvement, it is an improvement on the same question 4 months
earlier when the response was 66%.

Just under half of patients thought it would be useful to have an
appointment reminder sent by text.

30% of patients were not happy with the reception area from a
confidentiality point of view.

59% of patients were waiting for more than 15 minutes after their
appointment time.

Over 90% of patients said they fully understood the advice given by the
doctor during the consultation and felt that they were listened to
adequately.