Standard Reporting Template Practice Name: GLASTONBURY HEALTH CENTRE Practice Code: L85047 Bristol, North Somerset, Somerset and South Gloucestershire Area Team 2014/15 Patient Participation Enhanced Service Reporting Template Signed on behalf of practice: Dr Nick Matthews Date: 30/3/2015 Signed on behalf of PPG: Mr Russell Kirk Date: 30/3/2015 1. 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: Face to face, Email, Other (please specify) Face to face meetings Number of members of PPG and/or PRG: 7 PPG members Detail the gender mix of practice population and PPG and/or PRG: % Male Female Practice 48 52 PPG 57 43 Detail of age mix of practice population and PPG and/or PRG: % <16 17-24 25-34 35-44 45-54 55-64 65-74 > 75 Practice 18 9 10 14 19 15 10 7 PPG 14 14 14 14 30 14
Detail the ethnic background of your practice population and PPG and/or PRG: White Mixed/ multiple ethnic groups British Irish Gypsy or Irish Other White &black White &black White Other traveller white Caribbean African &Asian mixed Practice 91.4% 0.7% - 4.2% 0.2% 0.2% 0.4% 0.8% PRG 100% (7) Asian/Asian British Black/African/Caribbean/Black British Other Indian Pakistani Bangladeshi Chinese Other Other Any African Caribbean Arab Asian Black other Practice 0.5% 0.0% 0.2% 0.3% 0.5% 0.1% 0.1% 0.1% - 0.2% PRG A graphical comparison of the gender, age and ethnicity mix can be found in the attached document: Graphical comparison of Practice to PPG mix.doc 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: All clinicians verbally canvassed patients about the need for the health centre to have a PPG representation, the value they would bring to the patients, NHS and health centre in developing services and in their views. Those patients who appear interested in supporting the health centred were invited to the next quarterly meeting, which was governed by an agenda and included a topic related to the health centre, federations and the NHS. We found that by the clinician inviting the interested patients to come to the PPG meeting was more productive and the previous methods used in the past. This selective method has however not ensured representation for all the age groups, we are missing the 45-54 age band, and we have more male representation than female. However we have a group that has met for four times in the last 12 months with good representation in numbers only once dropping to 4 PPG members.
The PPG group has made a positive and useful contribution to the practice including: - A discussion about a telephone answering made us realise the data we had extracted from the phone system was inaccurate. Use of the information together with insights from the patient survey have helped us to reconfigure the way the phones are answered, including a greater push for online booking and repeat prescribing to reduce the pressure on the phones. - Review of a cleaning audit with feedback about the waiting room - Contribution and feedback on local GP commissioning ideas and concerns on a variety of issues relating to primary care and Glastonbury Health Centre including GHC healthy living initiative. - Advice and feedback regarding the practice website and TV screen messages in the waiting room. 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? YES We have a 45-54 year age bulge patient base (19%) and are acutely aware we do not have representation from this age group on the PPG. We hope that in the next year to be in a position to attract this age group, by having a stand in the waiting area and advertising a virtual PPG sign up with the aim to attract existing patients increase patient awareness and engagement for their valued support. We plan to add a section to the New Patient Questionnaire for virtual PPG sign up. There are a number of other registered population characteristics which differ from other practices in the vicinity, and which may contribute to some of the difficulties we have had in engaging with our patient group - We have a significant number of patients of all ages, including families with children, who have non-mainstream health beliefs, and/or way of life. There is significant use of non-nhs complementary medicine, and the way in which this group interacts with health and other services is different to the rest of the population - We have a high prevalence of both major mental disorder, depression and other mental health issues. - We historically have a relatively high patient turnover for a small town in Somerset. There is a subgroup of the population who move to Glastonbury because what it is perceived to offer, and stay for a relatively short period of time.
A combination of the above factors, and the fact that a good proportion of the above will fall in to the 45-54 age group are factors which limit our ability to engage with this demographic. We have close informal links with local 3 rd sector groups (previously the Robert Barton Trust, latterly the ELIM SLAP programme) who have offered advice on how to make access for the more marginalised members of this group easier, and advocate/ feed back on their behalf. An example of this is our willingness and system to fully register patients who have no fixed abode or care-of address. We are hopeful therefore that this harder to reach group does have a way of feeding back in to our service provision, albeit indirectly. We anticipate that this will continue, as we have periodic informal meetings with these organisations to explore common issues. The partners have specifically approached a number of people from this group, but as yet have been politely turned down. If you have answered yes, please outline measures taken to include those specific groups and whether those measures were successful: This year, we have concentrated our efforts to engage with the patients who have shown an interest in attending PPG meetings, making it interesting and not too demanding on their time. Our patients are passive and from experience in previous years, have expressed a dislike to conform formerly with structure our chairperson hierarchy. We have put our energy into engaging regularly with the PPG and gaining their confidence to contribute and valuing their ideas. We feel we have accomplished a great deal with quarterly meetings since December 2013 and aim to continue to build on the face to face engagement we have established, but will also seek develop a virtual group in 2015 to gain a wider opinion from a wider demographic, which will actively target carers and 45-54 year age group. We are actively engaged in developing the Mendip Test and Learn pilot on managing long term conditions, and as part of this approach, we will be looking at and measuring patient activation and working with a group of patients to develop a new model of care planning and deliver. We will actively seek to engage members of this patient group to give us and the other practices in the Federation feedback and constructive criticism so we can improve the delivery of our part of the service.
2. Review of patient feedback Outline the sources of feedback that were reviewed during the year: National Paper/technology tablet. Friends & Family The health centre signed up to the F&F test in September 2014. We explained this new mechanism of engaging with patients to review their visit to the health centre to our PPG and have discussed the results at every meeting. It was interesting that the PPG group felt that patients being handed a slip and asked to complete would be more productive than a handheld device. Along with the patients tiring of this survey and not wanting to engage if they have completed a survey last week. A copy of the monthly F&FT reports for the PPG can be found in the attached document: FaFT presentations to PPG.pdf Service Telephone patient survey Sit & Wait Urgent Care We designed a new service to enable patients to have same day consultation with the Urgent Care Team (a GP and /or nurse). The aims and objectives of the survey was to see if patients liked the use of skill-mix service provision, sit & wait concept, seen on clinical need and whether patient pressure managed demand. To capture patient feedback, we contacted by telephone, 40 patients who had used the service within the last 3 days and asked them 10 questions on how the rated the service. The PPG were also involved with the service design of sit & wait concept, being asked for the clinical nature and welcomed this as a mechanism to enable patients to be seen when necessary by the appropriately trained person.
A summary of the results from the patient survey can be found in the attached document Sit and Wait Patient Survey.pdf PPG Projects PPG monitoring telephone answering response The PPG highlighted to us their concern with the wait for answering incoming calls. We investigated using the Oak telephone monitoring software and share to the PPG group the number of incoming telephone calls received daily, peak activity times and average duration of calls. We were able to review with the PPG telephone contacts and how we could manager telephone demand more effectively. As a result the following mechanisms were developed to manage call demand: Repeat prescription telephone line access was reduced to 2 hours daily over a lunchtime when incoming calls for appointments were a minimum. Care Homes had planned regular visits by a GP to reduce their telephone demand Online appointment booking/cancellation Patient notices to increase awareness of other ways to access services other than the telephone A clear audit cycle was followed to ascertain if incoming call demand was reduced and if the wait for incoming calls to be answered improved. This audit activity was shared with the PPG so that the management system could be appreciated by all. PPG Prescription service, EPS and reduction of reprint scripts. We held a PPG meeting on the topic of prescribing and the use of EPS for patients to obtain medication at the pharmacy of their choice. We explained to the PPG the demand for prescriptions with the 2500+ patients currently on 4 or more medicines was increasing the prescription signing, resulting in prescriptions being mislaid either by the practice or
pharmacy and the safety concerns involved by this. We shared with the PPG the development of EPS (electronic prescription service) and asked their view and how this would support telephone demand management. The new system for patients to request repeat medication and the processing of the electronic prescription was explained to the PPG, who felt this would be safer and benefit all. The service went ahead and the reprints monitored and proven to reduce from a 10-20 per week to 1-2. This has been monitored and sustained. An audit of prescription reprints (from June 2013 to March 2015) can be found in the attached document Prescription reprints (Jun 13-Mar 15).pdf Healthy Mondays - Working with other agencies to improve patient welfare The PPG were involved in the development of Healthy Mondays where other agencies related to social & health welfare would have stands and engage with the patients attending the health centre. We asked for suggestions from the PPG and the PM worked closely to engage with these agencies. Since September the PPG has had the 90% of their suggested agencies attend the health centre. This has now been extended to include the community of Glastonbury, as it is advertised in the paper, radio and public venues in Street & Glastonbury. The PPG feel this has been a major benefit to the patients the community and the health centre staff as they have become to understand that demand on the clinical staff is not confined to health but also social wellbeing and how this concept of signposting patients to other services can help the patient become self-reliant and access appropriate support other than the GP or nurse.
Health Walks The PPG were involved in a suggestion of Health Walks to support patient self-reliance and combat loneliness. Since September, when this first walking group set off with 3 patients the group on alternate Fridays, the group has grown to 14 regular walkers twice weekly! How frequently were these reviewed with the PPG and/or PRG? The above appear and were discussed and updates share at every quarterly PPG meeting.
3. Action plan priority areas and implementation Priority Area 1 Description of priority area: Answering incoming calls remained a concern. We found that the telephone monitoring software was programmed incorrectly giving response times from when the caller clicked into the automated message this is Glastonbury health centre rather than hen the actual operator answered the caller. This issue has taken a full year of tweaks to ascertain accurate data on telephone response times and telephone duration times. We believe we have a reliable monitoring tool to feedback to the PPG and stakeholders and base action plans ensuring accurate data to aid decisions and audit cycles. If we considered reducing incoming lines to manage demand, but this would result in an engaged tone when patient caller demand exceeded line capacity. To increase the employees was not a viable option financially. However, working SMARTER would be explored. Could we manage incoming calls better? The telephone system had a simple call management system (1 = appointments, 2 =Test results, 3= prescriptions and 4= cancel appointment). What actions were taken to address the priority? Telephone software needed to be reliable and timed from when the caller was answered by the GHC receptionist. The incoming caller had to wait 7 seconds for the recorded message to complete prior to being put through to a GHC receptionist. Commsplus, telephone system supplier was contacted to discuss options to improve data reliability and accuracy, facility to monitor from the PC desk top and ideas to improve the service concern.
Incoming call peak times were identified, 8 to 9am, 11 to 12noon, 3 to 4pm. Identify reason for incoming call, appointments, prescription requests, test results and advice. Monthly monitoring of call data and reliability of monitoring function. Quarterly feedback to the PPG Result of actions and impact on patients and carers (including how publicised): The call monitoring software was made accessible to Practice Managers and Data Administrators desktop PC so that regular monitoring could be viewed. This confirmed frequent glitches in the software reliability in monitoring and has only been running consistently for the last 3 months and will be continued and shared the results shared with the PPG and monitored for the effects of tweaks in the audit cycle. The telephone contractor suggested we reduce the amount of incoming lines from 8 to 6 and rather than an engaged tone a message explaining the caller that we are experiencing high call volume and if a medical emergency to call 999 or call back. We explained that the PPG and GHC staff felt unhappy to have an engaged tone. We discussed with staff and at the PPG quarter 4 meeting and felt unhappy to reduce incoming lines for the following reason: the practice registered patient list is growing and we would need to pay to reduce the incoming lines only to be required to increase them within 12 months. We decided to implement a message informing the incoming caller that we were receiving high volumes of calls to be patient or call back. A copy of the original telephone report (from March 2014) can be found in the attached document PPG Telephone Facts and Figures (Mar 14).pdf We identified peak incoming call times to caller reasons i.e. prescription line opened at 11am until 4 pm daily. The PPG felt that to take the prescription line access would be safer but would upset a great deal of patients who were
housebound, employed or lived outside of the town. It was agreed to reduce the telephone line to 3 hrs daily (11am to 2pm) and to signpost patients to other ways in which to request their repeat medication (sign upon-line request via web, via pharmacy sign up, batch prescribing, dropping in part 2 of prescription, manual request posting/hand in). A campaign to increase patient awareness of how to order medication other than the telephone was developed by using the following : Using the patient electronic noticeboard in the waiting room GHC staff informing patients how to order prescriptions (GPs/Nurses, receptionist and prescribing clerks) Every letter to include a paragraph of how to order repeat medication via on-line etc. A campaign to increase patient awareness and uptake of on-line access to book appointments, order repeat medication and cancel an appointment was conducted using the above methods (staff, letters & noticeboard). To date 589 patients have signed up for on-line access, 168 appointments have been booked online, and 1447 online prescription requests have been done. The quarterly statistics and data are reviewed with the PPG at their quarterly meetings and suggestions to tweak considered. The PPG appreciate that we have instigated various changes to improve the response of answering incoming calls.
Priority Area 2 Description of priority area: GP appointment access. Staff complaining that they were never enough appointments Patients complaining no appointments GPs exhausted, doing 15 hr days What actions were taken to address the priority? PPG informed of GP deficit and recruitment concern nationally. PPG felt that GPs need to make patients aware of national concern and to use appointments wisely. Campaign to increase patient knowledge of how to access appointments and what to use appointments appropriately with the GP and nurse and signposting to agencies to help patient self-reliance and social welfare issues. Health Mondays agency visits published within the GP/Nurses waiting rooms, notice boards and since January 2015 locally in the paper, radio and public community places (library, community hospital website). The concept of a new Sit & Wait Service was discussed with the PPG, involving skill-mix in a team to see patients based on clinical need by the appropriate clinical person GP or a Nurse. Development of Sit & Wait urgent care clinic for patients that want to be seen. Patients contact the health centre to make an appointment and if the patient did not want to wait for the next available appointment, or felt they needed to be
seen that day the receptionist would book them in on the Urgent Care Team list and the patient would be seen on clinical need by the appropriate skill mix from the urgent care team. Patients who did not wish to give the nature of the clinical problem to the receptionist clerk would be placed on the GP triage telephone list, where the GP would telephone the patient and enquire to the nature of the problem. A telephone survey has been completed to see how clinic users felt the new service met their need and expectation. Result of actions and impact on patients and carers (including how publicised): The PPG group were consulted in the October PPG meeting about a nurse practitioner as a means to combat the GP Recruitment deficit, and many had in previous practices been seen by a nurse practitioner and were pleased with the service concept and felt that patients would not be concerned. This has resulted in us employing a Nurse Practitioner who is also a prescriber, to cover the Urgent Care Team daily all day Monday and mornings Tuesday to Friday. GPs are finding that they can accommodate visits earlier and that the pressure is lifted on them as a Duty GP. The telephone survey of sit & wait service users showed overall satisfaction A summary of the results from the patient survey can be found in the attachment on page 5 of this report
Priority Area 3 Description of priority area: Repeat prescriptions being generated and being mislaid from the time the prescription request was printed to being signed and placed in the box for collection either by the patient or pharmacy. Patients being informed by the pharmacy that they did not have a prescription to process. Patient coming into the health centre to collect and the clinical record indicating the prescription had been produced but not in the collection box. Resulting in prescription reprints being produced (433 reprinted prescriptions between June 2013 and March 2014). Concern over patient safety and pharmacy accountability. What actions were taken to address the priority? Dedicated prescription team supported by a pharmacist, Prescription manager and clerk, who dealt with all patient requests. Reduced prescription line access from 11am to 4pm daily to 11am to 2pm All staff signposting patients to on-line service and benefits Dedicated GP prescription sign off time to reduce risk of prescriptions being mislaid. All prescriptions for pharmacy collection are scanned into batches to prove prescription whereabouts. PPG introduced to concept and prescription pharmacist and manager.
Prescription team KPIs reduce reprints patient uptake of on-line access Patient sign up to EPS Result of actions and impact on patients and carers (including how publicised): Reduced reprints from 20 per week to less than 3 per week EPS uptake 1735 patients have now signed up for EPS Patient on-line access has impacted on a reduction of telephone prescription requests since March 2014, 228 patients have used the online system to request their prescriptions, and 1447 online prescription requests have been made during that time (i.e. there were over 1440 less phone calls to the prescription team, thanks to the online system). Improved patient safety and medicine management accountability at the pharmacy. The quarterly statistics and data are reviewed with the PPG at their quarterly meetings and suggestions to tweak considered. The PPG appreciate that we have instigated various changes to improve the safety and service quality.
Progress on previous years If you have participated in this scheme for more than one year, outline progress made on issues raised in the previous year(s): We have been disappointed that our previous DES submissions were not acceptable. However, we feel the progress achieved this year with the development of on-line services has improved the effectiveness and quality of the following services: Incoming call response rate o On-line appointment access o EPS and pharmacy repeat medication ordering o Reducing the repeat prescription line to 2 hrs daily Electronic noticeboard informing patients of the following: o How to use appointments wisely o Types of appointments available o How to book an appointment
4. PPG Sign Off Report signed off by PPG and/or PRG: YES/NO Date of sign off: 30 th March 2015 How has the practice engaged with the PPG and/or PRG: How has the practice made efforts to engage with seldom heard groups in the practice population? Has the practice received patient and carer feedback from a variety of sources? Was the PPG involved in the agreement of priority areas and the resulting action plan? How has the service offered to patients and carers improved as a result of the implementation of the action plan? Do you have any other comments about the PPG or practice in relation to this area of work? Stand in the waiting room advertising that we wanted PPG members, either face to face and a virtual group A completed and signed Sign Off form can be found in the attached document PPG Sign off.pdf