YORK HOUSE MEDICAL CENTRE PPG REVIEW 2013/2014. Prepared 24 March 2014

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1 YORK HOUSE MEDICAL CENTRE PPG REVIEW 2013/2014 Prepared 24 March 2014 York House Medical Centre PPG 24 MARCH 2014

2 In 2013 / 2014 the Patient Participation Group has been very active in seeking the views of patients and in discussing with the practice how improvements to services suggested by patients can be brought about. In that period we have been operating under national NHS guidance on the establishment of patient participation groups, and this report briefly summarises the progress that we have made to date, referring to the 2012/2013 commitments: - each of the steps referred to below relate to the sections of that guidance which we are required to achieve. We reported last year that the PPG had discussed with the practice s senior management the practical implications of the changing NHS structures within which the practice is working. At the time of writing this report we do know that 2014 onwards will be a significant period of change for general practice as both new requirements for patient service emerge as well as the detail of the financial constraints under which general practice throughout the country will be operating. As a practice and a PPG we are concerned that the rising level of demand will not be matched by available resources and we feel that it is important that the wider patient base understand the detail of this greater debate and we have backed the campaign developed by the Royal College of General Practitioners and the National Association for Patient Participation Put Patients First Back General Practice During the year we met with Dr Richard Taylor, President of the Independent Community and Health Concern Party and now Co Leader of the National Health Action and we were pleased, following press and social media comments concerning the practice, that he was able to spend a whole day with us looking at the ways in which we have been trying to meet the care needs of our patients. This report highlights the work which the practice has undertaken with the PPG in the year, looks at some of the intentions we had in the previous report and is structured on the various steps required in the national Directed Enhanced for patient participation Step 1: Develop a structure that gains the views of patients and enables the practice to obtain feedback from the practice population, e.g. a Patient Reference Group (PRG) The Patient Participation Group, which now comprises 10 members, has been meeting on average every 6 weeks. The Chairman of the PPG, Tim Berry, regularly meets with members of the partnership and the practice team to discuss areas of common concern including the impact which current changes on the NHS structures nationally and locally will have on patient services Members of the PPG are proactive in assisting the officers in developing the work of the PPG and have attended meetings of the CCG and Health and Well Being Board - Tim Berry is a member of the Wyre Forest Commissioning Consortium Advisory Group we are members of the National Association for Patient Participation Information about the YHMC PPG is available in the surgery reception area and the PPG has always had its own section within the practice web site where patients can make direct contact with the PPG and the managers of the practice.. Nonetheless we are keen to increase the number of patients whose views can be represented and we understand that not everyone wants to or can attend meetings. On the basis of the recommendations 2 P a g e

3 made in the last report, we have developed the system for operating a virtual PPG and we now have 1850 members of this group which represents 18% of the practice list aged over 18 We have analysed how representative that group is of the age and gender breakdown of the practice as a whole and the following are some key statistics Of the 1850 members of the virtual PPG:- 879 are male which represents 47% of the vppg and 971 are female representing 53% of the practice population over 18 which compares favourably with the total practice population over 18, 52% of whom are male and 48% are female Within the age group we have:- 155 members who are male and 96 members who are female which represents 62% and 38% respectively of this age group whereas 53% of the total practice population between 18 and 30 are male and 47% female Within the age group we have:- 348 members who are male (44%) and 435 members who are female (56%) compared with 52% and 48% of the total practice population within that age band Within the age group 55+ we have:- 376 members who are male (46%) and 440 members who are female (54%) compared with 52% and 48% of the total practice population within that age band The PPG believe that this number of patients who are willing to be consulted on an occasional basis regarding the planning of practice services gives us a statistically significant group of patients, spread over the age ranges from whom we look to gain useful patient feedback and opinion. The PPG has taken the view that it lacks active feedback from patients under 18 and one of the commitments for 2014 is to assess the most appropriate way of getting that feed back so that services for that age group can be appropriately designed overall this level of active involvement in the practice gives us a meaningful base from which to develop As is commented below, we intend that this group will be vital in assessing the major changes we have made to our appointments system and during the first half of the coming year we anticipate that this will be the major area of review we propose, as was highlighted in our report last year, to establish a Friends and Family Test drawing on the active input from this virtual PPG Step 2: Agree areas of priority with the PRG. The PRG and the practice will shape areas covered by the local practice survey. In 2013/2014 we again looked at those areas of concern which had been expressed in previous reports and which were highlighted in the surveys which we undertook during the year. Difficulty in accessing the practice by telephone, the ability to see a named GP or the opportunity to make advanced bookings were often highlighted. 3 P a g e

4 A considerable part of the PPG s year has been spent commenting on the relative impacts of those recommendations and statistics and assessing the ways in which we can deal with these problems and during the year not only did we look at the ways in which the new telephone triage service operate, but we analysed in depth the telephone use statistics and were pleased that the practice has increased the number of staff available to answer calls during the 8-11 am slot which our research showed us again is our period of peak demand As with most general practice we are constantly trying to find the balance between ensuring that patients who have an urgent need to consult a GP is weighed against those who value continuity of contact with a named GP During the year the PPG discussed the merits of the telephone triage service in ensuring that patients who had an urgent need were seen promptly and recognised that there would inevitably be a delay in seeing a named GP where this was preferable but not urgent During those discussions, which formed a significant part of the agendas of the PPG meetings, the role of the GP in handling calls was discussed and it was agreed that in many instances managing needs over the telephone could solve particular requirements appropriately without the need for a face to face appointment or could agree that an appointment was made for a face to face appointment where that was appropriate. It was also agreed that the relationship between the patient and the receptionist in managing this process and in ensuring patients were placed on the telephone list was essential although there had been a number of incidents (and some comments on face book) where patients did not wish to disclose the reason for their calls It was agreed that we have to put more time into explaining this process which is aimed at enabling the GPs to spend more of their finite time in direct patient care there are others services and requests which can be managed more effectively by other members of staff One of the requirements in our contract for 2014 onwards is to ensure the ways in which a named GP service can be delivered. In the first instance the NHS is asking all general practice to offer this Named GP led service for patients over 75 and we will be considering the practical ways in which this can be managed - we hope that we can make an even closer working relationship exist between the practice, community and other staff and we have been particularly interested in the ways in which IT can promote this still further During the year we have continued to engage Advanced Nurse Practitioners who, as prescribers in their own right, are able to deal with a significant number of acute patient needs. We have also engaged additional pharmacy support to enhance our management of prescribing and medication reviews so that a considerable element of this is not now undertaken by GPs, releasing them to devote more time to patient care In January of this year we became the first practice in Worcestershire to operate Electronic Prescribing which will, when fully operational, do away with a significant amount of paper handling in the practice and ensuring that a patient s chosen pharmacy can provide a more tailored service, including home deliveries 4 P a g e

5 2 years ago a major concern expressed by the PPG was the time taken and the length of queues involved in the management of prescriptions. By enabling patients to order repeat prescriptions on line, by having a dedicated prescriptions office in surgery, by investing in extra specialist pharmacy time and in the development of the electronic systems we are encouraged to see that these queues and bottle necks have disappeared this means that both receptionists and GPs alike have more time to handle other patient needs Step 3: Collate patient views through the use of survey. The practice must undertake a local practice survey at least once a year. The number of questions asked will be a matter for the PRG and the practice to decide but should be based on the priority areas they have identified. When the survey is complete the practice should inform its PRG of the findings. We noted in our 2013 report that the top 3 issues carried forward had been consistent concerns and that these are Being able to see the same GP Ensuring that there are emergency appointments available Ensuring that telephone contact is improved Step 4: Provide PRG with opportunity to discuss survey findings and reach agreement with the PRG on changes to services. The following areas were discussed during the year so that we could reflect on matters raised in the previous survey, followed up in the 2013 GPAQ questionnaire included within our patient website and featured in other patient feedback received throughout the year Seeing the same GP We have made significant improvements in the running of our Long Term Conditions Clinic which provided an opportunity for a structured (at least) annual review of those patients who are suffering from a chronic condition. These clinics are an opportunity for clinical review as well as life style discussions and are increasingly the forum in which patients can meet with their regular GP in a structured way As is discussed above the development of our telephone triage service has played a significant part in ensuring both that emergency appointments are available but also in ensuring that regular contact between a patient and their usual GP is maintained We will be reviewing the impact of this service during 2014 to see whether there are any improvement and efficiencies we can make and this will be discussed in detail both with the PPG and the vppg. We also agreed that a major commitment in 2014 should be the development, for patients with long term conditions, of a personalised care plan which is accessible, available electronically and linked to their GP health record 5 P a g e

6 Emergency Appointments / Telephone Triage We recognised last year that there was a need for some patients to see clinical or nursing staff on a same day basis (not necessarily for an emergency) and that this had previously been a problem although the level of patients attending A & E within surgery hours remains a concern of all general practice, this has not, with the data available to us, been on a significantly upward trend In November 2012 we piloted the telephone triage system and from February 2013 onwards we made this part of our core appointment system investing in additional GP and Advanced Nurse Practitioner resources. Telephone Service As was mentioned above telephone response time remains a hot topic although our new telephone consultation system has reduced the length of first up telephone calls we will, however monitor this closely. In 2013, in addition to our overall questionnaire, we commissioned a separate poll solely to look at telephone service and the results of both of these are discussed below that questionnaire was designed by a member of the PPG, Tony Gavin, and will form the basis of our action research during 2014 Reception/Front of House Management In 2013 the PPG had looked at the issue of queues at reception. The consensus is that the joint impact of our telephone triage system and the parallel running of our prescriptions and pharmacy office has had a significant impact of queues and that this is now both manageable and acceptable Advance Booking The need for advanced booking was discussed in last year s report and is consistently highlighted in patient feedback this is discussed below Our core opening hours remain as below but this year and in conjunction with our NHS Area Team we looked again at extended opening hours and with the additional funding they were able to make available we have been offering appointments from 7.00 am onwards. We will be analysing the success of that scheme to see whether it offers additional access to patient groups including whether it meets the needs of particular patients who find accessing our services in the core periods difficult or inconvenient From 7 April 2014 onwards we will be operating a Super Monday service in which we will front load the working week with acute same day capacity to deal with patient need that may have developed over the weekend, or have generated Out of Hours and or A & E care similarly we might expect increase home visits for that day. We will analysis the impact of this initiative as part of the PPG s action programme and assess the extent to which it manages both acute demand and enables us to offer routine appointments with named GPs during the rest of the week 6 P a g e

7 We review our opening hours consistently in an attempt to ensure that we provide the greater possible access and at present we are open: Monday 08:00-18:30 Tuesday 08:00-18:30 Wednesday 08:00-18:30 Thursday 08:00-18:30 Friday 08:00-18:30 Weekend Closed Involvement in Practice Decisions/ Services As is mentioned above there is close and continuing working contact between the PPG and the Practice s management The PPG is concerned to make sure that the practice appreciates the needs of differing patient groups but that the patients as a whole understand how the practice is committed to using its service as effectively as possible 2013 was a period of significant change for the NHS in general and for GP surgeries in particular and the PPG worked very closely with the practice to ensure that the interests of the patients are protected during this time and that patients receive up to date information the speed of change in the NHS and in general practice in particular will increase in 2014 and we envisage that important decisions regarding our clinical services and practice management will need to be taken and it is essential in ensuring that the widest possible patient feedback and involvement with that process is enabled. During the year, in addition to feedback from our patient web site (which generates an average of 5,500 hits a month) we undertook 1 patient survey directed to our vppg which was looked at telephone access and the opportunities which on line and social media presented in providing alternative opportunities 7 P a g e

8 TELEPHONE POLL The majority call in the morning 20% are ringing for repeat prescription or tests results can we manage this better/differently 51% think we answered the phone quite quickly or better, and over 80% were satisfied by the way in the call was handled Almost 50% of the respondents regularly use Facebook but 8% would only use this for contacting us 85% of respondents would be happy to use means other than the telephone for contacting us with , web site and mobile phone apps scoring highly Patient On Line Access is not penetrating sufficiently if 18% of callers were unaware they could order repeat prescriptions on line, or 20% cancel appointments 35% unaware that they could book a telephone consultation in advance and 44% unaware of consultation options significant room for maneuver here The discussion points which emerged are 1. Our move into social media is enterprising but we should not expect a quick return and neither should we expect Facebook to our principal means of communicating with our patient list. Our analysis is based on responses from patients aged We should consider how best to use Facebook to communicate with the under 18s 2. The responses suggested that the web site is a significant mode of communication and we should use our other systems on social media to signpost to the web site but ensuring that the site was easy to use, contain simple and unambiguous language and was frequently updated 3. We need to positively encourage are patients to use our systems but needed to ensure that if telephone traffic re prescriptions was channelled to the prescriptions office then these were promptly answered 4. The web site front page had been designed to have a simple easy to read look but the various means of patient on line access were cumbersome and often encouraged patients to telephone as that was the easier option we need to discuss with our providers how this could be made more user friendly our statistics for the use of patient on line services were encouraging but we could increase this take up and we have agreed to become a Patient on Line Accelerator so that additional resources can be directed to improve the impact of on line services 5. Most patients rang during the morning, the majority wanted to discuss/arrange a medical appointment and half of the respondents thought we answered quite quickly and 80% thought that the calls when answered were handled well the number of adverse comments received which referred to receptionists dealing with medical queries is a problem which we need to overcome and it was suggested that the services of the Telephone Helpline Association might be useful in creating an authoritative but reassuring style for all receptionists to use. We accepted that we could not increase the number of receptionists but could propose that other non designed receptionists staff could have a telephone handling role during peak times 6. We agreed that we had to continue to promote our alternatives to telephone usage where appropriate, but accept that the behaviourial change was bound to be gradual and only successful if it was seen to be an effective, quicker and more reliable alternative to the status quo e.g. s to GPs needed to be answered promptly if were to successfully persuade patients to use this means of communicating with us; some comments reflect on the occasional technical unreliability of systems prompting users to just pop in. 7. It was agreed that nationally and internationality there are many examples of good practice where advanced telephony is promoting greater access and increased self management as part of primary care; there are also examples of pump priming funds which could be tapped into. These were beyond the scope of individual practices and it was agreed that we should as a PPG propose via other Wyre Forest PPGs that the CCG should be proactive in helping practices develop social media and advanced telephony TELEPHONE POLL 8 P a g e

9 269 responses to the telephone poll were received as December 2013 This represents 3 % of the practice population aged 18+ Of these respondents % of respondents % of practice list 127 were male were female Of these respondents 156 were under were over Of those who responded Contacted by phone in last week in last month in last 3 months not contacted 9.67 Those who did ring rang in the morning rang in the afternoon rang in the evening 2.97 The purpose of the call was to arrange a doctors' appt arrange a nurses' appt order a repeat prescription get test results 9.29 Was the call answered quickly 5 rings or less 8.92 quite quickly not quickly other Were you satisfied with the way in which the call was handled 9 P a g e

10 Yes No Do you have a computer/mobile phone internet Yes No 0.37 Social Media - Do you use Facebook Twitter Linkedin My Space 0.00 Other 1.49 Would you contact the practice other than by phone if you could Yes No If yes to the last question which option would you use Facebook 8.92 Practice Web Site Mobile Phone app Twitter Other 1.86 Are you aware of the practice web site Yes but not visited it Yes and have visited it No 4.46 Are you aware of practice Facebook Yes but not visited it Yes and have visited it 6.69 No Are you aware of practice twitter 10 P a g e

11 Yes but not visited it Yes and have visited it 2.97 No Did you know you could order repeat prescriptions on line Yes No Did you know that you could book and cancel appointments on line Yes No Did you know you could request a telephone call from the doctor on line Yes No Did you know you can your doctor for non urgent advice on line Yes No In addition to analysing the above poll results we have also looked at the results from our GPAQ poll for the most recently completed 12 month period and which features the responses from 312 patients, 2.5% of the patient list Please see the website link to read the results of this. These results reiterate many of the issues contained in this report and in previous reports. 71% of respondents were aged over 55 and 66% of those respondents confirmed that they were suffering from a long term condition and it is clear that although statistically skewing our results, the level and kind of service that we need to offer this patient group may be radically different to those who require an emergency appointment where the actual GP is of less significant 11 P a g e

12 This reaffirms our view that we need a mixed economy of appointment types, including face to face, on line and via the telephone to meet the widest range of needs despite pressures on the capacity of appointments the fact that over 65% of respondents confirm that they can see a doctor within 2 days and 60% who need to be seen urgently the same day confirmed that they were able to get a suitable appointment is encouraging Step 5: Agree action plan with the PRG and seek PRG agreement to implementing changes and where necessary inform the CCG/Area Team. The above issues continue to be discussed in depth by the PPG and are featured the development of the practice s business plan That business plan is being designed around the current changes in local NHS structures it has been completed and will be updated on a regular basis and the Chairman of the PPG meets with the practice s Management Team which is creating this plan, thereby ensuring that there is constant patient feedback into this process The major element of our patient focussed action plan is managing effectively patient access and this is discussed below Step 6: Publicise actions taken and subsequent achievement. A Patient Participation Report should be posted on the practice s website. In addition to posting this report on the practice web site, improving the layout of the website and incorporating into it a revised questionnaire, the PPG will be working with the practice to improve communication and the involvement of patients within the design of practice services by, Ensuring that the PPG is closely involved at all times with the evaluation of practice processes Creating a virtual PPG allowing more patients to send their views to the PPG and the practice electronically Increasing the information on practice development available via the web site and in surgery so that patients are aware of their ability to influence the ways in which services are designed Telephone Triage Our major innovation in 2013 was the development of a telephone triage system, the main features of which are A patient will call the surgery, asking for a consultation with a named GP or any available GP The receptionist will take basic details (as some patient requests can often be managed by administrative staff) and will book the patient on a list to be called back The GP will call the patient back and with their full record available, will agree a way of managing the problem, which can be to continue to be dealt with over the phone, or to agree an appointment for a face to face appointment The Practice s view is that operating a system on this type, and versions of it are successfully running all over the country, will enable us to focus our clinical resources more accurately and provide better patient care, more promptly We are also, in conjunction with the CCG, reviewing our overall appointments systems and capacity. 12 P a g e

13 Our Mission Statement in our Business Plan is To provide the highest possible quality of care to patients we can within the resources available and to make sure that York House Medical Centre is the practice that patients would choose to register with and would recommend to their friends and family In 2013, with the projects and proposals outlined above, and with greater clarity of the changes to the NHS structures with which we will need to work, we will be using our PPG and our virtual PPG as a vital way of testing our ability to provide services which patients want and to communicate the changes which we need to make to meet those needs To this end we have improved our website committed extra resources to patient communication and will seek to develop our discussions with the PPG and the virtual PPG Richard Jarman Business Manager York House Medical Centre March P a g e