Bristol, North Somerset, Somerset and South Gloucestershire Area Team 2014/15 Patient Participation Enhanced Service

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1 Bristol, North Somerset, Somerset and South Gloucestershire Area Team 2014/15 Patient Participation Enhanced Service Practice Name: St George Health Centre Practice Code: L81062 Signed on behalf of practice: Dr Mark Eddison Date: 25 March 2015 Signed on behalf of PPG: Jo Williams Date: 17 March Prerequisite of Enhanced Service Develop/Maintain a Patient Participation Group (PPG) Does the Practice have a PPG and/or PRG? Yes Method of engagement with PPG and/or PRG: with written communication to representatives without access to Number of members of PPG and/or PRG: 16 Detail the gender mix of practice population and PPG and/or PRG: % Male Female Practice PPG Detail of age mix of practice population and PPG and/or PRG: % < > 75 Practice PPG StGHC Patient Participation Report Page 1 of 12

2 Detail the ethnic background of your practice population and PPG and/or PRG: White Mixed/ multiple ethnic groups British Irish Gypsy or White Other White &black White Other Irish &black white African &Asian mixed traveller Caribbean Practice PRG Asian/Asian British Black/African/Caribbean/Black British Other Indian Pakistani Bangladeshi Chinese Other Other Any African Caribbean Arab Asian Black other Practice PRG Describe steps taken to ensure that the PPG and/or PRG is representative of the practice population in terms of gender, age and ethnic background and other members of the practice population: The patient participation group had historically grown to in excess of 60 members. Some of these members subsequently ceased to be actively involved. The practice made a decision this year, to engage on an ongoing basis with those members who actively (i.e. has responded to communications in the last year) wanted to be involved in shaping services to patients. Therefore the group reduced in size. The practice has since taken the following steps to make the group more representative of the practice population and to recruit new members: Invite all new patients at the point of registration Invite existing patients at routine visits Advertised on the practice website Advertised within the surgery by means of: o Posters o Electronic communications board o Flyers in the practice for reception staff and clinicians to proactively hand to patients Are there any specific characteristics of your practice population which means that other groups should be included in the PPG and/or PRG? e.g. a large student population, significant number of jobseekers, large numbers of nursing homes, or a LGBT community? NO If you have answered yes, please outline measures taken to include those specific groups and whether those measures were successful N/A StGHC Patient Participation Report Page 2 of 12

3 2. Review of patient feedback Outline the sources of feedback that were reviewed during the year: Patient feedback forms Patient complaints Friends and family test CQC verbal inspection feedback (formal report pending) Local community groups (e.g. new parents) How frequently were these reviewed with the PPG and/or PRG? Quarterly (as agreed with the PPG) StGHC Patient Participation Report Page 3 of 12

4 3. Action plan priority areas and implementation Priority Area 1 Description of priority area: To develop nursing team services What actions were taken to address the priority? Minor Illness Increased the number of minor illness appointments available Recruited a nurse practitioner to see children over 6 months Increased the number of conditions seen, through staff training Reduced the age which one of our nurses can see patients (from over 16s to over 12s) Continue to provide ongoing training to further increase the number of conditions seen and to increase appointment availability for under 12s Implemented a new procedure for suspected urinary tract infections (UTIs) whereby patients bring a sample in by 2:30pm to be tested. This negates the need for an appointment Nurse practitioner currently attending a six month independent prescribing course to issue and sign off prescriptions in the consultation Reception and clinicians signpost appropriate patients to use the minor ailments scheme with local pharmacies. This frees up clinical appointments for more serious conditions Produced a flyer for GPs to hand to patients who are seen in a GP surgery with conditions which are more suited to self care, a pharmacy or a minor illness clinic Triage Implemented nurse practitioner triage to deal with requests for same day appointments, ensuring urgent clinical problems are prioritised Implemented GP triage at periods of peak demand StGHC Patient Participation Report Page 4 of 12

5 Spirometry Obtained new equipment resulting in patients needing a shorter appointment. (We halved the appointment duration thereby increasing appointment availability.) Trained a second Health Care Assistant in this procedure which increases appointment choice for patients Trained the nurse practitioner to interpret spirometry results and manage a patient s ongoing care. This will free up appointments currently booked with GPs Dressings Trained a Health Care Assistant to provide appointments for ongoing wound care Implemented a booking slip that a nurse completes for a patient to give to reception. This ensures patients seen at appropriate intervals and appointment durations. We will be training a further member of staff to provide a dressing service Currently piloting a dressing clinic so patients care is shared between nursing staff to ensure continuity of care for the patient Ear Syringing Trained a Health Care Assistant to provide adult ear care appointments Issue patient information packs prior to appointment to ensure ear care is appropriate and risks involved are understood. The self care required by a patient (prior to attending an appointment) is explained within the pack. Currently training a further HCA to provide this service, increasing appointment choice for patients Purchased a second ear syringing machine to prevent service interruption Chronic Disease Management For patients with more than one chronic disease (e.g. diabetes, asthma, hypertension) we now encourage patients to make one annual review appointment instead of one per illness Supported a nurse in undertaking an asthma diploma which provides more appointment choice for patients Supported and trained a nurse to manage asthma consultations for older children Supported a nurse to undertake a COPD diploma Currently supporting a nurse who is undertaking an independent prescribing course Actively encourage patients to be aware of when their annual review is due and to book in advance. Admin team write to patients who do not make a timely appointment. Trained phlebotomists to perform blood pressure monitoring at blood test appointments. This increases appointment choice and reduces the length of time a patient needs to be in the practice. Purchased a new ECG machine to provide a heart rhythm trace service for patients as the older machine has been causing service interruptions. StGHC Patient Participation Report Page 5 of 12

6 Contraceptive Procedures Ongoing registration to deliver the For Young People Scheme (4YP) providing sexual health services and emergency appointments to years olds. Trained a nurse to provide contraceptive implants, freeing up GP appointments Introduced a nurse led coil fitting consultation service (prior to fitting) to ensure the patient is fully informed Trained a nurse to fit coils Increased appointment availability for smears, offering clinics in out of hours e.g. Saturday mornings Result of actions and impact on patients and carers (including how publicised): The practice has an improved mix of nursing team services to deliver a more responsive supply of appointment types and times Improved access to urgent/same day nursing medical advice and consultations Greater opportunity for contraceptive advice with a trained nurse who will carry out the procedure Improved continuity of care for the management of patients with long term conditions Number of visits to the practice will be reduced due to combining appointments and the improved skill set of staff Appointment length of specific tests/procedures reduced due to introduction of new equipment Increased nursing capability has freed up GP appointments to cope with increased patient demand This report is available on our website, at reception and as part of a waiting room display Patient Newsletter to be implemented in the year StGHC Patient Participation Report Page 6 of 12

7 Priority Area 2 Description of priority area: o To improve continuity of care for patients with ongoing conditions (whilst recognising, from previous patient surveys, that 68% of patients stated they were happy to see any GP with a one off condition) What actions were taken to address the priority? Updated the practice leaflet and website to include the sessions each GP works so that patients are fully aware of clinician availability when booking appointments. Routine GP appointments made available to book online and with exactly the same access to appointments as for patients telephoning or booking in person. Introduced pre bookable telephone consultations for patients to support continuity of care Wrote to all over 75s in June 2014 confirming their named GP. Changed named GP where patient requested and aligned couples with the same named GP where desirable to support caring activity GPs now working in a formal paired system so paperwork and queries can be covered when one of the pairing is not on duty. In this way we are trying to ensure that GPs are more familiar with patients ongoing care management. Routine GP appointments can be made at least four weeks in advance to improve accessibility to the same GP 50% of GP appointments are released within five working days as a result of a previous patient survey on this matter. This system continues to be effective. Agreed a practice wide standard to take responsibility for documenting a patient s ongoing management plan, when presenting with a new condition Issued Care Plans for 170 patients to better support their ongoing care and management Receptionists actively encourage a patient to book with the usual GP for an ongoing concern Care Plans reviewed on an ongoing basis Recruited a further GP in March 2015 who will manage an individual patient case load Result of actions and impact on patients and carers (including how publicised): This report is available on our website, at reception and as part of a waiting room display Patient Newsletter to be implemented in the year Patients are better directed to the appropriate GP managing their condition Reduced feedback/complaints re particular GP availability Reduced feedback/complaints re clinical management of patient problems by multiple GPs Introduction of care plans and sharing with out of hours providers will improve continuity of care StGHC Patient Participation Report Page 7 of 12

8 Priority Area 3 Description of priority area: To maximise the effective use of extended hours appointments to meet patient demand What actions were taken to address the priority? Following patient feedback and a successful pilot, we now open at 7:30am on Mondays for nursing and routine GP appointments Continue to provide extended hours until 7pm on weekdays (excluding Fridays which are not popular) Continue to open the surgery on one Saturday per month during the Autumn/Winter. We do not open in the summer months due to the high proportion patients who do not attend appointments at these times Continually review from ongoing patient feedback the best allocation and timings of the funded extended hours Note Our extended hours arrangement is for a finite number of GP and nursing hours (being 5.5 hours per week) in accordance with the funding provided. Result of actions and impact on patients and carers (including how publicised): Extended hours appointments are fully utilised Patients and carers who work or have limited availability to access GP appointments have utilised online booking of these appointments We have publicised this to patients and carers on external practice signs, front door signs, practice leaflet and our website This report is available on our website, at reception and as part of a waiting room display Patient Newsletter to be implemented in the year StGHC Patient Participation Report Page 8 of 12

9 Progress on previous years Please see progress made on issues raised in the previous years and : Patient Survey You said We did Outcome You would like to book, change and cancel appointments online We listened to our patients and said we would introduce online booking when our new booking software was installed. This was piloted in April 2014 with a small number of GP appointments. Following the successful pilot this was implemented in April 2014 All routine GP appointments are available to book online, via the telephone or face to face in the surgery. Patients who have signed up for online access can also cancel appointments online. Reviewed how appointments are released for GPs There is sometimes a long wait to see my usual GP for ongoing problems (continuity of care) Reviewed the number of active patients who see each GP in comparison to the number of sessions the GP works each week. Ensured all clinicians are aware of up to date appointment availability when asking a patient to book with a specific clinician. Whilst we have reviewed these matters, we constantly monitor and adapt appointment availability to meet the needs of our patients and the ever changing patient demand. Updated our practice leaflet and website to show which days each GP holds a surgery. StGHC Patient Participation Report Page 9 of 12

10 You said We did Outcome It can be difficult to get through on the telephone at peak times Employed an additional receptionist, on a daily basis, so that prescriptions and administrative tasks are dealt with away from the telephones. This freed up the reception team to maximise the volume of calls taken. Moved our main switchboard station for answering calls in Q Transferred the more time consuming calls (such as complex queries and referrals) to our secretaries, freeing up receptionists to take more incoming calls. Phone statistics show a dramatic reduction in the average time patients wait to get through to the surgery. We are pleased to say that complaints concerning getting through on the phone are now rare. The receptionist on the switchboard station can now focus on answering calls without work based interruptions, meaning less waiting time for our patients Ongoing You liked the open surgery suggestion for urgent problems There is too much prerecorded information to listen to when telephoning the surgery Increased monitoring of phone statistics from 3 to 4 times per day in February 2015 against set targets with action taken accordingly In March 2013 we piloted test sessions initially to gauge feedback from staff and patients. We implemented changes following this feedback and have since been running two emergency surgeries per day. Patients who need to see a GP urgently will be seen within 24 hours. They are asked to come to the surgery at a given time and be prepared to wait. Patients are informed that the on call doctor will deal with one urgent problem in the consultation. Updated our recorded message to make it as succinct as possible in Q Ongoing We review daily the patient demand for urgent/same day appointments and take proactive steps to manage demand for our patients Reduced time for patients waiting to get through to the surgery StGHC Patient Participation Report Page 10 of 12

11 Patient Survey You said We did Outcome 100% of you were able to be seen for urgent healthcare within 24hrs 86% of you felt the provision for urgent healthcare had improved. 9% did not know if the provision had improved and 5% felt the provision had not improved mainly that waiting times were not appropriate. 60% of you were aware you could request repeat prescriptions online and 24% had already signed up for online access. 56% of you would book appointments online 72% of you know who your registered GP is 68% of you are happy to see any GP 59% of you are aware minor ailments can be seen by a pharmacy 88% of you are aware we run a minor illness clinic, with 97% of you happy to use this service Maintained our two urgent surgeries each day Allocated appointment times for the urgent surgery with effect from March Publicised the on line prescription request service on i) website ii) posters in practice iii) message on prescriptions Implemented online booking for routine GP appointments in April 2014 We held a service development meeting on Saturday 26 April 2014 for all GPs and Managers. We considered improvements to, new and different systems and staff working arrangements that could enhance continuity of care for a patient seeing more than one GP. Continue to direct patients to pharmacies as appropriate via reception, GP and Nurse triage. Continue to operate this service and refine in terms of the conditions and ages seen with staff training and development. Patients are seen within 24 hours for urgent clinical care Reduced waiting time for patients in the urgent surgeries Increased patient choice and ease of ordering repeat medication. Patients are also being encouraged to sign up for the Electronic Prescribing Service which is due to go live in April 2015 Patients can book or cancel appointments online. The practice monitors online bookings to ensure they are appropriate. We now: 1) Document and inform patients of their management plan 2) State if the patient should return to see a named GP GP appointments are not taken for conditions which can be dealt with elsewhere thus keeping GP appointments for more serious conditions We have dealt with many actions which are covered in priority area 1 of this report StGHC Patient Participation Report Page 11 of 12

12 4. PPG Sign Off Report signed off by PPG and/or PRG: YES Date of sign off: 23 March 2015 How has the practice engaged with the PPG and/or PRG: Via ed information (postal communications for members without access) How has the practice made efforts to engage with seldom heard groups in the practice population? Leaflets, posters and direct address by receptionists Has the practice received patient and carer feedback from a variety of sources? Yes Was the PPG involved in the agreement of priority areas and the resulting action plan? Yes How has the service offered to patients and carers improved as a result of the implementation of the action plan? Extended hours More appointments available ahead and to chosen GP More training for nurses to relieve GPs and increase patient access More patient care plans to improve coordination Teaming up of GPs to ensure better support for patients Coordinated appointments for patients with multiple issues Quicker response time from receptionists when patients phone These are to name but a few improvements Do you have any other comments about the PPG or practice in relation to this area of work? I m very impressed to see that all suggestions made have at least been discussed and most put into action quickly and effectively. StGHC Patient Participation Report Page 12 of 12

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