Healthwatch Slough s findings on:

Our Findings Briefing Five Healthwatch Slough s findings on: How GP Practices provide and communicate information to patients around appointment booking and access to primary care? Contents: Executive Summary Page 3 Acknowledgements Page 5 Background Page 5 Four areas of Investigation Page 7 a) How good are GP Surgery websites at promoting extended hours appointments? Page 7 b) How good are GP surgery answer machine messages? Page 8 c) How good are surgery environments at providing information about extended hours? Page 10 d) Patients knowledge of the extended hours appointments Page 11 Conclusion: Healthwatch Slough s recommendations to Surgeries Page 13 Appendices Page 14 a) CCG statement & background brief issued 16.6.15 Page 14 b) Summary of finding for each of the surgeries Page 15 i) The Avenue ii) Bharani Medical iii) Crosby House iv) Cippenham Surgery v) Farnham Road vi) Herschel Medical Centre vii) Kumar Medical viii) Langley Health Ctr ix) Manor Park Medical Ctr x) The Orchard xi) Ragstone Road xii) 240 Wexham Road (Dr Sharma) xiii) Shreeji Medical Cre xiv) Slough Walk In Health Ctr xv) Sussex Place xvi) 242 Wexham Road Your feedback Page 31 Contacts Page 32 2

Executive Summary What we did: Extended hours GP appointments (evenings and weekends) were made available in all 16 surgeries in Slough in 2014/15 as part of a successful bid for 2.95 million from the Prime Minister's Challenge Fund (PMCF) set up to improve access and innovation in the delivery of GP services. Due to the number of comments that Healthwatch Slough received about patients finding it difficult to access GP appointments, we decided to investigate how well publicised extended hours appointments were and if patients were able to access these additional appointments. Healthwatch Slough has carried out a fourpronged review: 1. We reviewed every practice website to see how well the scheme was promoted 2. We phoned every surgery after 6.30pm 3. We visited 11 surgeries to look at how the scheme was advertised 4. We spoke to 65 patients to find out about their knowledge of extended hours. A briefing was published for each of these four areas of investigation. What we found: We found good practice in some surgeries and have awarded them a star rating. 3

Areas that need attention One of the core principles that lie at the heart of Healthwatch s work is that every single person matters and every single person is entitled to the highest quality of care. So, whilst it is good to be able to report good practice, at the same time there is still work to be done to ensure that all patients trying to get a GP appointment have a good experience. Some of the areas that we think need attention are: 1. Information available on websites varied greatly between surgeries. In particular it appeared that individual practices had not come together to deliver constant and clear information relating to access to extended hours appointments and planned improvements. 2. It would be good to see all Slough GPs to agree a standard for telephone messages for the Slough patients that includes information on the 5 key areas we have identified. 3. Appointment-booking facilities and flexibility vary depending on surgery. Patients at some surgeries (e.g. 242 Wexham Road) can have contact with a GP in the same day (in person or by telephone), and there is no limit on how far ahead they can book appointments. Patients at other surgeries have a longer wait for appointments and/or must comply with specific time limits (e.g. Crosby House - 1 week window). Some surgeries offer their patients the facility to book appointments online but others do not. We encourage all GP practices in Slough to work together to develop a consistent approach to appointment booking and online facilities. 4

Acknowledgements Over the past two years, patients of Slough have been giving us feedback about their experiences of their GP surgeries. Without this feedback we would not be able to do what we do. Thanks to all receptionists and Practice Managers for their assistance. Finally, we would like to acknowledge the Healthwatch volunteers who helped carry out this piece of work: We would also like to thank Dr Jim O Donnell, Chair of the Clinical Commissioning Group for giving us the mandate to go and find how local surgeries can be improved. Chaitra Dinesh Satber Sandhu Alan Rose Sarah Shahid Preeti Sandhu Alexa Connor Dolly Bhaskaran Zhora Jeffries Background Healthwatch Slough helps people get the best out of their local health and social care services. Whether improving them today or helping to shape them for tomorrow. Healthwatch Slough enables local voices to influence the design and delivery of local services. Healthwatch Slough has received a number of comments about people finding it difficult to access GP appointments. In addition, Healthwatch Slough received a greater number of comments about people presenting at Slough Walk-in Centre at Upton Hospital. These observations prompted us to look in more details at what the 16 Slough GP surgeries that received some of the 2.95 million from the Prime Minister's Challenge Fund (PMCF) had done to improve access to GP services for patients. 5

Whilst the recent GP Survey (Ipsos MORI, July 2015, https://gp-patient.co.uk/slidepacks/july% 202015#S) shows that 76% of Slough patients surveyed were able to get an appointment to see or speak to someone an improvement of 3% on the previous year. Of those successful in getting an appointment 55% described their experience of making an appointment as good. 21 % stated their experience as neither good nor poor. This leaves a number of patients (25%) who are having a poor experience of making an appointment. The plan was that the Slough Clinical Commissioning Group (CCG) would: Increase access to GP services by extending weekday and weekend opening times Deliver access to extended hours appointments via four hubs. Introduce a range of innovative new projects: This includes introducing a free opt-in text service to promote patient wellbeing and provide reminders about routine health checks to online web appointments. 1.8m of the 2.95 million potentially equates to 922 additional appointments offered each week (341 on weekdays, 581 during weekends). Over a 12 month period this would total 48,000 additional GP appointments. The funding might also be used to offer longer appointments for patients with complex conditions. Healthwatch Slough has carried out a four-pronged review of this project. 1. We reviewed every practice website to see how well the scheme was promoted; 2. We phoned every surgery after 6.30pm; 3. We visited 11 surgeries to look at how the scheme was advertised 4. We spoke to patients to find out about their knowledge of extended hours; A briefing was published for each of these four areas. This briefing 5 brings together the findings from the whole investigation with a section on each of the 4 areas and a section for each GP surgery. 6

4 Areas of Investigation 1. How good are GP Surgery websites? Healthwatch Slough reviewed all 17 GPs websites during March & April 2015. The key questions we considered were: What are this surgery's online facilities like? How well do they rate against each of the 11 key features of an excellent GP surgery website as identified by Healthwatch (see below)? What works well and what could be improved? Healthwatch Slough believes that an excellent GP surgery website should include all of the following features :- 1. General information about the surgery 2. Extended hours appointments 3. Innovative projects through the extended appointments 4. Emergency/A&E or 999 5. NHS 111 6. Patient Access/Patient online 7. Booking appointments online service 8. Cancelling appointments online service 9. Inviting feedback/comments 10.Complaints process information 11.Healthwatch Slough details Information available on websites varied greatly between surgeries. In particular it appeared that individual practices had not come together to deliver constant and clear information relating to the Prime Minister's Challenge fund and planned improvements. At the time of investigation our volunteers were unable to find three Slough GP surgeries appear not to have a websites by searching through NHS Choices: Dr G Burden, 40 Ragstone Road Slough, Berkshire SL1 2PX Crosby House Surgery, 91 Stoke Poges Lane, Slough, Berkshire SL1 3NY Slough Walk In Health Centre (formerly known as Chapel Street), Upton Hospital, Slough, Berks, SL1 2BJ (run by Berkshire Healthcare Foundation Trust not the Slough Clinical Commissioning Group) Five GP surgeries in Slough were rated as having good websites, with a Healthwatch rating of 8-9. Healthwatch Slough is keen for these examples of good practice to be shared with other surgeries. Farnham Road & Weeks Drive Surgery Herschel Medical Centre The Orchard Practice Shreeji Medical Centre Wexham Road 7

WHAT HAS HAPPENED AS A RESULT OF OUR INVESTIGATION? The CCG made it clear that there were no PMCF requirements around surgery websites. However we believe updating a website is a cost efficient way of improving communication, the patient experience and their access to services. The website provides a 24 hour communication tool to inform patients about the extended appointments which can also allow them to book their appointments. It would also benefit the patients being able to see and find out further information of their hub surgery Crosby House now have a website http://www.crosbyhousesurgery.co.uk/ Ragstone Road surgery now has a website http://www.ragstoneroadsurgery.co.uk/ We are waiting for Berkshire Healthcare Foundation Trust to update their NHS Choices entry making it clear that the Health Centre (GP surgery) is separate to the Walk In Centre provision http://www.nhs.uk/services/gp/staff/defaultview.aspx?id=42624 Whilst around a third of patients say they would like to be able to book GP appointments online, analysis of the July 2015 Ipsos MORI GP Patient Survey data shows that an average of about 6% of patients are using the online facilities to book appointments and between 10-14% of patients are ordering repeat prescriptions online. Healthwatch Slough believe encouraging and supporting online access can help GP practices to improve the patient experience. 2. How good are GP surgery answer machine messages? In the July 2015 Ipos Mori GP Patient Survey 47% of Slough patients said it was easy to get through to their GP by phone and 50% said that it was not easy. Healthwatch Slough callers rang the 16* surgeries between 6.30pm and 7.30pm on Wednesday 15th April 2015l & Saturday 18th April 2015 1.00pm 3.00pm. Listening to each surgeries recorded message, we noted down the information we heard for the following areas: * (Manor Park Medical Centre and 15 Princes Street Practice, as well as The Orchard Practice & 11 Wheelwrights Place share the same telephone number) The key Healthwatch Criteria for GP Mystery Call were classified into 5 areas 1 Surgery Opening Times 2 Information on contacting the 111 Service 3 Information on contacting the 999 service in life threating emergencies 4 GP extended hours information 5 - Ways to book extended hours appointments Healthwatch Slough believes the following is an example of a clear and concise message: Thank you for calling the xxxx Surgery. The Surgery is now closed and will re-open Monday to Friday at xxxx and close at xxxx, except for Bank Holidays. If your call is regarding your extended hours appointment please call XXXXX You will now be given two options. 1. If you have a potentially life threatening condition? Please hang up immediately and dial 999. 2. 2. For any other medical queries that can-not wait until the surgery re-opens please hang-up and dial 111. Thank you for your call. 8

How Slough surgeries performed against this rating. Improving a recorded telephone answering machine message costs nothing. All surgeries in Slough could easily meet all the criteria for answer machine clarity. The Langley Health Centre Answering Machine Service, available on 01753 544288, has been rated the best answer machine message in for the surgeries that we called. We are recommending that all surgeries in Slough adapt their message to follow suit. It would be good to see all Slough GPs to agree a standard for telephone messages for the Slough patients. 9

3. How good are GP surgery environments at providing information about extended hours appointments? A team of 8 Healthwatch volunteers and staff visited 11 Slough surgeries to establish how Slough patients can find out information on the extended hours appointments and book appointments at local surgeries. Healthwatch team members entered the GP surgeries and observed posters, leaflets, notices boards and information screens. The team were looking for information about: GP Extended Appointments Choose well information Health information Social Care information Slough local and community information How can patients provide feedback and comments at the surgery? The team ensured they visited at least one surgery from each hub area. Their choice of specific surgeries was made on an otherwise random basis. We would encourage the surgeries that we did not visit to look at our findings to check how their surgery would rate. The team requested to speak to the reception lead in order to fill in the Healthwatch questionnaire. The questionnaire provides us with specific surgery information relating to booking appointments and patient feedback. Healthwatch was amazed and impressed at the number of Practice Mangers, GP Leads and reception team who took out time of their busy schedule to meet with us, complete the questionnaire and provide guided tours. It was good to see that all surgeries had information on the five areas available in their surgeries. The majority of practices had patient feedback boxes/post boxes/forms in prominent areas of the surgery inviting patients' feedback. Appointment-booking facilities and flexibility vary depending on surgery. Patients at some surgeries (e.g. 242 Wexham Road) can have contact with a GP in the same day (in person or by telephone), and there is no limit on how far ahead they can book appointments. Patients at other surgeries have a longer wait for appointments and/or must comply with specific time limits (e.g. Crosby House - 1 week window). Some surgeries offer their patients the facility to book appointments online but others do not. We encourage all GP practices in Slough to work together to develop a consistent approach to appointment booking and online facilities. 10

4. Patient s knowledge of the extended hours appointments We surveyed 65 Slough residents. The questionnaire was made available on our website & promoted through our e newsletters with hard copies available at Citizen Advice Slough. The questionnaire was also distributed via Healthwatch community engagement, such as our pop-up shops in the Observatory shopping centre, and was shared online through Slough community networks. The Clinical Commissioning Group conducted their own patient feedback surveys in October 2014, January 2015 and March 2015. A total of 878 people completed the questionnaire. Over 95 % of said that their appointment time was convenient. The benefit of Healthwatch Slough being an independent consumer champion is that we have access to a more varied cross section of the community. Rather than survey people already sat in surgery waiting rooms, we were able to engage with people out and about in the community. The majority of people we spoke to were not aware about extended access to GP appointments and that they could book an appointment in the evening or at the weekend. 11

Summary of key Survey Questions Data of survey responses Q 10. Are you aware of the Prime Minster Challenge Funding for Slough patients? Q.4 Approximately how many times have you tried to make an appointment with your GP 70% of patients were not aware of the GP services in Slough receiving 2.95 million award from the Prime Minister s Challenge Fund to improve access to Primary Care across 7 days Almost a quarter of patients tried to make an appointment more than 5 times with their GP over the past year Q.5 My experience of booking a GP appointment at my surgery Only 13% of those surveyed felt their experience of booking a GP appointment at their surgery was Very good Q.7 If you have been unable to make an appointment why was this? Common themes we heard were Lack of GP appointments when required, Preferred doctor not available, Unable to contact GP surgery Q.9 What would you suggest to make appointments more accessible for patients? Q.8 When you have been unable to make an appointment with your GP and have needed to be seen what services have you used? Q.11 Have you attended a GP appointment at your GP surgery or hub during the following times. Q.12 In the last 8 months I have experienced that GP appointments are more accessible To improve access to appointments, patients felt there could be more GP s available, more appointments available, more online booking and more telephone lines available to patients. Many patients visited the Walk-In Clinic or had to make an appointment for another time when they could not get an appointment when they needed 59% of patients made use of extended hours appointments by attending a GP appointment between the hours of 6.30pm 8pm (Monday- Friday) 40% of patients Strongly Agreed or Agreed that have experienced that GP appointment are more accessible over the last 8 months. Q.13 In the last 8 months my overall patient experience has been improved 39% of patients Strongly Agreed or Agreed that their overall patient experience has improved over the last 8 months Quality of information, particularly in relation to improving patient experience, is widely acknowledged and has been researched by the Kings Fund (for further details http:// www.kingsfund.org.uk/sites/files/kf/independent-inquiry-gp-3-defining-and-measuring-qualitygeneral-practice-march-2011.pdf). 12

Surgery Websites Conclusion: Healthwatch Slough recommendations to Surgeries Healthwatch Slough believes that an excellent GP surgery should include all of the following:- 1. General information about the surgery 2. Extended hours appointments 3. Innovative projects through the extended appointments 4. Emergency/A&E or 999 5. NHS 111 6. Patient Access/Patient online 7. Booking appointments online service 8. Cancelling appointments online service 9. Inviting feedback/comments 10.Complaints process information 11.Healthwatch Slough details Surgery Answer Machine Messages Healthwatch Slough advises that an information answer machine should provide: 1 Surgery Opening Times 2 Information on contacting the 111 Service 3 Information on contacting the 999 service in life threating emergencies 4 GP extended hours information 5 - Ways to book and access extended hours appointments Healthwatch Slough would encourage surgeries to review their answer machine message and adapt our recommended message (see page 5) to suit their surgery. Patient Information and feedback Healthwatch Slough would like to see: more information screens being available with updated information (as observed in The Avenue & Langley Health Centre surgeries.) information available on Choose well, Health, Social Care & Community activities and resources all surgeries to actively promote patient feedback channels, displaying what patients have fed back and what they have done in response. Extended Hours Appointments Healthwatch Slough recommend that: all Slough Surgeries provide their patients with clear information on how you book evening and week-end appointments. details of extended hours to be displayed prominently in all Slough surgeries the details of surgery Hubs be shared in all surgeries including photos and local maps, showing how to get to there. all surgeries to consider providing patients with extended hours details (e.g. phone number, locations etc.) in a business card format for convenient reference. Booking Appointments Healthwatch Slough recommend : Surgery Specific information about Patient Access to support booking and cancelling appointments online Surgeries across Slough review their advance booking arrangements to ensure they meet the patients needs and are comparable with other surgeries; with a view to providing a more consistent standard of service across Slough. Environment and Display For surgeries to have sound available to create background noise. This can be achieved via monitor screens and/or music in waiting or booking areas. The benefits of achieving a more relaxed environment by playing music can be found here http:// www.practicemanagement.org.uk/uploads/ access_guide/3_the_practice_environment.pdf For practice staff to look at information displays (e.g. by visiting other surgeries or using the examples pictured in Healthwatch Slough's Briefing 3) and implement the ideas in their own surgery environment. 13

Appendices Prime Ministers Challenge Fund CCG statement and background brief issued 11.6.15: Dr. Jim O Donnell, Clinical Chair, Slough Clinical Commissioning Group, said: We always welcome feedback about the services we commission and we listen to, and work closely and collaboratively with our patients, practices and partners. GP access is a national issue and in Slough we took a pro-active approach with our patients and practices which led to the successful bid for the Prime Ministers Challenge Fund (PMCF) to improve access at a local level. In April 2014, Slough CCG on behalf of its member practices and their patient groups was awarded 2.95m through PMCF. PMCF is a pilot project to enable practices to deliver GP appointments seven days a week and to test new and improved new ways of working. Within three months of receiving the funds, extended opening hours had been fully implemented across Slough (the fastest implementation in England) and now patients have access to local GP appointments seven days a week until 8pm, and 9am until 5pm at weekends, delivered by four hub practices. This has been a huge undertaking and one that is being successfully delivered with an additional 44,000 appointments provided over the last 11 months. This has only been possible with the hard work of our patient groups, GP practices and support from our partner organisations including Healthwatch, who also participated in our patient workshops. In addition, the funds have enabled us to take forward a number of innovative projects which have come from direct patient feedback and via Healthwatch and others about services they wish to see such as Group Consultations and text messaging services. To be clear, the funds are not intended to be used to update practice websites, as this would be an inappropriate use of the money. There are strict NHS England criteria and a great deal of close national oversight in how the money is spent and this is fully audited. However, all practice websites include information on their opening hours. We note from the Healthwatch report that three GP Practices were highlighted as not having websites. This is incorrect. Only one does not have an individual website: The Chapel Medical Centre, co-located with the Slough Walk-in Centre and operated by the Berkshire Healthcare Foundation Trust on whose website its opening hours and practice information can be easily found. We aim to give patients as much choice as possible when it comes to accessing primary care services, whether booking appointments online or by telephone/text to ordering repeat prescriptions. Feedback is encouraged through NHS Choices, as is the same for any GP practice or NHS service. Communication with patients, their families and carers is important which is why we use a variety of methods to speak with and engage our patient population which includes online, practice level and wider communication tools. For PMCF to work successfully, a targeted approach was taken in Slough when providing additional appointments. GPs understand their patient population and as such have been able to utilise the additional and longer appointments for those patients that need more comprehensive primary care support such as those with Long-Term Conditions or fulltime workers who may not be able to access a normal in-hours appointment. This targeted approach is delivering results and the pilot becomes sustainable by reducing the number of unnecessary A&E visits by those that should be seen in primary, and not emergency care settings. Patient surveys have shown consistently high levels of patient satisfaction with the latest survey showing 97% satisfaction amongst those patients that have used an extended hours appointment. These findings and updates about the scheme are shared with a wide range of stakeholders, including Healthwatch who have been supporting this work. We would like to thank Healthwatch for giving us this opportunity to correct and clarify some of the inaccuracies and misunderstandings found in their report. Ends 14

Summary of findings for each of the surgeries The Avenue Surgery Online Findings - We would like to see the surgery website include the 11 features recommended by Healthwatch Slough. The Avenue Surgery Rating Healthwatch Slough Rating Criteria Action 7/11 5-7 OK website Requires improvement Telephone Findings We recommend that the Avenue surgery adapts its out of hours telephone answer machine message to include all five areas of information recommended by Healthwatch Slough. Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice 1 Opening times 2 111 Service 3 If life threatening 999 service Met 1,2,3 Unmet 4,5 None to report Visit findings What could be improved? Create headings for posters on display What we recommend That the surgery share with other Slough surgeries: the ways in which it successfully creates a calm environment Information on the TV monitor screens and how to implement The process for creating surgery displays and posters - we observed clear, current information displayed in topics and themes. It s written definition of an emergency appointment - wording could be used on posters by other surgeries. Supporting Healthwatch information Healthwatch Star Rating Calm environment, Background music in the waiting area, TV monitor available, Notice board and posters up to date, clear and organised Survey findings - None of the survey respondents identified themselves as patients from the Avenue Medical Centre. However, Avenue patients may be among those respondents who did not specifically name their surgery. Next steps - Healthwatch looks forward to reporting on the implementation of its recommendations and suggestions, including sharing areas of good practice with other surgeries. We recommend that the surgery implements our overall recommendations. 15

Bharani Medical Surgery Online Findings - We would like to see the surgery website include the 11 features recommended by Healthwatch Slough. The Bharani Surgery Rating Healthwatch Slough Rating Criteria Action 6/11 5-7 OK website Requires improvement Telephone Findings - We recommend that the Bharani surgery answering machine message include all five areas of information on the Healthwatch checklist, and that the surgery addresses the concerns highlighted. Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice 2 111 Service Met 2 Unmet 1,3-5 Concern 1 For the surgery to investigate there telephone answer machine operating times Concern 2 For the surgery to immediately change their automated telephone message which includes information such as having a real emergency Visit findings The Bharani surgery was not one of the 11 surgeries visited by Healthwatch. Healthwatch suggest that you read the briefing three report to identify any findings that may relate to your surgery. We strongly recommend working with your PPG (patient participation group) to carry out an equivalent site visit/ observation exercise of your own. This will enable you to identify any improvements needed and good practice to be shared. Survey findings 2% of survey respondents identified themselves as being registered at the Bharani surgery. (In addition, other Bharani patients may have been among those respondents who did not identify their surgery). Overall only 13% of survey respondents described their experience of booking a GP appointment at their surgery as 'Very good'. Next steps Healthwatch looks forward to reporting on the changes to the telephone answer machine service together with liaison with the Langley Health Centre to share and implement good practice as suggested. We advise that the surgery updates its website to include all 11 recommended features and implements our overall recommendations. 16

Crosby House Surgery Online Findings At the time Healthwatch conducted it s review, Crosby House surgery did not have an operational website available for the public to access. Healthwatch are pleased to report as an impact of our findings Crosby House now has a website. We would like to see the new website include the 11 features recommended by Healthwatch Slough. Telephone Findings We recommend that the Crosby House surgery answer machine message includes all five areas on the Healthwatch checklist areas. Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice 1 Opening times 2 111 Service 3 If life threatening 999 service Visit findings Met 1,2,3 Unmet 4&5 (extended hours) None reported What could be improved? What we recommend Supporting Healthwatch information - Activate the monitor screens and include current information displayed in surgery - Check that posters, leaflets and notice boards are up to date - To create a PPG information notice board or poster. - To create some form of sound ( radio, TV, music) so that conversations with patients at reception are less audible to others. For the surgery to: - introduce more methods to encourage patient feedback N.B. Crosby House reported that feedback was collected through the website, Healthwatch Slough found that this surgery did not appear to have an operational website at the time of its review - For the surgery to visit The Avenue or Farnham Road Practice to gather ideas on collecting and encouraging patient feedback. - For the PPG group to gather patient feedback on booking appointments 1 week in advance only - For the surgery to liaise with other surgeries to find out what could be done to offer the patients more opportunity than booking in a 1 week window. - For the surgery to make online booking and medication ordering available to patients.- Crosby House was the only surgery reported to have a maximum of 1 week booking in advance option. We encourage the surgery to seek information on how other surgeries have an increased time frame. Survey findings - 17% of survey respondents identified themselves as being patients at the Crosby House surgery. This was our highest response for a specific surgery. To improve access to appointments, patients suggested there could be more GPs available, more appointments available, more online booking and more telephone lines available to patients. Next steps - We recommend that the surgery implements our overall recommendations and would encourage the PPG to carry out a review of the new surgery website. 17

Cippenham Surgery 261 Bath Road Online Findings At the time of the Healthwatch report being conducted the Cippenham Surgery website task was not carried out. We would like to request for the surgery to carry out the Healthwatch online task with their PPG group Telephone Findings We recommend that Cippenham surgery revises its answering machine message to cover all five areas on the Healthwatch checklist and addresses the concern raised by Healthwatch. Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice 1 Opening times 2 111 Service 3 If life threatening 999 service Met 1,2,3 Unmet 4and5 (extended hours appointments) Concern - The wording of the 111 service should be consistent with the advice given by other surgeries. The Cippenham surgery message states that you should only call 111 "in an emergency". if you need a doctor in an emergency please call 111. Use this number in an emergency only. If life threatening call 999 The information/wording does not make clear the intended use of the 111 service, or the difference between how 111 and 999 should be used. Visit findings What could be improved? What we recommend Supporting Healthwatch information -Activate the monitor screens and include current information displayed in surgery -Check that posters, leaflets and notice boards are up to date That the surgery implement more methods to encourage patient feedback. Ensure that leaflets and noticeboards are easy to access and read. The surgery has a comprehensive leaflet on the services it offers, very informative. Survey findings - None of the survey respondents identified themselves as Cippenham patients. However, Cippenham patients may be among those who did not name their surgery. The findings reported that 59% of patients that have attended an extended hours GP appointment at their GP surgery or hub during Mon Fri 6.30 8.30pm. Next steps - We recommend that the surgery implements our overall recommendations, that it ensures its out of hours answer machine message includes all five areas on the Healthwatch checklist, and works with the PPG to review its website. 18

Farnham Road Surgery Online Findings - We would like to see the surgery website include the 11 features recommended by Healthwatch Slough. The Farnham Surgery Rating 9/11 8-9 Good website Add the remaining three features from the Healthwatch checklist to achieve the excellence rating. Once completed, share good practice with other surgeries. Telephone Findings We recommend that the Farnham Road surgery answer machine message cover all five areas from the Healthwatch Slough checklist. Visit findings Healthwatch Slough Rating Criteria Action Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice 1 Opening times 2 111 Service 3 If life threatening 999 service Met 1,2,3 Unmet 4&5 (extended hours appointments) None reported What could be improved? What we recommend Supporting Healthwatch information - Activate the monitor screens and include current information displayed in surgery. - Create headings and themes for posters and notices. To check that posters, leaflets and notice boards are up to date. - Look at the area in which waiting patients sit and to redesign information to support the space. - Limit amount of posters on wall to reduce cluttered look That the surgery share the following with other Slough surgeries: - surgery-specific literature about Patient Access - the 'New Service for Patients' (Navigator) poster. Healthwatch recommends that all surgeries adopt this poster. - 'Friends & Family Test' notice board (once completed) Healthwatch Star Rating Posters and leaflets about Patient Access specific to surgery Survey findings - 8% of survey respondents identified themselves as being patients at the Farnham Road surgery. It was noted that Overall only 4% of survey respondents had heard of the Navigator Service from their GP surgery. A poster like that used by Farnham Road surgery would therefore useful to promote the service to patients across Slough. Next steps Healthwatch looks forward to reporting on the implementation of the Healthwatch recommendations and suggestions, including sharing areas of good practice (e.g. Patient Access literature) with other surgeries. 19

Herschel Medical Centre Online Findings - We would like to see the surgery website include the 11 features recommended by Healthwatch Slough The Herschel Surgery Rating Slough Rating Healthwatch Criteria Action 8/11 8-9 Good website Add the remaining three features from the Healthwatch checklist to achieve the excellent rating. Once completed, share good practice with other surgeries Telephone Findings - We recommend that Herschel surgery answer machine message cover all five areas from the Healthwatch Slough checklist. Information covered (numbered 1 to 5 on Healthwatch checklist) Healthwatch Criteria 2 111 Service Met 2 Unmet - 1, 3, 4, 5 Healthwatch Highlights special concerns or good practice The surgery has reported that the limited content of the answer machine service is due to patient feedback indicating callers do not want a long message due to telephone cost. However, our team found that the five areas of information recommended by Healthwatch can be recorded in less than 50 seconds. We believe the message has no extra cost to the patient and it will provide them with information to make an informed choice. Visit findings What could be improved? What we recommend Supporting Healthwatch information - Activate the monitor screens and include current information displayed in surgery - Create headings and themes for posters and notices For the surgery to share with other Slough surgeries: - Tips for displaying notices and posters in surgeries - Poster on DNA* (sad face) / patients treated (happy face) as we found this poster an easy and effective way of sharing a key message *patients who did not arrive for apt Clear and informative in -house posters and displays. Survey findings - 9% of survey respondents identified themselves as being patients at the Herschel Medical surgery. Overall comments included I often self-medicate and hope for the best [when unable to GP appointment]. Next steps Healthwatch looks forward to reporting on the implementation of the Healthwatch recommendations and suggestions, including improvements to the telephone answer machine and sharing areas of good learning (posters & displays) with other surgeries. 20

Kumar Medical Surgery Online Findings - We recommend that the Kumar surgery includes all 11 website features recommended by Healthwatch Slough Kumar medical Surgery Rating Healthwatch Slough Rating Criteria Action 6/11 5-7 Ok website Room for Improvement Telephone Findings - We recommend for the Kumar surgery to include the 5 criteria areas to their telephone answer service. Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice 1 Opening times 2 111 Service Met 1,2 Unmet 3-5 None reported Visit findings The Kumar Medical surgery was not one of the 11 surgeries visited by Healthwatch. Healthwatch suggest that you read the briefing three report to identify any findings that could relate to your surgery. We strongly recommend working with your PPG to carry out ) to carry out an equivalent site visit/observation exercise of your own. This will enable you to identify any improvements needed and good practice to be shared. Survey findings - 3% of survey respondents identified themselves as being patients at the Kumar Medical surgery. Overall survey findings included the fact that 37% of patients felt their experience of booking a GP appointment at their surgery was Poor. Next steps Healthwatch looks forward to reporting on the implementation of the Healthwatch recommendations and suggestions, including improvements to the website, telephone answer machine and arranging a walk-in mystery shop with your PPG. 21

Langley Health Centre Online Findings - We would like to see the Langley Health centre surgery website include all 11 website features recommended by Healthwatch Slough. Langley Health Centre Surgery Rating Healthwatch Slough Rating Criteria Action 7/11 5-7 Ok website Requires improvement. Telephone Findings The Langley Health Centre was the only surgery in Slough whose telephone answering service fulfilled Healthwatch Slough's five criteria to achieve an excellent ranking. Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice 1 Opening times 2 111 Service 3 Information on contacting the 999 service in life threatening emergencies. 4 GP extended hours information 5 Ways to book and access extended hours appointments. Met 1,2,3,4,5 Healthwatch Star Rating Excellent message We recommend for the Langley Health Centre surgery answer machine message to be used to show and share good practice to support patient access and information to support them to make informed choices. Visit findings Star Rating What could be improved? What we recommend Supporting Healthwatch information Create headings and themes for posters and notices. To check that posters, leaflets and notice boards are up to date and plan information areas in view of seating and waiting areas. Create some form of sound (radio, TV, music) so conversations with patients at reception are less audible to others. For the surgery to share with other Slough surgeries on: Information on the TV monitor screens, highlighting the specific surgery information and how to implement To share the large extended hours poster with other surgeries Healthwatch Star Rating For the monitor/ information screens available which includes the surgery specific information Survey findings - 11% of survey respondents identified themselves as being patients at Langley Health Centre. Overall survey comments included No male doctor available, often different doctors working rather than a regular doctor, and a 3 week wait for appointments Next steps Healthwatch looks forward to reporting on the implementation of the Healthwatch recommendations and suggestions, including the sharing of good practice and learning with other surgeries. 22

Manor Park Medical Centre Online Findings - We would like to see the surgery website include all 11 website features recommended by Healthwatch Slough. Manor Park medical Surgery Rating Healthwatch Slough Rating Criteria Action 7/11 5-7 Ok website Room for improvement. Telephone Findings - We recommend for the Manor Park surgery include the 5 criteria areas to their telephone answer service. Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice 2 111 Service 3 If life threatening 999 service Met 2,3 Unmet 1, 4&5 None reported Visit findings Manor Park Medical Centre was not one of the 11 surgeries visited by Healthwatch. Healthwatch suggest that you read the briefing three report to identify any findings that could relate to your surgery. We strongly recommend working with your PPG to carry out an equivalent site visit/ observation exercise of your own. This will enable you to identify any improvements needed and good practice to be shared. Survey findings - None of the survey respondents identified themselves as being Manor Park Medical Centre patients. However, some Manor Park patients may be among those who did not name their surgery. Overall survey findings included the fact that 13% of respondents described their experience of booking a GP appointment as 'Very good'. Next steps Healthwatch looks forward to reporting on the implementation of the Healthwatch recommendations and suggestions including improvements to the website, telephone answer machine and carrying out a walk in mystery shop with your PPG. 23

The Orchard Practice Online Findings - We would like to see the surgery website include all 11 website features recommended by Healthwatch Slough. The Orchard Practice Healthwatch Criteria Action Slough Rating 8/11 8-9 Good website Add the remaining three features from the Healthwatch checklist to achieve the excellent rating. Once completed, share good practice with other surgeries Telephone Findings - We recommend for the Manor Park surgery include the 5 criteria areas to their telephone answer service. Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice 2 111 Service Met 2 Unmet 1,3,4,5 Concern in the event of medical emergencies please call 111 or for emergencies contact A&E at Wexham Park Hospital No number provided for Wexham Park Hospital A&E and no advice about when to use 999. Visit findings What could be improved? What we recommend Supporting information Activate the monitor information screens and include current information displayed in the surgery Activate the patient feedback machine. Create headings and themes for posters and notices. To check that posters, leaflets and notice boards are up to date to avoid duplication. Add colour to posters/backing area of the black and white posters. For the surgery to share the concept with other Slough surgeries on the display banner available to show patients how to use the feedback service None reported Survey findings 5% of survey respondents identified themselves as being patients at the Orchard surgery. Overall survey findings included 29% of respondents said they would use the Navigator Service, 13% said they would not and 58% said they were not sure if they would use the service. Next steps Healthwatch looks forward to reporting on the implementation of the Healthwatch recommendations and suggestions, including improvements to the telephone answer machine and sharing the surgery feedback options & banner with other Slough surgeries. 24

Ragstone Road Surgery Online Findings At the time of the Healthwatch report being conducted Ragstone Road surgery did not have an operational website available for the public to access. Healthwatch are pleased to report as an impact of our findings Ragstone Road now has a website. We would like to see the new website include all 11 website features recommended by Health watch for patient access to information.. Telephone Findings We recommend for the Ragstone Road surgery answer machine message cover all the 5 areas from the Healthwatch Slough checklist. Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice 1 Opening times 2 111 Service 3 If life threatening 999 service Met 1,2,3 Unmet 4&5 (extended hours appointments) None reported Visit findings Ragstone Road surgery was not one of the 11 surgeries visited by Healthwatch. Healthwatch suggest that you read the briefing three report to identify any findings that could relate to your surgery. We strongly recommend working with your PPG to carry out an equivalent site visit/observation exercise of your own. This will enable you to identify any improvements needed and good practice to be shared. Survey findings 6% of survey respondents identified themselves as being patients at the Ragstone Road surgery. Overall survey comments included: Since our surgery has extended opening hours to evenings and weekends, it has prospered in serving their patients. If a consultation can be done over the phone then it should be done instead of using appointments which waste time. I would suggest other surgeries do the same. Next steps Healthwatch looks forward to reporting on the implementation of the Healthwatch recommendations and suggestions. It would encourage the PPG (patient participation group) to carry out its own review of the new surgery website and conduct a site visit/observation exercise (equivalent to those conducted by Healthwatch Slough). Healthwatch Slough will be happy to support you with these tasks. 25

Dr Sharma s surgery, The Surgery, 240 Wexham Road Online Findings - We would like to see the surgery website include all 11 website recommended by Healthwatch Slough 240 Wexham Rd Healthwatch Slough Rating Criteria Action 5/11 5-7 Ok website Room for improvement Telephone Findings We recommend that the answer machine at 240 Wexham Road surgery cover all 5 areas from the Healthwatch Slough checklist. Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice 2 111 Service 3 If life threatening 999 service Visit findings Met 2,3 None reported What could be improved? What we recommend Supporting Healthwatch information Activate the monitor screens and include current information displayed in surgery For some in house posters to be written in a more appropriate customer friendly tone and manner e.g. poster which list medications not available on prescription - it would be useful to add the reason/s why. Create some form of sound radio, TV, music so conversations with patients at reception are less audible to others For the surgery to meet with the Avenue Surgery or Langley Health Centre to collect ideas on writing information for individual surgeries Building work was taking place at the surgery so some information have been moved, taken down on a temporary basis. Survey findings 3% of survey respondents identified themselves as being patients at the Wexham Road surgery. (We understand that this number could relate to both/either Wexham Road surgeries) Overall survey comments included More telephone lines and an opportunity to talk to the doctor over the phone. Next steps Healthwatch looks forward to reporting on the implementation of the Healthwatch recommendations and suggestions, including the outcome of the meeting with the Avenue or Langley surgery team to help you develop your in-house posters. 26

Shreji Medical Centre Online Findings - We would like to see the surgery website include all 11 website features recommended by Healthwatch Slough. Shreji Medical Centre Slough Rating Healthwatch Criteria Action 8/11 8-9 Good website Add the remaining three features from the Healthwatch checklist to achieve the excellent rating. Once completed, share good practice with other surgeries. Telephone Findings We recommend that the Shreeji Medical Centre surgery answer machine message cover all five areas from the Healthwatch Slough checklist. Healthwatch rating 2 111 Service 3 If life threatening 999 service Healthwatch criteria Met 2,3 Unmet: 1 (opening times) 4&5 (extended hours) Healthwatch Highlights Concerns or good practice Concern To update the telephone number given on the Slough CCG website as the wrong number is provided to contact the surgery. Visit findings The Shreeji Medical Centre was not one of the 11 surgeries visited by Healthwatch. Healthwatch suggest that you read the briefing three report to identify any findings that could relate to your surgery. We strongly recommend working with your PPG (patient participation group) to carry out an equivalent site visit/observation exercise of your own. Together you can identify any improvements needed and good practice to be shared. Survey findings 5% of survey respondents identified themselves as being patients at the Shreeji Medical Centre surgery. Overall survey comments included Phone permanently engaged, I had to visit surgery in person to get an appointment. Next steps - Healthwatch looks forward to reporting on the implementation of the Healthwatch recommendations and suggestions, including updating the surgery information held by Slough CCG (and published on their website) and to encouraging the PPG group to carry out a walk-in mystery shop exercise. 27

Slough Walk in Health Centre (also know to Consumers as the Chapel Surgery) Online Findings Chapel Surgery no longer exists. Berkshire Healthcare Foundation Trust (BHFT) runs Upton Walk In Health Centre (all the patients from Chapel Surgery transferred here). Healthwatch are working with BFHT to ensure that this information is updated on the NHS Choices website, BHFT s website and that patients are informed of the correct name of the surgery and how it differs from the Walk In Clinic. Online Findings - We recommend for the Sussex Place & Village Medical surgery answer machine message covers all five areas from the Healthwatch Slough checklist. The Walk in surgery website Healthwatch Slough Rating Criteria 5/11 5-7 OK website Action Requires improvement. To make clear on the website the difference between the GP surgery and the Walk in clinic Telephone Findings The Walk in clinic surgery number was answered (not a recorded message) on both occasions and answered as Slough Health Centre. Patients were informed that the GP surgery was closed but that they could use the Walk in part of the service. Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice NA NA Good practice the telephone line was answered in the evening after 6.30pm and Saturday afternoon. This was the only Slough surgery where the telephone was answered during the extended hours period. Visit findings What could be improved? What we recommend Supporting Healthwatch information Activate the monitor screens and include current information displayed in surgery Create headings and themes for posters and notices To theme the leaflets available to avoid duplication Create information (poster, leaflet, banner) to encourage patients to use the feedback screens. Create some form of sound radio, TV, music so conversations with patients at reception are less audible That the surgery contacts other surgeries who are offering online ordering of medication with the aim to provide this service. To provide clearer visual indicators differentiating the Walk in service and the GP service. to others Survey findings 5% of survey respondents identified themselves as being patients at the Walk in surgery (Healthwatch has merged this data with the named surgery, i.e. the Chapel surgery) Overall survey findings included the fact that 24% of survey respondents indicated that they had visited the Walk-In Clinic when they were unable to get an appointment with their GP. Next steps Healthwatch looks forward to reporting on the implementation of the Healthwatch recommendations and suggestions, including updating the surgery information on the NHS Choices website and its own literature to inform patients of the correct name/location/status of their surgery. The BHFT website should make a clear distinction between the Walk in facility and the GP services surgery. We encourage the PPG to repeat the Healthwatch out of hours telephone task using our checklist to review the surgery' answer machine message. 28

Upton Medical partnership ( Sussex Place & the Village Medical Centre) Online Findings - We would like to see the surgery website include all 11 website features recommended by Healthwatch Slough. Healthwatch will offer support to achieve this and we suggest that Upton Medical partnership staff meet with staff from one of the 5 surgeries whose website was rated 8-9. Sussex Place and the village Medical Centre Healthwatch Slough Rating Telephone Findings We recommend for the Sussex Place & Village Medical surgery answer machine message covers all five areas from the Healthwatch Slough checklist. Visit findings we visited Sussex Place Surgery Criteria 4/11 1-4 Website needs support Action Requires immediate improvement Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice 1 Opening times 2 111 Service 3 If life threatening 999 service Met 1, 2,3 Unmet 4&5 (extended hrs) None reported What could be improved? What we recommend Supporting Healthwatch information Activate the monitor screens and include current information displayed in surgery Display leaflets on a shelf/leaflet rack or in a file. Organise the leaflets in themes to avoid duplication Create headings and themes for posters and notices Plan the area that patients sit in in/walk past and redesign information to support the space For the surgery to meet with the Avenue Surgery or Langley Health Centre to collect ideas on writing information for individual surgeries. To share the facility to book appointments up to six weeks with other Slough surgeries. None reported Survey findings 12% of patients identified themselves as being patients at the Upton Medical Partnership surgery. Overall survey findings included the fact that almost a quarter of patients tried to make an appointment with their GP more than five times over the past year. Next steps Healthwatch looks forward to reporting on the implementation of the Healthwatch recommendations and suggestions; including sharing details of the facility for booking appointments up to six weeks in advance with other surgeries. 29

Wexham Road - 242 Wexham Road Online Findings - We would like to see the surgery website include the 11 website features recommended by Slough Healthwatch. 242 Wexham Road Healthwatch Criteria Slough Rating 8/11 8-9 Good website Telephone Findings We recommend for 242 Wexham Surgery answer machine message cover all 5 areas from the Healthwatch Slough checklist.. Visit findings we visited Wexham Road Action Add the remaining three features from the Healthwatch checklist to achieve the excellent rating. Once completed, share good practice with other surgeries. Healthwatch rating Healthwatch criteria Healthwatch Highlights Concerns or good practice 1 Opening times 2 111 Service 3 If life threatening 999 service Met 1, 2,3 None reported What could be improved? What we recommend Supporting Healthwatch information Activate the monitor screens and include current information displayed in surgery Create headings and themes for posters and notices. To check that posters, leaflets and notice boards are up to date. To update the PPG board Create some form of sound radio, TV, music so conversations with patients at reception are less audible to others. For the surgery to share with other Slough surgeries: - Patient communication regarding access to speak to GP via telephone consultation - The facility to book in advance with no time period limit - The business card available which offers a direct contact number to a senior GP and directions of getting to the Hub surgery For the surgery to seek information from other Slough surgeries about how appropriate monitoring is ensured when offering the facility to order medication online Healthwatch Star Rating The facility to book in advance with no time limits. The business card for patients including a direct line contact number and map to extended hours hub. Survey findings 3% of survey respondents identified themselves as being patients at the Wexham Road surgery. (We understand that this number could reflect either/ both Wexham Road surgeries) Overall survey comments included Easier booking system [but] receptionists ask too many prying questions. Next steps Healthwatch looks forward to reporting on the implementation of the Healthwatch recommendations and suggestions, including sharing good practice patient communication systems, business card, booking in advance with no time limits. 30

Your feedback on Briefing 5: Healthwatch Slough is keen to find out how useful this report has been to you, and/or your organisation in further developing your service. Please provide feedback below or via email. We found the report to be: Useful / Not useful Why do you think this?............ We have made the following changes since reading this report:............... Please mail to: Healthwatch Slough c/o Citizen Advice Bureau 27 Church Street, Slough, SL1 1PL or email to: enquiries@healthwatchslough.co.uk 31

Contact us in a variety of ways: Tel: 01753 325333 Online: www.healthwatchslough.co.uk Email: enquiries@healthwatchslough.co.uk Healthwatch Slough c/o Citizen Advice Bureau 27 Church Street, Slough, SL1 1PL Telephone 01753 325 333 enquiries@healthwatchslough.co.uk If you would like this report in large print, another language or format please contact us 32