The Mill Medical Practice

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1 The Mill Medical Practice Local Patient Participation Report March 2014 The Mill Medical Practice Catteshall Mill Catteshall Road Godalming Surrey, GU7 1JW Practice Manager: Robin Forward T:

2 The Mill Medical Practice Local Patient Participation Report Executive Summary The following report outlines requirements for a Local Patient Participation Report to satisfy the Patient Participation Direct Enhanced Service requirements as directed by the; THE NATIONAL HEALTH SERVICE ACT 2006 The Primary Medical Services (Directed Enhanced Services) (England) (Amendment) Directions 2011 Insertion of new direction 12A - Patient Participation Scheme The survey results in this report have been collated since 1 st April 2013, and continue on from results in March 2013 Local Patient Participation Report. The Mill Medical Practice Catteshall Mill Catteshall Road Godalming Surrey, GU7 1JW Practice Manager: Robin Forward Number of full time doctors (FTE) 8.50 Number of patients The practice has seven partners, three female and four male doctors. Four partners are full-time partners and three part-time. In addition the practice employs four part-time Salaried GPs and two part-time GP registrars. Patient Participation Direct Enhanced Service Methodology: The practice engaged with NETbuilder to provide their comprehensive managed survey solution, NBSurvey, to enable the collection of views from patients in multiple locations across various demographic groups. This enabled us to canvas our patients opinions via an input channel most suited to them, from physical paper and in-practice touch screen kiosks, through to virtual online surveys. Patient Reference Group Summary: The practice has a virtual Patient Reference Group. This means that patients are invited and encouraged to give their feedback via surveys on various aspects of the practice in a number of ways; by completing a paper format of the survey, by accessing surveys from the practice website, completing a survey whilst they are in the practice using the kiosk, or if they have previously given their address. The practice also has a registered charity Friends of the Mill (FOTM) which meets twice a year. We are hoping to combine these two groups to form a more cohesive Patient Reference Group. From October 2013 we started a strong campaign to recruit new members. We began at our annual Flu Clinic handed out flyers to our patients. Flyers we are handed out by individual GPs in their clinics as well as left at reception for patients to pick up. We had our first meeting on the 27 th November 2013 with our current FOTM committee and prospective new members to discuss the way forward. Our second meeting on the 19 th February

3 The Mill Medical Practice Local Patient Participation Report , we discussed our financial year end accounts, renewing our subscription to Go Godalming and preparation for our AGM in April The current number of PRG members is 63. This has reduced from 68 last year. This has been determined by the s no longer in use and have bounced back to my in box. Recruitment is on-going. Use of the kiosk, paper surveys and the web portal have been used, and will continue to be used to collect feedback from patients about their experience. Results Summary Item Total Number of Surveys 5 Number of Responses 558 Number of Input Channels 3 Summary Outcomes & Action Plan PPDES Year 3 Results Following feedback from members of our virtual group our main target this year was Customer Service and Patient Confidentiality. Patient confidentiality was chosen due to the new National initiatives regarding Summary Care records and Care.data which many of our patients may be aware of. We believe it is vital we provide high quality customer service at the practice and therefore wanted to get feedback from the patients to see if there were any areas we could improve on. We have also recently updated our website and wanted to know if our patients were using it and what options were they using. Action Plans: Following feedback from patients we have considered opening a second window at reception to improve privacy at the desk. This would then provide a better service for those who are concerned about confidentiality. Patients have the option to opt out of any shared data. The National Care.data has been put on hold so patients do not need to be concerned. Our practice website holds important information for patients and we are hoping they will use it more often. We will be actively promoting the use of our website and access on line appointment booking.

4 The Mill Medical Practice Local Patient Participation Report Contents Executive Summary 2 Patient Participation Direct Enhanced Service Methodology: 2 Patient Reference Group Summary: 2 Results Summary 3 Summary Outcomes & Action Plan PPDES Year 3 Results 3 Contents 4 About The Practice 6 The Partners 6 Salaried GPs 6 The Practice Staff 6 Practice Nurses 6 District Nurses and Community Matron 6 Midwives 6 Health Visitors 6 Opening Hours 7 Nurse appointments 7 Home Visits 7 When the Surgery is closed 7 For general health advice only, please visit 7 Local Survey Methodology 8 The NBSurvey Methodology 8 Input Channel Evaluation Criteria 12 Patient Reference Group 14 PRG Membership 14 Member Profiles 14 PRG Recruitment & Representation 14 Results, Outcomes & Findings 15 Summary Information 15

5 The Mill Medical Practice Local Patient Participation Report Survey results by Input Channel 15 Summary of Demographics Survey 15 Survey Results 15 Discussions & Action Plans 19 Outcomes & Action Plan PPDES Year 3 Results 19 Summary of the PPDES 2013/14 20

6 The Mill Medical Practice Local Patient Participation Report About The Practice The practice was established in 1968 original based in Godalming High Street, now resides at Catteshall Mill, in Catteshall Road. The practice is a large multi-disciplinary primary care team and prides in providing high quality care and services to our patients in Godalming. The Partners Dr. Ailsa Borthwick Dr. Felicity Overington Dr. Anthony Cerullo Dr. Steven E D Simons Dr. Klaus Green Dr. Leslie J F Campbell Dr. Suzanne Clark MA MB BChir DA 1982 (Cambridge) MB BS DRCOG MRCGP 1988 (London) State Exam 1990 (Pisa) MB BS DA DFFP MRCGP 1989 (London) MA MB BChir DRCOG MRCGP 1992 (Cambridge) MB BChir DRCOG MRCGP 1990 (Cambridge) MB ChB MRCP DRCOG MRCGP DFFP 1997 (Liverpool) Salaried GPs The Practice employs four fully trained part-time GPs for some additional surgery sessions per week. Dr. Sarah Taylor-Smith Dr. Helen Carr Dr Georgina Dalton Dr Ann Summersgill The Practice Staff BM DRCOG MRCGP 1997 (Southampton) MB BS MRCGP DFFP DCCH DRCOG MSc 1991 (London) MB BS MRCGP DCH DRCOG (London) MB BChir MRCP MRCGP DRCOG DFFP (Cambridge) Practice Nurses The Treatment Room is manned by our five Practice Nurses and three Treatment Room assistants, who carry out blood tests, travel immunisations, dressings, ear syringing etc. as well as running various clinics. Penny Randall RGN Melisa Yeardley RGN Linda Smith RGN Alison Tucker RGN Jenny Boyden RGN Sandra Greener Jacqueline Sherrington District Nurses and Community Matron The district nurses are based at the surgery and visit patients at home when necessary. Midwives The midwives provide care and advice during pregnancy and after childbirth. Health Visitors The health visitors provide care and advice to parents after childbirth and monitor the development of the child to ensure it is healthy.

7 The Mill Medical Practice Local Patient Participation Report Opening Hours Monday Friday 8:00 18:30 Saturday and Sunday CLOSED The Surgery is closed every Monday at lunchtime between 13:00 and 14:00. The practice appointment system provides more availability for 'on the day' appointments and a smaller number of pre-bookable appointments for those who need to book ahead. Appointments can be made either on the telephone or via the internet. To access appointments via the internet please ask reception for details. For an on-the-day appointment, please telephone the surgery preferably in the morning. Pre-bookable appointments are opened up each weekday two weeks in advance. These appointments can be made at any time. Please be aware our phones lines are exceptionally busy first thing in the morning but will be answered as soon as possible. We encourage patients to see their usual or registered GP wherever possible. However, our part time GPs are able to see those patients whose usual GP is not available. We will provide up-to-date information about individual GPs' current surgery times on our website and from our reception desk. Please note that these times may change from time to time. We have EMIS access, giving on-line patient access and an automated facility on our telephone system to enable patients to book, cancel or check appointments on the phone. Both these facilities are available to patients out of hours. Nurse appointments These can be pre-booked in person or on the telephone and there is very limited availability on the day for urgent appointments only. Home Visits Home visits are available for patients who are too ill to visit the surgery. When the Surgery is closed Out-of-hours cover is now the responsibility of the NHS 111 service. Out of hours means urgent calls outside of normal surgery hours i.e. weekdays 6.30pm to 8.00am the following morning and from 6.30pm Friday to 8.00am Monday morning. Please restrict out-of-hours calls to genuine urgent problems that cannot wait until the next working day. If you need to be seen by a doctor, this may be either at your own home or at the nearest Primary Care Centre. For urgent medical advice or treatment telephone NHS 111 on 111. For general health advice only, please visit

8 Local Survey Methodology The Mill Medical Practice Local Patient Participation Report The practice engaged with NETbuilder to provide their comprehensive managed survey solution, NBSurvey, to enable the collection of views from patients in multiple locations across various demographic groups. This enabled us to canvas our patients opinions via an input channel most suited to them, from physical paper and in-practice touch screen kiosks / laptops, through to virtual online surveys. Findings from previous studies carried out by NETbuilder exposed that multiple short surveys with a maximum of 8-10 questions each are more effective than one long survey running continually throughout the survey period. Each survey was customised to the investigational design and measures, for example measuring how effective it is for patients to get an appointment using a short survey (The Access Survey). Additionally, this encourages patients to give feedback for the areas relevant and important to them. The NBSurvey Methodology

9 The Mill Medical Practice Local Patient Participation Report Step Description Surgery Comments / Experiences Continual Development of Patient Reference Group (PRG) The PRG is a representative group of patients from the practice. They are responsible for providing feedback on the production of practice surveys and collaborating with the practice to analyse the results and agree realistic change opportunities. We had a good outcome of patients participating in our survey. Hopefully more patients will join our PRG and the practice will continue to promote it. Determine Priority Areas Design & Build Surveys Key areas include but are not limited to the following: Access Overall Satisfaction Seeing a Doctor See a Nurse The Reception The Surgery Environment Demographics Specialised Clinics (e.g. Flu, Vasectomy) The PRG and other patients complete the Patient Priorities Surveys to prioritise the areas (above) to determine the order in which key areas are addressed by the practice. Patients are also given the opportunity to provide comments regarding other areas they would like to see addressed. The practice work closely with NETbuilder to design and build the surveys. Each survey is designed to measure the patient s view of the identified key areas. Each survey contained between 8-10 questions. Patients are able to choose to complete the surveys they believe are relevant to them and ignore those that are not. In year 1 of the PP DES we conducted a patient priority survey; this gave us a good idea of three areas of priority that patients wished to look at. Seeing a Doctor Seeing a Nurse Access Practice Information In year 2 of the PP DES we ran the following surveys; Access Surgery telephone Patient priorities Seeing a Doctor or a Nurse Patient participation Group In year 3 of the PP DES we ran the following surveys; Access Surgery telephone Patient participation Group Seeing a Doctor or a Nurse Customer Service & Confidentiality Survey The practice will collaborate with the PRG to agree the questions in each survey, to the areas mentioned above.

10 The Mill Medical Practice Local Patient Participation Report Decide on Input Channels and Publish Surveys Advertise Feedback Channels The practice worked closely with NETbuilder to agree which input channels are suitable for the surgery and patients. Input channels available are: Surgery Kiosk Web Portals Laptop Paper Face to Face Each survey can be used on (published to) one or more of the input channels listed above. Inform patients of the available input channels and current surveys, in order to create a greater number of participation responses. Types of promoting include but is not limited to: Encouragement slip given by the doctor Noticeboard Posters Leaflets News Letters We used the Input Channel Evaluation Criteria to help us decide which channels to use for The Mill Medical Practice: In-surgery Kiosk: to capture patients from all demographics visiting the surgery Paper: available in the surgery as an alternative to the kiosk or to be completed on behalf of others if required. The GPs can also target patients from all demographics in the consulting room Web Site: open to all practice patients Paper input has proved popular with patients who like to take the survey home and complete it there and return it at their convenience. In year 2 & 3 we continued to use the following input channels; In-surgery Kiosk: to capture patients from all demographics visiting the surgery Paper: available in the surgery as an alternative to the kiosk or to be completed on behalf of others if required. The GPs can also target patients from all demographics in the consulting room Web Site: open to all practice patients We will continue to use all these methods to promote the surveys and participation in the PRG. We put up notice boards, website and a competition was set up for the admin team to promote the survey and encourage patients to complete.

11 The Mill Medical Practice Local Patient Participation Report Encouragement from all Practice Staff & PRG Surgery Website Capture Patient Experience Produce & Distribute Reports Patients will continue to complete surveys using the available input channels as listed above. Results in the form of reports will be produced for each individual survey and distributed via the Practice Website, Practice Meetings, Surgery Notice Board, PRG consultations. Data from paper forms is inputted onto the NETbuilder Paper Survey links by practice staff. This allows patients to use an additional input method especially where they do not use technology in everyday life and maybe wouldn t otherwise complete the survey. It does however take up time within the surgery to do this so we also encourage patients to use the other input channels as much as possible. We will continue to encourage the use of the Kiosk and website, though many patients find it easier to complete the paper survey. This was not as onerous as thought to be. The results of the surveys were ed to the Patient Group and feedback was requested. Copies of the surveys were also made available in the Reception area prior to the Practice Meeting. The results will be published on our website and displayed on the Notice board together with this completed report. Collaborate with PRG to Analyse Results The Practice Manager will discuss & analyse the survey results with the Practice Doctors and then discuss with the PRG for further analysis. Having a virtual PRG which can be contacted via , post or telephone will make this process much easier than having regular meetings which have not proved popular with our patients in the past. We will discuss this at our PHCT meeting as this affects all members of staff. I will also arrange another meeting with the PRG once we have an action plan in place.

12 The Mill Medical Practice Local Patient Participation Report Agree Action Plan Implement Change Detailed action plans are created at the end of year 1 (2011/2012), end of year 2 (2012/2013) and end of year 3 (2013/2014) of the PP DES. Practice must obtain the agreement of its local PCT to its proposals for any significant change, e.g. change of opening hours. Approved changes can then be implemented. An agreed action plan between the PRG & Surgery was created after the year 1 result (2011/2012) according to the outcome of the analysis from the results. Further action plans were created following the year 2 results (2012/2013) and year 3 results (2013/2014). Details of the year 3 action plan are provided in the section Discussions & Action Plans below. Details provided in the section Discussions & Action Plans below. Input Channel Evaluation Criteria Input Channels should be thoroughly evaluated for their suitability for use by patient belonging to a practice. The following table describes the advantages and disadvantages of each input channel currently supported for practices. Input Channel Advantages Disadvantages Paper Surveys Public Web Surveys Surveys Suitable for a large percentage of patients across most services Known and trusted media for many patients Instant feedback Fast deployment of survey Easily changeable Instant feedback Fast deployment of survey Easily changeable Excellent for tracking feedback for specific treatments (e.g. specialised clinics) Production, deployment and collection of surveys required Data input required Limited to patients with internet access Limited to patients with the ability to use technology Limited to patients with internet access Limited to patients with the ability to use technology Limited to patients with accounts

13 The Mill Medical Practice Local Patient Participation Report Limited to patients who have provided Trust with addresses Phone Surveys Touch Screen Kiosks Touch Screen Tablets / Laptops Standard Desktop Face to Face interviews Instant feedback Fast deployment of survey Easily changeable Excellent for tracking feedback for specific treatments Immediately and conveniently accessible before and after appointments Instant feedback Fast deployment of survey Easily changeable Instant feedback Fast deployment of survey Easily changeable Immediately and conveniently accessible before and after appointments Portable Fashionable Instant feedback Fast deployment of survey Easily changeable Immediately and conveniently accessible following treatment Instant feedback (proving tablet used to input response) Fast deployment of survey Easily changeable Immediately and conveniently accessible following treatment Patients able to converse with a person, puts at ease Rapport building Limited to patients with telephone access Limited to patients with the ability to use a telephone Additional cost to practice Limited to patients with the ability and willingness to use a touchscreen kiosk Requires suitable physical location Limited to patients with the ability and willingness to use a touchscreen tablet Requires overnight charging Limited to patients with the ability and willingness to use a desktop PC Requires suitable physical location Requires protection from being damaged, lost or stolen Canvasser must be independent Additional resource required Patients may be reluctant to give honest answers to canvassers

14 Patient Reference Group PRG Membership The Mill Medical Practice Local Patient Participation Report Member Profiles Members of the Patient Reference Group are recruited from patients registered at The Mill Medical Practice. Nationality PRG Profile White 100% Mixed 0% Asian or Asian British 0% Other 0% Age Group PRG Profile years 3.85% years 23.08% years 23.08% years 23.08% 65- over 26.92% Gender PRG Profile Male 34.62% Female 65.38% Employment PRG Profile Employed 53.85% Unemployed 3.85% Permanently sick or 15.38% disabled Fully retired 23.08% Other 3.85% PRG Recruitment & Representation In order to ensure that members of the group are fully representative of our registered patients, the Surgery uses the following means to recruit: The practice website Display Screen in waiting room Posters on full view in reception and waiting areas Leaflets available on reception desk Leaflets in consulting rooms for GP s to recruit individuals Current members recruitment drive The current number of PRG Members is 63. Recruitment is on-going using all the methods described above. Note: Feedback is not solely reliant on the PRG, surveys are also completed by other Patients from the Practice via the surgery kiosk and web portals etc.

15 Results, Outcomes & Findings Summary Information Item Total Number of Surveys 5 Number of Responses 558 Number of Input Channels 3 Survey results by Input Channel Input Channels Survey Kiosk Paper Website Total Customer Service & Confidentiality Patient Participation Group Access Seeing a Doctor or Nurse Surgery Telephone Total Summary of Demographics Survey Our Practice took the strategic decision not to solely rely on our Patient Reference Group for feedback to our surveys and wanted to capture the views of as many of our patients as possible. To support this decision we invested in a touchscreen kiosk and web portal technology. The intention was to encourage patients visiting the practice to provide us with in the moment feedback about the service they had just received. The web portals enable us to reach-out to patients who are unable to visit the surgery. In addition, our committee members came into the surgery over a two week period to hand out paper surveys and encourage recruitment onto our PRG. We believe that this strategy will provide the practice with feedback from a representative demographic of our patient population. Survey Results Detailed reports for each survey can be posted on The Mill Medical Practice Website All results were discussed with the PRG and relevant practice staffs, the key outcomes for each survey are highlighted below. Please note that the reports found on the website display the latest feedback captured and therefore may contain more results than are summarised in this report.

16 The Mill Medical Practice Local Patient Participation Report Customer Service and Confidentiality When asked whether other patients could overhear what they were saying to the receptionist 46.62% said yes, but I don t mind, 10.55% said yes and I m not happy about it, 36.71% said they didn t notice and 6.12% said other patients can t hear 69.2% of patients said the last time they requested an appointment they were able to see or speak to someone on the same day or next working day 6.33% of patients said they are normally seen on time for their appointment, however a total of 61.81% patients said they were seen within 15 minutes of their appointment time 76.58% of patients said they are ok with having to wait and don t have to wait too long 95.78% of patients said they were satisfied or very satisfied with the care they receive at the surgery When the patients were asked what they had use the website for they answered: Check opening times % Request or cancel appointment % Update their details % Order a repeat prescription % Haven t used the website % When the 52.07% of people were asked why they had never used the Website they said: Don t have computer access % Prefer to phone the surgery % Prefer to visit the surgery % Didn t know about the website % Another reason % 66.88% of patients said they felt OK about anonymous data relating to their medical history being shared with other organizations for research purposes and to plan and improve healthcare services 26.58% said they wouldn t want to share anonymous data about their medical history 51.27% of patients said they were aware that patients of 16 years and over have confidential medical records that cannot be accessed by their parents, 17.51% were not aware and 31.22% said it wasn t relevant to them 38.61% of patients surveyed said they were aware that carers must have pre-authorised permission to access confidential medical records for a person in their care, 21.31% were not aware and 40.08% said it wasn t relevant to them Access 78.26% of patients normally book an appointment by phone 52.17% of patient prefer to book appointments by phone The patients that have tried to contact the surgery by phone rated the service as good or excellent in the following areas; Getting test results 57.14% Getting through 36.36% Speaking to a doctor 33.33% Speaking to a nurse 22.22%

17 The Mill Medical Practice Local Patient Participation Report % of patients were able to get an appointment to see a doctor on the same day or within 2 working days % of those that couldn t get an appointment on the same day or within 2 working days said there were no appointments left 91.30% of patients have tried to book ahead to see doctor, 52.38% of those patients were able to book an appointment for more than two days in advance Seeing a doctor or nurse 75% of patients said they saw a doctor the day they came to the surgery and 25% saw a nurse The doctors were rated as satisfactory or good in the following areas: Asking about symptoms 92.31% Explaining test and treatments 69.23% Giving enough time 100% Involving patients in decisions about their care 84.61% Listening 100% Treating patients with care and concern 91.67% 75% of patients said that they had confidence or confidence to some extent in the doctor they saw 83.33% of patients said they would be happy to see the same doctor again When seeing a doctor, patients gave their reasons for having a consultation as: Asking for advice 25% Routine check-up 8.33% One off problem 33.33% Prescription 8.33% On-going problem 25% The nurses were rated as satisfactory or good in the following areas: Asking about symptoms 100% Explaining test and treatments 100% Giving enough time 100% Involving patients in decisions about their care 100% Listening 100% Treating patients with care and concern 50% 75% of patients said that they had confidence or confidence to some extent in the nurse they saw 50% of patients said they would be happy to see the nurse again Telephone The patients that have tried to contact the surgery by phone rated the service as good or satisfactory in the following areas; Getting test results 60% Getting through 41.18%

18 The Mill Medical Practice Local Patient Participation Report Speaking to a doctor 50% Speaking to a nurse 66% 35.29% of patients find the surgery answerphone messages useful 76.47% of patients would prefer to be put in a queue when the phone line is busy Patient Participation Group Survey 2 people completed the Survey and 1 of those people said they would like to join the Virtual Patient Participation Group 1 person was male and 1 person was female and both were under 17 and white 1 person was in Full Time Education and worked 30 hours or more a week and the other person was unemployed 1 person surveyed said they had a longstanding physical condition 1 person surveyed said they were the parent or legal guardian of children aged 16 years or under currently living at home Both people said they rarely come to the Practice 1 person said they preferred to be contacted by and the other by post

19 The Mill Medical Practice Local Patient Participation Report Discussions & Action Plans Outcomes & Action Plan PPDES Year 3 Results This year we decided to target our survey on Customer Service and Patient Confidentiality. The reason we chose Customer service as our first topic was in relation to feedback from members of our virtual group. We also believe it is vital we provide high quality customer service based practice. Most patients surveyed were able to discuss their condition on the same day. The wait on average is between 5 and 15 minutes after they have checked. Most patients are ok with having to wait. And most importantly the majority of patients are satisfied or very satisfied with the care they receive at our practice. Patient confidentiality was chosen due to the new National initiatives regarding Summary Care records and Care.data. We are aware with the open plan in reception patients may feel their confidentiality is being breached and we wanted to know their opinions. Thirty-six percent didn t notice whilst nearly fifty percent don t mind. With regards for anonymous data of medical history being shared, sixty-six percent of our patients were ok as long as it is anonymous. Most patients are aware that children over the age of sixteen have the right to medical record confidentiality. Whereas only thirty-eight percent of patients surveyed knew that carers needed pre- authorisation to access confidential medical records. We have recently updated our website and wanted to know if our patients were using it and what options were they using. Fifty-two percent of our patients surveyed have not used the website. Those who did mostly used it to check our opening times. The main reason they did not use the website was that they preferred to call the practice. Action Plans: As a practice, we are aware that we are a very busy practice and we have a high volume of patients every day. It appears waiting times and being able to see their doctor about recent condition is not a concern at the moment and no action is needed. However, we will revisit these issues later in the year. We have considered opening a second window at reception and moving the touch screen log in to another area in order to provide a second receptionist and privacy for those at the desk. This would then provide a better service for those who are concerned about confidentiality. Patients also have the option to opt out of any shared data. The National Care.data has been put on hold so patients do not need to be concerned. Summary Care records are only shared with other NHS organisations for the benefit to the patient being seen in case they are out of area. Our practice website holds important information for patients and we are hoping they will use it more often. As noted in previous surveys, our phone lines are extremely busy and you may be able to book an appointment or order a repeat prescription from there rather than waiting for a clear phone line. We will be actively promoting the use of our website and access on line appointment booking.

20 The Mill Medical Practice Local Patient Participation Report Summary of the PPDES 2013/14 Over the last year we have had a total of 558 patients respond to our surveys and for the most part they have been positive. We very much appreciate the time patients have taken to complete these surveys and find they are a valuable part of providing a better health care service. We also recognise many of our patient s concerns and value their feedback. Even though our PPG is not a fully established group, the virtual group has been tremendously helpful by contributing as part of our national requirement. The five surveys open for comments covered a variety of issues and we will continue to monitor the areas that need to change. Looking towards next year, we are hoping to get an early start on targeting areas for feedback and/or review. We are also hoping that the establishment of new recruits to the PPG will inspire active participation and new ideas. We would also like to set up regular meetings and fund raising as a way of becoming a bigger part of the community. Most importantly, thank you to all our patients and we hope we can continue to keep the line of communication open and provide a service you deserve.

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