Drs Beales, Crowley, Strachan & Navamani North Road Surgery, 77 North Road, Kew, Richmond, TW9 4HQ www.northroadsurgery.nhs.uk

24th March 2013 Drs Beales, Crowley, Strachan & Navamani North Road Surgery, 77 North Road, Kew, Richmond, TW9 4HQ www.northroadsurgery.nhs.uk

Introduction North Road Surgery This report summarises the development and outcomes of the North Road Surgery Patient Reference Group (PRG) and is in line with the requirements of the Patient Participation Directed Enhanced Service. The report contains: Profile of practice population and PRG Process used to recruit to our PRG Priorities for the survey and how they were agreed Method and results of patient survey Resulting action plan and how it was agreed Progress made with the action plan Confirmation of our opening times Outlined below are the details of the work undertaken by the Practice to meet each of the six steps within the Patient Participation DES Step 1 Establish a PRG comprising only of registered patients and use best endeavours to ensure PRG is representative The Practice has worked hard to develop a Patient Group and have had a core group of members for a significant time. In recognition of the need to ensure this group was representative of the full practice list a recruitment drive was implemented in 2011/12 to attract members. We launched an advertising campaign to recruit members to the group by: Putting up posters in the practice Offered leaflets to patients attending practice Speaking to patients when they came into the Practice Telephoned patients to personally invite them to join the PRG Placed messages on the bottom of our repeat prescriptions Placed a message on our website Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 2 of 19

We currently have 10 members of our Patient Group and 130 Virtual Group Members who we share information with via e-mail. We believe this extends our capability to communicate with a much wider group of patients, and to capture more representative views of all patient groups. Below are the demographic information relating to our full patient list and our PRG members. Patient and PRG group age Patient List age PRG age Virtual group age Age Range Total % Total % Total % Under 16 1416 21 0 0 1 1 17 to 30 835 12 0 0 6 5 31 to 44 1605 24 1 10 33 25 45 to 60 1415 21 2 20 33 25 61 and above 1414 21 7 70 57 44 Patient and PRG group gender Patient list gender PRG gender Virtual group gender Gender Total % Total % Total % Male 3254 49 2 20 44 34 Female 3431 51 8 80 86 66 Patient and PRG group ethnicity* Patient list ethnicity PRG ethnicity Ethnic Group Total % Total % White British 1819 74 10 100 White Irish 73 3 0 0 Indian 22 <1 0 0 Pakistani 4 <1 0 0 Bangladeshi 1 <1 0 0 Black African 5 <1 0 0 Black Caribbean 7 <1 0 0 Chinese 13 <1 0 0 Other ethnic group 509 21 0 0 TOTAL RECORDED 2453 100 10 100 *This data has not been recorded in all patient records, and has not been collected for our virtual group members Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 3 of 19

Step 2 North Road Surgery Agree with the PRG which issues are a priority and include these in a local practice survey At our PPG meeting on 16 th January 2013 we discussed key issues of importance to our Patients to help us decide what priority issues to include in our Patient Survey: Extract of minutes, Patient Participation Group 16 January 2013 Item 2. Areas raised by the Group for possible inclusion in the patient survey Appointments/Automated telephone system. Members pointed out that if patients are not aware of the days partners work, they may not be getting an appointment because the GP they want to see is not available that day. It was agreed that we would ask Molin to state this information on the website - the information is stated in the practice leaflet. Online booking for appointments or booking through the website Parking. Everyone is aware of the problem, be interesting to see how it rates in the survey! Website. Some of the group and the virtual group were not aware of our Website, which is: www.northroadsurgery.nhs.uk therefore there are probably many others who are not aware. Newsletter A quarterly newsletter was suggested to provide some communication to patients e.g. website and Helen asked if one of group members would be interested in being responsible for this with the Surgery s agreement to the content. Nuala kindly agreed to take this forward as she was on her way out! Support groups. Mary suggested having support groups for long term conditions self help. Helen offered to come in one evening if the group would like to organise. Referral services, better access i.e. physio don t have the room to offer on the premises at present. Messages through different means email, text messages Self help. Information on conditions Premises. Warwick informed the group that we have now outgrown the premises here at North Road and we are trying our best to find somewhere suitable in the Kew area. The key issues covered in our survey were agreed as: Access to the surgery Communication Being able to get an appointment Premises Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 4 of 19

Step 3 Collate patient views through local practice survey and inform PRG of the findings Once we had established our key issues to include in the survey we developed the questions to be included We carried out the survey using Survey Monkey on line Paper forms available at reception We reminded our patients to complete the survey by Advertising in the surgery using posters Providing all patients attending the surgery with a leaflet to take away and read Texting a reminder to all our patients with a mobile telephone number on their records E-mailing all patients who had provided us with an e-mail contact address Our PRG members encouraged their friends and relatives who are our patients to complete our survey Placing a reminder on the bottom of our repeat prescriptions Speaking to individual patients as they attended the surgery We carried out the survey between 21st January and 10 th February 2013 and received a total of 112 responses. The results of our survey can be found in Appendix A. Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 5 of 19

Step 4 North Road Surgery Provide PRG with opportunity to comment and discuss findings of local practice survey. Reach agreement with PRG of changes in provision and manner of delivery of services. Where the PRG does not agree significant changes, agree these with the PCT The survey results were collated and a survey results report written (Appendix A). The patient group reviewed the survey results at 8 th March 2013 and discussed improvement actions with the practice members attending the patient group meeting. Extract of minutes on 8 March 2013, to give a feel for the discussion Appointments/On-line booking Helen explained that before we started using the automated telephone booking system (approx 2010). Warwick had explored the possibility of on-line booking. Our medical system, which is INPS Vision, did not have an on-line booking software programme and no other companies had one that was compatible with the Vision system. We therefore went for the telephone booking system. Molin, Helen and Robyn (our Reception representative) have since met with INPS as they do have an on-line booking programme available now, but after the presentation we felt it was quite cumbersome. As it didn t compare very well to our existing telephone booking system and couldn t be used in conjunction with it, we felt it best not to consider changing at this stage to something that may be worse! We discussed DNAs (did not attend) patients who fail to attend their booked appointments and do not cancel. These patients have normally booked in advance and forgotten to cancel, although these appointments can easily be cancelled on the automated system. Pre-bookable appointments are available one month in advance and quite a few of these are DNAs which is why we do not book further ahead than one month. We have noticed repeated offenders. Looking back for the month of February 78 patients DNA d Doctors appointments and 58 DNA d nurses appointments this equates to 6 surgeries and 3 clinics. We have had to implement a DNA policy which is displayed on our website. Premises as discussed at the previous meeting we are in great need of larger premises as we have registered an extra 2,000 patients since April 2012 due to the closure of a neighbouring practice. We have taken on a new partner since July 2012 and now have another Health Care Assistant. We are in the process of making some changes in reception, both to the layout and the staff, so it doesn t appear to be so hectic. At present the partners do not have a consultation room each and hot desk with each other. Website we need to ensure that we are advertising this as much as possible. One suggestion was to obtain everyone s email on registration and asking for consent to use Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 6 of 19

this as another form of communication we were thinking of distributing a Newsletter informing patients of the website and what can be found on it i.e. extended hours, how to speak to the GP on the telephone. Speaking to a GP on the telephone Alex was surprised by this because she feels the partners are quite accessible. If appointments have gone for the day and the patient feels they need to see a doctor a call will be put on for the GP to phone them back and sometimes advice is all that is required. Rachael commented that patients need to know they can ask the receptionist if they need to speak to a GP for advice etc again more communication, more advertising. We realise we may need to be more flexible to make life easier for the patient and the GPs and would welcome any ideas on telephone communication. Weekend opening At present we do not have enough staff and would struggle to implement this. Out of Hours & 111 Alex explained that 111 replaces NHS Direct and that we are a pilot practice for 111 and would welcome any feedback patients may have. The programme is coming out on a National basis and all households will receive relevant information shortly. We felt it was better to join as a pilot because it is always better to get on board at an early stage and be ahead of the game! Results we discussed emailing test results to patients. Partners need to discuss test results as a whole i.e. explaining, involving and receiving of. Cleansing Gel this is at present made available on the reception counter. However it was felt that it probably came up in the survey due to patients using the touch screen check in system in the waiting room. We have therefore agreed to make the gel available on the wall in the waiting room. The survey results were also shared more widely with virtual group members and feedback requested via e-mail. Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 7 of 19

Step 5 North Road Surgery Agree with the PRG an action plan setting out the priorities and proposals arising out of the local practice survey. Seek PRG agreement to implement changes and where necessary inform the PCT It was agreed that the following issues would be addressed by the Practice in the coming year Speaking to a GP on the telephone Managing Wasted appointments Providing test results to patients Improving our Website Email communication An action plan (Appendix B) was developed to allow for more efficient monitoring of progress. The key actions were Advertising campaign to promote speak to doctor service Implement DNA policy to reduce wasted appointments Partners to review current process for acting on investigation / test results Advertising campaign to increase patient use of our website Collect patient e-mail addresses to allow us to communicate more effectively with our patients on a wide range of practice information The PRG were generally pleased with the outcome of our Patient Survey and agreed with the results. There were no actions requested by the PRG that the practice would not agree to. The PRG will continue to monitor progress against the improvement plan with the practice. There were no significant changes to our services as a result of the survey findings. Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 8 of 19

Step 6 North Road Surgery Publicise the Local Patient Participation Report on the practice website and update the report on subsequent achievement. The expectation is that the year 2 reports posted by practices should build upon the year 1 report, demonstrating how issues raised in year 1 have been addressed. The Patient Participation DES report has been publicised within the Practice and added to our Practice Website: www.northroadsurgery.nhs.uk Progress made with the action plan A summary of the progress as of 31 March 2012 is: You said We did The result is You didn t know you could speak to a GP on the telephone You sometimes have difficulty getting an appointments You get frustrated having to make an appointment to receive test results Many of you do not use our Practice website You would like to be able to communicate more efficiently with us Our doctors are always happy to speak on the telephone with patients Reviewed our DNA rates Considered how we could communicate with you regarding test results Promote the website with our patients Collect patient e-mail addresses and investigate the best way to introduce e- mail communication We are going to advertise this more widely to ensure patients are aware they can ask to speak to a doctor We are going to manage DNAs better to ensure wasted appointments are reduced Our GPs are going to review our management of test results and agree the best way to manage all associated issues We hope that many more patients will be aware that they can use our website to access key information We will begin to distribute information electronically where appropriate e.g. newsletters and practice news Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 9 of 19

Confirmation of our opening times North Road Surgery As a result of the survey we have not changed out opening times. They are: The Surgery is open from 8.30am to 12.30pm and then from 1.30pm to 6.00pm Monday to Friday The reception can be contacted during these times on 0208 876 4442 GP appointments are available throughout these times We also offer extended hours on Wednesday mornings (7.05am to 8.00am); Thursday morning (7.30am to 8.00am) and Wednesday evening (6.30pm to 7.40pm) for prebooked GP appointments The surgery is closed for any other matters during these times and the telephone lines are transferred to the out-of-hours service We are not open at weekends Outside of our opening hours please 111 to be directed to the most appropriate service to meet your needs Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 10 of 19

Appendix A: Survey results report 112 patients responded to our Patient Survey. 62 patients submitted online responses via survey monkey and 50 hard copy surveys were collected in the surgery. These are the results of our survey Age of survey responders 61 and above 46 to 60 years 31 to 45 years 17 to 30 years 0 20 40 60 Number of respondents Gender of survey responders Male 41 Female 72 Number of respondents Ethnicity of survey responders Other Ethnic group White European Mixed Race White Irish White British Number of respondents 0 20 40 60 80 100 Number of respondents Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 11 of 19

Distance from surgery to work Patients were asked if they work, how far are they from the surgery More than 1 hour away 30-60 minutes away Work from home Up to 30 minutes away 0 5 10 15 20 Number of respondents Patients were asked how frequently they attend the surgery Attendance at surgery Rare Occasional Regular 0 50 100 Number of respondents Practice opening hours We asked our patients if our opening hours were suitable for their needs Opening hours are fine 5% Occasionally not open at convenient times Opening hours are not convenient 23% 72% Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 12 of 19

Additional opening hours We asked which additional hours patients would like to see the surgery open 45 35 25 15 5-5 Early mornings Lunchtime Evenings Weekends None, I am satisfied How easy do you find accessing the building? Not Easy Fairly easy Very easy 11 99 0 20 40 60 80 100 Premises How clean is the surgery? Number of respondents Clean 43 Very clean 68 Patients were asked how they travel to the surgery Travelling to the surgery Bus 1% Walk 62% 88% of drivers said they found it easy to park at the surgery Car 34% Bike 3% Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 13 of 19

We asked if other patients can hear conversations with the receptionists Yes, but I don't mind Yes, and I'm not happy No, other patients cannot overhear 13% 9% 78% Reception We asked how helpful our receptionists are Very helpful Fairly helpful Not helpful Not at all helpful 3% 1% 21% 75% Talking to a doctor on the telephone 22% of patients felt they could always speak to a doctor if they had a medical query 27 19 14 12 9 Number of respondents Always Almost always A lot of the time Some of the time Almost neveer Never 4 Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 14 of 19

85 responders recalled seeing a doctor for a PRE-BOOKED appointment in the last six months. We asked how long they had had to wait after their pre-booked appointment time to be seen 60 40 20 0 GP consultations Less than 5 minutes Less than 10 minutes Less than 20 minutes We asked our patients how happy they are with their GPs Taking problems seriously Treating with Care & concern Involving you Explaining tests & treatments Listening Asking about symptoms Giving enough time 0 20 40 60 80 100 120 Very good Good Neither good nor poor Poor Very Poor 99% had confidence and trust in the doctor they saw Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 15 of 19

URGENT appointments 43 patients recalled trying to see the doctor URGENTLY in the last six months 79% reported that they had been able to see the doctor on the same day. Reasons given for not being able to see the doctor URGENTLY were given as follows: 2 patients said there were no appointments 1 patient said the appointment time offered did not suit the patient 4 patients said the appointment was offered with a doctor the patient did not want to see 1 patient said the automated system gave an appointment which was one week away Nurse consultations 80% of respondents felt it was very easy or easy to get an appointment with a Practice Nurse We asked our patients how happy they are with their Nurses Neither good nor poor Good Ver good 0 10 20 30 40 50 60 Number of recepients Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 16 of 19

www.northroadsurgery.nhs.uk Website Overall satisfaction We asked if patients used our Practice website 23% had used the website 22% knew about the website but had not used it 12% knew there was a website, but did not know the address 43% did not know we had a website We asked our patients how satisfied they were with the overall care at the Practice Neither good nor poor Good Very good 0 20 40 60 80 Number of responders Suggestions for improvements at the surgery A cycle-rack would be great A few more parking spaces would be helpful Ability to book appointments & request prescriptions online Ability to send emails regarding things like test results, etc. An additional nurse Blood test appointments can be booked up quickly, having more blood test appointments would be good It would be convenient if we could speak to the doctor on the phone instead of coming to the surgery It would be good to be able to book an appointment for tomorrow, or the next few days Gel for cleaning hands in the reception / waiting room More information on the website re common health problems Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 17 of 19

Comments North Road Surgery General comments were made, some of which are noted below to give a flavour of the patient perception of The North Road Surgery An excellent practice - well done! Doctor and receptionists are always very helpful especially where my children are concerned Dr Strachan has been totally amazing It s so reassuring to have a supportive surgery Excellent appointment system, caring doctors and staff, well done! On the last two visits I have made to the surgery, I have felt rushed & not fully listened to I am a relatively new patient at this surgery and the automatic appointment system takes some getting used to! I am delighted by the care and service I receive I am often surprised to be asked if I want private referrals for secondary care because it is felt I will have to wait too long for NHS I find the receptionists to be exceptionally helpful, kind and smiling and am very impressed with them Generally very happy with service but would prefer more privacy at the desk I could not be in a better practice and would never change I find on the day appointment system doesn't always work I have the impression that the practice is overwhelmed too many patients and not enough doctors or nurses I sometimes struggle to get a routine appointment with my doctor when using the automated system I think this surgery is very well run and all the staff including the doctors are very friendly I'm very happy with the practice, you are always polite cheerful and helpfulit would be good to be able to book an appointment for tomorrow, or the next few days Receptionists, they are helpful but appear frazzled The booking system is crazy, it is ludicrous to be expected to get up in the middle of the night to get an on the day appointment The standard of care and courtesy at the surgery is extremely high Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 18 of 19

Appendix B: Improvement Plan ISSUE TO BE ADDRESSED IMPROVEMENT GOAL KEY ACTIONS REQUIRED BY WHOM? BY WHEN? REVIEW DATE Which specific area are you going to focus on? What do you want to achieve? What needs to be done to achieve the goal? There may be more than one action Who is responsible for ensuring it happens? When do you think this will be completed? When will you check on progress? Speaking to a GP on the telephone Easier access for patient when a consultation may not be necessary Advertising so the patient is aware to ask if they need to speak to a doctor. Put on the Website. Practice Manager 1 month - Update of website, but ongoing project Quarterly with PPG for patient and user feedback Wasted appointment Reduce DNA rate Implement DNA policy Practice Manager With immediate effect Quarterly with PPG Providing test results to patients Ensure patients are able to receive test results Partners to review current process for acting on investigation / test results GPs 3 months (June 2013) 6 months Website Advertising so as many patients as possible know how to access. Increase advertising within the surgery, on call display in waiting room, on prescriptions, eventually a newsletter Practice Manager liaising with PPG 6 months (Sept 2013) Ongoing project 8th months (Nov 2013) Email communication We can then communicate other information this way Distributing the information. A member of the PPG suggested Constant Contact. We will cost it and also see if this can be done from our Website Practice Manager & PPG 6 months (Sept 2013) 8 months (Nov 2013) Report compiled by CHATTAN SUPPORT Ltd March 2013 Page 19 of 19