patient participation group report march · pdf filepatient participation group report march...

______________________________________________________________________

Dr Debbie Donovan, GP Principle

Cranleigh Medical Practice

18 High Street

Cranleigh

Surrey GU6 8AE

01483 782478

Patient Participation Group Report

March 2012

Local Patient Participation report | 2

Executive Summary The following report outlines requirements for a Local Patient Participation Report to satisfy the PP-DES 2011 – 2012 requirements as directed by THE NATIONAL HEALTH SERVICE ACT 2006 The Primary Medical Services (Directed Enhanced Services) (England) (Amendment) Directions 2011 Insertion of new direction 12A - “Patient Participation Scheme”.

18 High Street Cranleigh Surrey GU6 8AE

Practice Manager: Jacqueline Stockill

Number of full time doctors 7

Number of patients 14514

The practice engaged with NETbuilder to provide their comprehensive managed survey solution, NBSurvey, to enable the collection of views from patients in multiple locations across various demographic groups. This enabled us to canvass our patient’s opinions via an input channel most suited to them, from in-practice touch screen kiosks and paper questionnaires through to virtual online surveys.

The practice has a core and a virtual Patient Reference Group. Patients are invited and encouraged to give their feedback via surveys on various aspects of the practice in a number of ways. The current number of PRG Members 10 in the core group and 130 in the virtual group and recruitment is on-going.

Results Summary

- The preliminary survey showed that the two areas of priority for our patients were Quality of Care

and Access to appointments.

- The in-depth Quality of Care survey showed that patients were very happy with the quality of clinical care they received, the time given to them, listening by the clinician, involvement in decision-making and information given to them. The PPG felt this was excellent and that no further improvements could be made in these areas. One of the survey questions revealed that a proportion of patients did not feel better able to manage their condition having seen their clinician. This may be because they were already managing as best they could, but may also be due to communication between patient and clinician and this is an area the PPG would like to explore further.

- The in-depth Access to Appointments survey showed good patient satisfaction with access. The

PPG would like to work on promoting the telephone consultations service and letting patients know they can contact the doctors secretaries for particular issues, rather than the doctor himself.

- The full survey results and discussions are contained later in this report.

-


Item Total

Number of Surveys 3

Number of Responses 285

Number of Input Channels 4

Survey results by Input Channel

Input Channels

Survey Kiosk Paper PRG Portal Website Total Patient (priorities & Demographics) 24 5 0 83 112

Access to Appointments 25 0 29 39 93

Quality of clinical care 22 0 32 26 80

Summary Outcomes & Action Plan

Working in partnership, the PPG and Cranleigh Medical Practice will be looking to implement the following over the next year:

- A Health Information Area for patients in the new building.

- Development and distribution of a leaflet promoting the PPG, showing contact details for local

health-related services, advising patients how to make best use of the surgery and how to get the

most out of their consultations.

- Improving communications between clinicians and patients.

- Promoting the PPG and extending membership of the Virtual Group, looking at the demographics to

make the group even more representative of the registered patient population.

- Repeat surveys to monitor change.

Experience and thoughts regarding the development of the PPG. Formalising the PPG and giving it more structure has enabled the group to focus intentions and carry out actions in partnership with the Practice. The common aim has been to increase communication and enable the “voice of the patients” to be heard and acted upon. The PPG are a highly motivated, interested and supportive group. Moving forwards to expand the role of the PPG has been very exciting and has been of enormous benefit to both the Practice and the patients.


CONTENTS

Executive Summary 2

Results Summary 2

Survey results by Input Channel 3

Summary Outcomes & Action Plan 3

Experience and thoughts regarding the development of the PPG. 3

About The Practice 6

Opening times and Extended Hours. 6

Appointments. 6

Home visits 7

When the surgery is closed. 7

Staff 7

Services 8

Research. 8

Quality of care. 8

Patient Reference Group 9

Patient Reference Group membership. 9

Member Profiles 9

Aims of the PPG 10

PPG recruitment and representation. 11

Summary of Demographics 11

Representation of Registered Patients 12

PRG Agreement of Priorities 13

Results of the preliminary survey to agree priorities which ran from 05/12/11 to 04/01/12 14

Local Survey Methodology 17

The NBSurvey Methodology 17

Input Channel Evaluation Criteria 21

Progress of PPG 22


Local Survey Outcomes & Discussions 23

Results and discussion of Quality of Care survey 23

Results and discussion of Access to Appointments survey 29

Steps taken by the Practice to provide an opportunity for the PPG to discuss the contents of the action plan. 33

Action Plans 34

In partnership, the Practice and PPG will be taking the following actions over the next year: 34

Areas for future consideration and PPG work outside the surveys. 34

Have the PPG met the aims that were formulated back in September 2011? 35


About The Practice Cranleigh Medical Practice is a large training practice serving 14,514 patients, set in a rural location 8 miles from the nearest District General Hospital. Our team provide high quality, evidence-based healthcare to our community. The GPs, Doctors in training, specialist nurses and healthcare assistants are well supported by a friendly and helpful administrative team. In October 2011 the Practice moved into temporary accommodation in Cranleigh Village Hospital whilst new premises were built on the old health centre site. The practice is aiming to move into its new building in September 2012.

Opening times and Extended Hours. The practice is open from 0800 to 1830 Monday to Friday. It does not close for lunch and access to services in the core hours is provided by telephone and walking in to speak to reception staff. 24 hour appointment booking and repeat prescription requests are available online through EMIS access which is linked to the practice website. The practice runs a duty doctor system which ensures people needing urgent telephone advice, appointments or visits are dealt with appropriately on the same day. Extended hours surgeries for pre-booked appointments run from 1830 to 2000 on Tuesday evenings and 0830 to 1030 on Saturday mornings and provide GP and practice nurse appointments at these times. During these extended hours, telephone advice is not available but reception remains open for prescription collection and registration. The Thamesdoc out of hours service covers emergencies at these times. One afternoon a month the Practice closes for three hours for staff training. The time this will happen is advertised on posters around the surgery and on the practice website. All telephone calls and emergencies are covered by Thamesdoc over this time.

Appointments.

An appointment can be made by either calling reception on 01483 782478 , by coming in and speaking to a

receptionist, or by booking online through our website www.cranleighmedicalpractice.com . In order to

access our online appointment booking and repeat prescription ordering service, patients are required to

show ID to the reception team who will provide them with a unique user name and password.

Urgent cases will always be seen on the same day. When a patient needs to be seen for a non-urgent

problem, he can choose to see his regular doctor and book up to six weeks in advance to do this, or he can

choose to see another doctor at a more convenient time if this is preferable. Patients are all registered with

the Practice and given a named or “usual” Doctor. We encourage patients to see their usual Doctor where

possible to ensure continuity of care, but recognise there are times when a patient may want to see a

particular GP for a particular problem, or need to be seen earlier than his usual GP could see him and we will

accommodate these requests.

http://www.cranleighmedicalpractice.com/


Patients are able to book a telephone appointment with a doctor for advice and help over the phone. If the doctor subsequently feels the patient needs to be seen face-to-face he will arrange this appropriately. We like to hold current mobile phone numbers for our patients to enable better communication and we also send text reminders out to patients the day before their appointment to remind them to come.

Home visits Home visits are available for patients who are too ill to come to the surgery.

When the surgery is closed. If patients telephone the surgery they will be redirected to Thamesdoc, the co-operative service that covers out of hours. Thamesdoc can be directly contacted on 0300 130 1305. Over the weekends and Bank Holidays, Thamesdoc hold an afternoon surgery at Cranleigh Village Hospital and we encourage our patients to ask to be seen there.

Staff Cranleigh Medical Practice currently has six GP Partners, four GP Associates and three doctors in training: Partners: Dr Bratty, Dr Christie, Dr Clark, Dr Donovan, Dr Turner, Dr Inglesfield Associates: Dr Verdon, Dr Kacker, Dr Hull, Dr Mayer In Training: Dr Page, Dr Hardy, Dr Gell Cranleigh Medical Practice is an active training practice, teaching and supporting the development of new GPs. There are currently four trainees in post, one ST3, two ST2s, and an FY2. The trainers are also supporting the development of two further ST1 grade doctors. Nursing care is provided by:

- Four Practice Nurses who specialize in chronic disease management and preventative medicine.

Appointments can be made for immunisations, cervical smears, HRT and contraceptive pill checks,

travel clinic, asthma and COPD reviews, diabetic checks, vascular checks, INR near-patient testing,

spirometry, stitch removal, administration of zoladex implants, 24 hour blood pressure monitoring.

- Two Healthcare Assistants who support the team by providing new patient checks, phlebotomy

services, urinalysis, B12 and flu injections, ECGs, blood pressure monitoring,

- One Minor Illness Nurse who runs a minor illness clinic every day alongside the Duty Doctor.

Patients can book directly to see her and reception hold a list of the conditions she will see. She sees

patients over the age of 1year.

- District Nurses and a Community Matron work alongside the team from the same premises.

Health Visitors and School nurse can be contacted on 01483 782440 – answering machine available. They are based in Bloggs Way, behind the Post Office and run a weekly drop-in clinic. Midwives from the Royal Surrey County Hospital Daisy team run surgeries from the Village Hospital. Booking appointments can be made to see them through the surgery main reception.


A member of the ACORN team, a dietician and counsellors from New Thoughts also hold clinics in the surgery. There are close links with our Macmillan Nurse. On the administrative side, there is a Business Manager, a Practice Manager and a team of friendly and helpful administrative and reception staff. A strong IT team supports the work of the clinicians and administrators. Carers support and registration is provided by two trained receptionists.

Services Services provided at Cranleigh Medical Practice include:

-core General Practice work -Near-patient testing INR clinic -On-site ECG, phlebotomy, spirometry, 24 hour blood pressure monitoring -Chronic disease management clinics for asthma, diabetes, COPD, hypertension, vascular disease including coronary artery disease and stroke, chronic kidney disease. -Minor surgery -Family planning services including coil and implanon fitting. -Smoking cessation -Childhood immunisations -Ear syringing -Travel clinic

Research. The practice is affiliated to the Primary Care Research Network and undertakes studies on its behalf. We believe the benefits our patients both immediately by allowing them to benefit from state of the art treatments and also by the enhancement of medical knowledge overall. It also provides a wider experience for our staff and trainees. Previously we have been involved with studies looking at diabetes, Parkinson's disease & memory disturbance. Currently we are assisting with nationwide studies looking at the management of cough in primary care, the genetics of bi-polar disease, management of atrial fibrillation, vitamin D levels in pre-menopausal women & partner notification in patients who have Chlamydia infection.

Quality of care. Cranleigh Medical Practice aims to provide high quality evidence-based healthcare to its patients. There are daily clinical discussion meetings for the doctors and weekly meetings for the wider clinical team and the nursing team. There are regular focused clinical discussions and local consultants often come in to talk to the team about particular areas of interest. Once a month the entire practice meets for three hours to work on patient pathways and protocols – during this meeting, telephone calls to the Practice and emergencies are covered by Thamesdoc. The practice scores highly in the Quality and Outcomes Framework, attaining near-maximum targets. It is actively working towards accreditation with the Royal College of GPs.


Patient Reference Group

Patient Reference Group membership.

Member Profiles The patient participation group had been established for many years as a group of patients who came together annually after each patient survey to discuss the results. The group was formalized in September 2011 and a more proactive role established, to improve the interface between patients and the practice and to act as an information channel between the two. A Chairman and Vice Chair were established in the core group and the group chose to be known as the Patient Participation Group (PPG). The core group is made up from the Practice Manager, two GP Partners, a member of the reception team and eight patients from differing backgrounds and age groups. The patient representatives of the core PPG are:

- A housewife with young children representing full-time mums and regular users of the health

centre. Also able to represent relevant issues for patients who are commuters, such as her husband.

- A patient who has been with the practice for 35years, was a Local Councilor for 20 years, who has

been involved with Cranleigh Health Watch since its inception and more lately involved with Surrey

LINKs.

- A retired Biochemist.

- An elected member of the Co-Operative Group with a special interest in involving all parts of the

community and focusing on encouraging healthy lifestyles for all.

- Long-time resident of Cranleigh, trained nurse, trustee of Cranleigh Village Hospital League of

Friends, member of Cranleigh Health Watch, volunteer in Cranleigh Village Hospital Trust shop.

Past member of the Community Health Council which monitored health services on behalf of

patients and hoping to continue to do this in the PPG.

- A representative of Elmbridge Retirement Village which provides accommodation for 270 retired

people and has a nurse on site.

- The other two patient members are long-time patients interested in putting across the voice of the

larger patient population and reaching out to disseminate information outwards from the practice.

The PPG core group meets regularly once a month with extra meetings between as needed. Agendas are set for each meeting and action plans generated and followed through.


Aims of the PPG

During the formalisation process, the Core PPG set out the following aims:

The overarching aim of the Cranleigh Patients Participation Group is to promote mental and physical well-being throughout the community which is served by Cranleigh Medical Practice through the means of a close collaboration between the health professionals and service users to provide the highest possible standards of mental and physical health care. Objectives 1. to enable doctors and staff of the practice and their patients to meet in a proactive ideas forum to discuss topics of mutual interest in order to support improved services for all patients. 2. to act as a voice for patients in the practice to comment on and influence the services available to patients of the practice. 3. to support the practice in meetings and events organised by health professionals of the practice for the dissemination of information on relevant health issues 4. to ensure that the practice provides patients with ongoing information on the services and developments within the Practice through newsletters, a dedicated website (or dedicated website pages) and information disseminated throughout the community. 5. to ensure that the practice provides patients with up to date information on new proposals in the NHS particularly those which will affect patients of the practice, and this in liaison with the commissioning doctor. 6. to provide feedback to the practice on the efficacy of all systems and innovations relative to patients. Organisation The Chair will hold office for one year. The Vice Chair will be elected annually for one year and move to Chair in the following year. Two practice doctors will be full time members of the committee, as will two designated members of the administrative staff The PPG will meet once per month on an agenda agreed in consultation of the Chair, Vice Chair and the practice Minutes will be recorded as actions and members’ roles will be flexible to adapt to circumstances. Meetings will be held under Chatham House rules to enable free and frank discussion within the meeting and a unified voice for the group once decisions are taken. The practice will subscribe to NAPP for the group and it is envisaged that the group will send representatives to the NAPP Conference.


PPG recruitment and representation. Once the core group had formalised their aim to foster close collaboration between health professionals and service users, it set about developing a “virtual survey group” – a larger group of patients who would sign up to receive surveys and information by email. To do this, a dedicated email was first set up and linked to a new “Patients Group” page on the practice website. A PPG feature was run on the website homepage. The PPG printed out 2,000 leaflets explaining the role of the PPG and the virtual survey group and inviting people to join by registering online. Members of the core PPG “launched” the group at the Flu clinics which ran in October 2011. They talked to patients waiting for their flu jabs, distributed leaflets and encouraged patients to take part. The leaflets were also distributed amongst local groups and clubs in the Cranleigh community, the local Retirement Village, placed in local pharmacies, given out at the surgery reception and given out by the doctors to the patients they were seeing. An article promoting the PPG and asking people to register their interest was placed in the Cranleigh People Magazine, which is a free monthly local magazine delivered to every house in the community. The local Primary and Secondary schools were emailed a copy of the leaflet, and of these, one Primary School emailed it to all the parents via the schools communications system. Invitations to join were also printed on the messages section of repeat prescription forms.

Summary of Demographics As a result of the above actions, the virtual survey group numbers rose to around 90 by the time the PPG put out its first survey in January 2012. Although a small number of patients, the demographics of the virtual PPG compared favourably with the demographics of the patient population as can be seen in the table below:

Age range Practice population 04.01.12 Surveyed population

<18 note: majority are age 5-16 22% 1%

18-30 13% 9%

31-40 11% 12%

41-50 13% 19%

51-65 20% 30%

>65 21% 28%

Recruitment to the virtual PPG is ongoing and by the end of February 2012 numbers had risen to 130. Our Practice took the strategic decision not to solely rely on our Patient Reference Group for feedback to our surveys and wanted to capture the views of as many of our patients as possible. To support this decision we invested in a touchscreen kiosk and web portal technology. The intention was to encourage patients visiting the practice to provide us with “in the moment” feedback about the service they had just received. The web portals enable us to reach-out to patients who are unable to visit the surgery. In addition, all surveys can be requested in paper format.

We believe that this strategy will provide the practices with feedback from a representative demographic of

our patient population.


Representation of Registered Patients Cranleigh Medical Practice feel that although the preliminary survey showed a fair representation across our patient dermographics, the numbers of respondents to all surveys were low and the following groups were not well represented:

- Children and young adults

- Nursing home residents

- Patients who rarely use the surgery

The following steps are being taken to increase representation:

- Children and young adults: the local schools were emailed when the PPG was launched and asked

to send out our PPG leaflet through their school communications system. Of four schools, only one

did and we are working on building relationships with the heads to discuss why reaching children

and young adults with our surveys is important for our community. We particularly want to reach

out to the teenagers.

- Nursing home residents: representatives from the nursing homes were invited to the PPG evening

meeting on 21st March but none attended. We work very closely with our local nursing homes and

the patients there receive their care mainly through home visits. We will be looking to take paper

surveys directly out to the homes for completion by the patients and/or their relatives.

- Patients who rarely use the surgery: we continue to promote the surgery and the PPG through our

website, local magazine, notes on prescription order forms, word of mouth and through the

surgery. We have set a link to our practice website on the NHS Choices website.

With the advent of our new building we are going to have much media coverage over the next six

months and will be involving the PPG with each event –for example in creating and burying a time

capsule next to the new build. Each media event will be an opportunity to let our community know

about what we do and what the role of the PPG is.

In the summer, as can be seen in the detailed action plan, we are going to have a PPG stall at a

Village Games event where the PPG will be distributing a directory they are going to compile of

local health services. This will be a high profile event and will bring the attention of a wide of variety

of patients to the PPG. We will ask the local newspaper, the Surrey Advertiser, to cover our high

profile activities and are considering the role that our local radio station may have to play in

promotion.


PRG Agreement of Priorities

In November 2011 the Core PPG decided to run an initial survey to find out which areas were important to our patients; the results of this were then used to design further surveys to look at the top two areas in more detail. The aim was to see whether any changes in service would be appropriate and if so whether these would be achievable. Plan to then repeat the exercise after any changes had been made to check the effectiveness. The initial survey was run in December 2011, using all the methods of data collection described in the methodology section of this report. The surgery had recently moved into temporary accommodation in the Village Hospital and this did have a knock-on effect to this process and adversely affected the number of responses received. In January 2012 the results were analysed and revealed the top two areas of priority for our patients were:

- Quality of Care

- Access to Appointments

The results of this survey were published on the Practice Website and in the Cranleigh People Magazine, a local magazine which is delivered free to every household in the community. In February 2012, two further surveys were launched to look at Quality of Care and Access to Appointments on more detail. The results of the second round of surveys were looked at by the Core PPG, published on the practice website and then taken to a special PPG Evening Event on 21st March. This event was attended by the PPG Core group, Practice Business and Practice Managers, two reception staff, four GP Partners and around thirty patients who responded positively to the invitation to attend which was emailed to the Virtual PPG and advertised in the surgery reception. The results were presented to the group, followed by round table discussions in small groups, and a final collaboration of ideas at the end of the evening.


Results of the preliminary survey to agree priorities which ran from 05/12/11 to 04/01/12 Responses via email / website 77, touch screen 24, paper copy 12, Total=113 Note: feedback through patients via paper responses/web/touch screen as well as the virtual PPG.


The number of responses is low however the demographics of the respondents do compare favourably with the demographics of the practice population as analysed on 04.0112 as can be seen below: Age range Practice population 04.01.12 Surveyed population

<18 note:majority age 5-16. 22% 1%

18-30 13% 9%

31-40 11% 12%

41-50 13% 19%

51-65 20% 30%

>65 21% 28%


Areas were ranked in order of highest importance:

1. Quality of Clinical Care (65.79%)

2. Access to emergancy appointments (47.37%)

3. Waiting times for routine appointments (43.86%)

4. Being able to see your regular doctor (29.82%)

5. The telephone system (6.19%)

6. Being able to see a specialist nurse (3.54%)

7. Understanding what a training practice means (2.63%)

8. Seeing a doctor out of hours (0.88%)


Local Survey Methodology The practice engaged with NETbuilder to provide their comprehensive managed survey solution, NBSurvey, to enable the collection of views from patients in multiple locations across various demographic groups. This enabled us to canvass our patients opinions via an input channel most suited to them, from physical paper and in-practice touch screen kiosks / laptops, through to virtual online surveys. Findings from previous studies carried out by NETbuilder exposed that multiple short surveys with a maximum of 8-10 questions each are more effective than one long survey running continually throughout the survey period. Each survey was customised to the investigational design and measures, for example measuring how effective it is for patients to get an appointment using a short survey (The Access Survey). Additionally, this encourages patients to give feedback for the areas relevant and important to them. Surveys are presented in multiple formats that allow a survey to be completed from within, but also off the premises of the surgery including; Kiosk, PRG Portal, Website Portal and Paper. Surveys can be filled in on belhalf of others, this enables any patient with the ability to be able to participate in any survey and

represented in data collected.

The NBSurvey Methodology


Step Description Surgery Comments / Experiences

Continual Development of Patient Reference Group (PRG)

The PRG is a representative group of patients from the practice. They are responsible for providing feedback to surveys and collaborating with the practice to analyse the results and agree realistic change opportunities.

We had an initial drive to recruit as many people as possible, this is an on-going process so that any of our patients, new or current, have the opportunity to contribute.

Determine Priority Areas

Key areas include but are not limited to the following:

Access

Overall Satisfaction

Seeing a Doctor

See a Nurse

The Reception

The Surgery Environment

Demographics

Specialised Clinics (e.g. Flu, Vasectomy)

The PRG and other patients complete the Patient Priorities Surveys to priorities the areas (above) to determine the order in which key areas are addressed by the practice. Patients are also given the opportunity to provide comments regarding other areas they would like to see addressed.

The preliminary survey was based on areas of interst highlighted in past practice GPAQ surveys and the experiences and observations of the Core PPG. A good response to the survey gave us two areas of priority that patients wished to look at.

Design & Build Surveys

The practice work closely with NETbuilder to design and build the surveys. Each survey is designed to measure the patient’s view of the identified key areas. Each survey contained between 8-10 questions. Patients are able to choose to complete the surveys they believe are relevant to them and ignore those that are not.

The PRG decided on the questions for the surveys; these were passed to NETbuilder to design the surveys within the constraints of the software available (eg limiting the number of possible options per screen to enable the survey to run in a readable format on the touchscreen in reception) and each survey was signed off by a member of the PPG before it went live.

Decide on Input Channels and Publish Surveys

The practice worked closely with NETbuilder to agree which input channels are suitable for the surgery and patients. Input channels available are:

Surgery Kiosk

Web Portals

Laptop

Paper

Face to Face

We used the Input Channel Evaluation Criteria to help us decide which channels to use for the Surgery:

In-surgery touchscreen kiosk: to capture patients from all demographics visiting the surgery

Paper: available in the surgery as an alternative to the kiosk or to be completed on behalf of others if required

PRG Web Portal: specific portal to for PRG Members


Each survey can be used on (published to) one or more of the input channels listed above.

Web Site: open to all practice patients

Advertise Feedback Channels

Inform patients of the available input channels and current surveys, in order to create a greater number of participation responses. Types of promoting include but is not limited to:

Encouragement slip given by the doctor

Posters

Leaflets

News Letters

Encouragement from all Practice Staff & PRG

Surgery Website

Notice Board

We promoted the surveys on the practice website, at reception, by posters around the surgery waiting areas and corridors, in the local magazine Cranleigh People, by word of mouth and encouragment to participate from the clinicans at the surgery when seeing patients, by adding it the the free text area on repeat prescription order forms. Members of the core PPG attended the surgery during busy clinic times to talk to patients directly in the waiting areas and to stand by the touchscreen encouraging people to use it.

Capture Patient Experience

Patients complete surveys using the available input channels as listed above.

Despite our wide promotion of the surveys and our official PPG launch in October 2011 at the flu clinics when core PPG members came to speak to the patients waiting for immunisations and distributed 2,000 leaflets advertising the PPG, the number of patients responding to the surveys was low. The fact that the whole surgery had just relocated to new temporary accommodation whilst its existing building was demolished and rebuilding begun, was thought to play an important part in this because it has been difficult to physically streamline patients into using the kiosk and paper copies to fill in the surveys, and a change in working practices associated with the move have meant it was harder for receptionists to push the survey as much as we would have liked. When the new building is completed and we move back in September 2012, we have made plans to address these issues. Expanding the PPG is an ongoing process and at the Evening meeting held on 21st March to a wider group, lots of ideas were generated as to how to involve more people over time.

Produce & Distribute Reports

Results in the form of reports are produced for each individual survey and distributed via the Practice Website, Practice Meetings, Surgery Notice Board, PRG consultations.

Our results were emailed to all our staff, core and virtual PPG members. They were published on the practice website and summarised in the local monthly magazine, Cranleigh People. The PPG Chair presented the results at a practice


Time Out meeting, to all the employed staff. The evening PPG consultation meeting on 21st March was arranged to present the results to a wider group of people as has been previously described.

Collaborate with PRG to Analyse Results

The Practice Manager will discuss & analyse the survey results with the Practice Doctors and then discuss with the PRG for further analysis.

The results were collected and presented to the PPG in graph form for discussion and analysis.

Agree Action Plan An agreed action plan between the PRG & Surgery will be created according to the outcome of the analysis from the results.

Details provided in the section Discussions & Action Plans below.

Implement Change Practice must obtain the agreement of its local PCT to its proposals for any significant change, e.g. change of opening hours. Approved changes can then be implemented.

Details provided in the section Discussions & Action Plans below.


Input Channel Evaluation Criteria Input Channels should be thoroughly evaluated for their suitability for use by patient belonging to a practice. The following table describes the advantages and disadvantages of each input channel we used.

Input Channel Advantages Disadvantages

Paper Surveys Suitable for a large percentage of

patients across most services

Known and trusted media for many

patients

Production, deployment and collection

of surveys required

Data input required

Public Web Surveys

Instant feedback

Fast deployment of survey

Easily changeable

Limited to patients with internet access

Limited to patients with the ability to

use technology

Email Surveys Instant feedback


Easily changeable

Excellent for tracking feedback for

specific treatments (e.g. specialised

clinics)

Limited to patients with internet access

Limited to patients with the ability to

use technology

Limited to patients with email accounts

Limited to patients who have provided

Trust with email addresses

Touch Screen Kiosks

Immediately and conveniently

accessible before and after

appointments

Instant feedback


Easily changeable

Limited to patients with the ability and

willingness to use a touchscreen kiosk

Requires suitable physical location


Progress of PPG

Step Completed Comments

Recruit PRG Core PPG formalised September 2011; virtual PPG growth ongoing.

Highly motivated and interested core PPG. Virtual PPG is continuing to grow nicely.

Canvass PRG for patient priorities Preliminary survey 05.12.11-04.01.12 Small reponse number but reflective of whole surgery dermographics. Clear response and clear indication of what subsequent surveys should cover.

Establish data collection methods October 2011 Practice signed up with NETbuilder for touchscreen, web and software technology support. Core PPG keen to use paper as well as electronic methods, following their face to face discussions with patients at the flu clinics in October.

Plan survey schedule based on results from the PRG agreed priorities .

Second surveys designed in December/January and run in February 2012

1-Quality of care 2-Access to appointments

Design & build surveys January 2012 Questions designed and agreed on by core PPG

Publish Surveys Results published in March 2012 On practice website. Discussed with staff at Time Out meeting. Emailed to the virtual PPG. Evening PPG meeting to present results to wider group of registered patients and members of the virtual PPG on March 21

st. Report summary prepared for

the Cranleigh People magazine April edition.

Monitor feedback progress Ongoing discussion every monthly PPG meeting.

Core PPG keen to repeat the same surveys after a period of time to see what has changed. Action plans generated from the survey results will lead to new surveys over the coming year.

Collate results and produce report for each survey

Final results published March 2012.

Publish results for review with PRG Preliminary survey results discussed with core PPG at monthly meeting on 30.01.12. Quality and Access survey results initially discussed with a subgroup of Core PPG on 24.02.12 and with the whole core PPG on 02.03.12. Evening meeting for extended group of virtual PPG / interested patients to review and discuss results on 21.03.12. Consolidation of action plan with core PPG 30.03.12.

The evening meeting was a great success with around 30 more registered patients attending to hear and discuss the results. Great discussion, lots of ideas generated, highly motivated, supportive and interested group.


Local Survey Outcomes & Discussions

Results and discussion of Quality of Care survey

79 responses: 21 touch screen, 32 paper, 26 web. Core PPG discussion:

- Focused on ways of extending the virtual PPG and increasing uptake and involvement with surveys.

Extended PPG discussion: - Ideas raised to increase the profile of the PPG and promote surveys. Consider writing for a second

local magazine, better advertising within the surgery itself (will be easier in the new building),

networking, word of mouth, website.


Core PPG discussion:

- Reflects dermographics of practice.

Extended PPG discussion: - To remember that when the PPG was launched in October 2012, it was through the flu clinics that

the first wave of Virtual PPg was recruited, so likely to have a high percentage over over-65s.



- These nebulous areas are what GPs and nurses value as the heart of good Primary Care so it very encouraging to see good performance here.

- Very encouraging results, the Practice should be proud of its achievements.

- Nobody thought they were not being taken seriously.

- Only 1 out of 79 thought not given enough time – the clinicians do their best to run to time, but there are cases when patients need more time than they are allotted. There are two ways of managing this – either giving them the time then and there or asking them to come back another day. Which path is chosen depends on the patents needs.

Extended PPG discussion (evening meeting):

- Patients feel they have a good relationship with their doctors and nurses and would like to say

“thank you” for the excellent service they receive.

- This is not a problem area for the practice; no further improvements can be made here.



- This is an interesting area. The clinicians do their best to meet the ideas, concerns and expectations of their patients, and engage them fully in decision making and developing management plans. This may be a good area to develop – getting patients to look after themselves more, taking responsibility for their health, actively managing their conditions.

- Two ways of looking at this – talking with the clinicians about informing patients and providing literature and self help material/management plans – this is an area our minor illness nurse is developing, as are our Practice nurses who deal with chronic diseases; and also talking to patients, getting them to prepare for their consultation in order to get the most out of it. Perhaps develop a


leaflet to help them prepare – there has been some work done on this which can be found at the NHS Choices website.

- Consider “wellness service” rather than “illness service”.

- Consider development of a local directory of Health Services for our patient population – to launch in the summer at a Cranleigh Village event.

Extended PPG discussion:

- Lots of discussion about communication – how best to communicate between doctors and patients,

between the surgery and the community, how to disseminate information efficiently and the

barriers to this. How to reach those people who are infrequent users of the surgery.

- Agreed that developing a Directory of services would be useful. Some good work on this has already

been done by the League of Friends of Cranleigh Village Hospital – to build on this.

- Like the idea of patients being more prepared before attending their appointment – focused, use of

writing notes and/or bringing someone with them.

- Would like to see the development of a “Health information area” in the new building – an area

where patients can sit and read appropriate literature, possibly with a computer linked to health

information resources. This would compliment advice and written information given by the health

care professionals. Updated information on health centre activities to be shown here and also on

screens in waiting areas around the building.


Results and discussion of Access to Appointments survey

92 responses: 24 touch screen, 29 paper, 39 web



- Historically, in previous years, the telephone system has been rated very poorly and has been one of the biggest concerns from our patients. It has taken a very long time to get the new system installed, up and running and it’s great to see there is now positive feedback about the phones!

- Not many people asked had actually used the new phone system.

- Discussion over whether patients would prefer music or “nothing” when on hold Extended PPG discussion:

- When on hold would be helpful to hear a message letting you know what position in the queue you

are in.

- There are some times of the day when it is harder to get through than others, would be good to do a

piece of work around this and see if any improvements could be made.

- Many patients unaware of telephone consultations service and phoning secretaries for results – to

look at ways of promoting these.



- Minor illness nurse is working out well and we are going to appoint a second one. She is usually fully booked. Our currently-running minor illness nurse survey is showing a very favourable response from patients who have seen her.

- People are being seen the same day by the duty doctor. In February 2010 we changed the duty doctor system to one where every patient needing a same-day appointment was triaged on the telephone by the duty doctor. Although this system worked well initially, it became over-run. The calls would stack up, and the duty doctor would book most people into an appointment anyway, so we have steered more away from telephone triage and back to making sure there are plenty of “on the day” appointments across the team for the reception staff to book patients into. This is working well

- May be worth looking at ways of promoting the secretaries as a point of contact to get help rather than feeling that the doctor has to be phoned directly.


- Patients like the minor illness nurse service.

- Patients like being able to phone their own doctor’s secretary and feel they have a good relationship

with the secretaries.

- Think about promoting the role of administrative staff more and how they can help, so patients

don’t automatically default to needing to speak to or see their doctor. This may be helped by

frontline staff promoting how other people may be able to help at the time when the patient phones

in. Also there is now a new system in place for getting test results which was introduced in February

2012. When a patient is sent for a test, a written copy of all the tests requested are given to him

along with a form showing them how to book for the test and how to get the results. The patient can

then keep contact with the surgery until he can tick off that all his results are back. The form lists out

the secretaries numbers and the doctor indicates on the form whether the patient should come back

to see him, whether he will write out a letter, or whether the patient should phone the secretary to

get the results.



- A patient will always be seen on the same day by a doctor if this is needed. Once all the appointments for the day are filled up, the duty doctor still has capacity to see emergencies and to go on home visits.

- From this data it is difficult to interpret the data on the nurses – as most people answering the survey would have attended to see a doctor, so information given on nurses waiting times may not be accurate. Some people may not have seen a nurse but the survey question prompted for an answer anyway. Likewise same with the wait for a blood test question – there was no chance to say “I haven’t had to wait or a nurse or a blood test”. This was not the best-designed question; on future surveys to make sure questions are structured in such a way that good quality data is gleaned.

- Patient group may want to design a new survey to look into nurses waiting times / blood clinic waiting times in more detail.


- Importance of designing good quality questions discussed.

- Roles of nurses reviewed. Would like to be able to book up for nurse appointments and blood test

appointments online; discussed the barriers to this around making sure the right type of

appointment was booked with the correct nurse who could give this service and making sure

appropriate length appointment was made. To much room for error so not to have online booking

for nurses at present.


Steps taken by the Practice to provide an opportunity for the PPG to discuss the contents of the action plan.

- Hosted monthly meetings for Core PPG and extra meetings as needed. Met with subgroup of Core

PPG to discuss Quality of care and Access to appointments surveys on 24.02.12 prior to discussion

with whole core PPG on 02.03.12.

- Discussion of the preliminary and second round of surveys timetabled into agenda of the monthly

core PPG meetings at the completion of each survey.

- Maintenance of PPG page on practice website and dedicated PPG email address.

- Chairman of PPG invited to speak to whole Practice Team at Time Out, to promote the role of the

PPG and share results of the Quality and Access surveys.

- Hired a room in Cranleigh Arts Centre on 21st March to host meeting for the core PPG and interested

members of virtual PPG and other registered patients to discuss results and action plan. Around

thirty registered patients attended. Also in attendance, 4 GP partners, Business and Practice

Managers and members of administrative team.

- Core PPG met to consolidate action plan on 30.03.12


Action Plans

In partnership, the Practice and PPG will be taking the following actions over the next year:

- Developing a Health Information area in the New Building which patients can use to find out about

local health services and can have access to information on self-help groups, Charities, Carers

registration and support as well as researching health conditions.

- Developing a directory of useful health-related services for patients – to include such information as

contact numbers for hospitals, support groups, dentists, Churches, how to make best use of the

surgery. This leaflet to be launched in July at the “Cranleigh Games” Village Event. It will also

promote the role of the PPG and aim to increase membership of the Virtual PPG.

- Extending membership of the Virtual PPG, working to increase representation from children / young

adults, patients who rarely use the service and Nursing Home residents.

- To look in more depth at the telephone system, to see if there are particular times when it is very

busy and hard to get through, and if so if there any actions that could be taken to help this.

- To work on ways of improving communication between clinicans and patients, so that a higher

percentage leave their consultation feeling more able to manage their problem – to repeat the

Quality of Clinical Care survey to monitor this change.

- To repeat the Quality of Care and Access to Appointments surveys to look for change.

- Raising our community’s awareness of the PPG by involvement with high profile events associated

with the new surgery building.

Areas for future consideration and PPG work outside the surveys.

- PPG to continue the discussions they have started with NHS Surrey and the practice about the Out of

Hours service changes which are scheduled for April 2013. PPG would like to be involved in

representing patients views where possible.

- Consider looking at the roles of the Nursing team in more depth and how long the waits are for

different types of nursing appointments.

- Look into the methods of data collection and software used to increase the quality of information

being fed back to the group – eg a method for adding free text feedback.

- Look at the provision of local mental health services accessible to Cranleigh Medical Practice

patients.

- Consider running health promotion evenings open to patients on particular topics eg prostate

awareness, diabetes, healthy lifestyle.


Have the PPG met the aims that were formulated back in September 2011?

Aim Comments

1- To enable doctors and staff of the practice and

their patients to meet in a proactive ideas forum

to discuss topics of mutual interest in order to

support improved services for all patients.

Objective met. Good lively monthly meetings and ongoing communication by email between the Core PPG members. Virtual PPG up and running. Evening meeting very successful.

2- To act as a voice for patients in the practice to

comment on and influence the services available

to patients of the practice.

Objective met. Use of surveys.Actions to be taken over the next year based on the survey results. Core PPG invited NHS Surrey members to come and talk about changes to the Out of Hours system and gave their views about the process.

3- To support the practice in meetings and events

organized by health professionals of the practice

for the dissemination of information on relevant

health issues.

To date, the closest meeting of this type was the Evening meeting organised by PPG to share results and discuss ideas with a wider group of registered patients. This was very successful.

4- to ensure that the practice provides patients

with ongoing information on the services

and developments within the Practice

through newsletters, a dedicated website (or

dedicated website pages) and information

disseminated throughout the community.

Work in progress. Development of the local directory of health services will build on this.

5- to ensure that the practice provides patients

with up to date information on new

proposals in the NHS particularly those

which will affect patients of the practice,

and this in liaison with the commissioning

doctor.

The monthly Core PPG meetings are a good forum for the GPs to bring new issues to the group - for example concerns about the change in out of hours provision which the PPG then took forwards to find out more with NHS Surrey.

6- to provide feedback to the practice on the

efficacy of all systems and innovations

relative to patients.

In progress. Surveys are a good start. Looking at systems to gather more valuable, text based feedback.

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