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Patient Participation 2011-2012. 1st Year

Patient Participation 2011-2012. 1st Year

 

Topic, Patients who do not attend (DNA’s)

 

This is the first year of the Patient participation service, devised by the Department of Health. The topic for the first year was “Patients who do not attend” (DNA’s)

 

Below is the survey results and the action plan created. The action plan has been appended with its progression with actions and review points where relevant (in Red). This “cut down” report has been created to reduce computer space taken on this Web Site

The full report is available from the practice manager

 

SURVEY RESULTS

 

DNA Survey

  
 

Total Surveys : 946

  
    

Question

Answer

n

%

Are you concerned about appointments wasted by people not attending?

Very concerned

441

47%

 

Concerned

312

33%

 

Neither concerned or unconcerned

110

12%

 

Slightly concerned

56

6%

 

Unconcerned

27

2%

Do you think patients who miss appointments should be contacted?  Please tick all that apply.

Informally - ensure no underlying problems

460

47%

 

After every appointment missed

281

29%

 

After 2 appointments missed

155

16%

 

Only after 3 or more appointments missed

53

5%

 

Never

28

3%

What is the least notice patients should give to cancel appointments?

The day before

398

44%

 

Half a day before

260

29%

 

2 hours before

251

27%

How many non-attendances, in a year, do you consider acceptable?

Less than three appointments

501

57%

 

Less than four appointments

107

12%

 

Less than five appointments

60

6%

 

Other

217

25%

For patients who have 2 missed appointments, in a year, should we ... (please tick all that apply)

Write to them?

552

52%

 

Telephone them?

453

43%

 

Respond in another way?

49

5%

What other way should the surgery respond?

Answered

365

92%

 

Unanswered

30

8%

For patients who have 3 or more missed appointments in a year, should we... (please select all that apply).

Write to them?

534

57%

 

Telephone them?

334

36%

 

Respond in another way?

69

7%

What other way should the surgery respond?

Answered

357

89%

 

Unanswered

43

11%

If patients have 4 or more missed appointments in a year do you feel they should be removed from the practice?

Yes

399

47%

 

No

454

53%

Would you like us to publicise the number and how much time is wasted through missed appointments ?

Yes

756

88%

 

No

104

12%

We cannot name/shame, nor charge non-attenders, under any circumstances.  What else do you think we could do?

Answered

 

 

 

Unanswered

 

 

 

Action Plan. First drawn up/published  March 2012. With updates in Red

 

 

 

INFLUENCE

Action

Method of Implementation

When to implement

Resource Implications

Method of review

Newsletter

A regular feature/article to be inserted in our practice newsletter

Next published newsletter (Spring 2012)

Done, Summer 2012

Winter 2013

Can be easily included within the newsletter articles

None needed but annually by way of good practice

Success. Newsletter is well received by patients.(evidenced in other survey) Continued re-inserts keeps influencing

Website

Publish DNA policy on our website including a home page link

When the policy has been finalised.  It can be published immediately

Published July 2012

Small amount of work required by practice staff to publish and necessary proof reading

This will be a permanent item on the website but annually by way of good practice

Success. Correct place for this information

Waiting room poster advising policy

Clearly worded poster advising all patients of our policy towards patients who miss appointments

March/April after creating poster

In Place from May 2012

Simply designed poster can easily be produced

Annually Reviewed May 2013

Success. Correct place for this information

Waiting room poster advising wasted appointments

Poster with numbers of wasted appointments from previous week/month

March/April 2012 after creating poster

In place June 2012

Suitable display material needs sourcing (able to display changing numbers)

Initial intention is that this will be a permanent item.  Review its visual impact at 6 monthly intervals.  Consider alternative methods of displaying  the wasted time.

Reviewed Dec 2012

Success. High impact. Patient talking point

 

 

 

ACTION - GENERAL

Action

Method of Implementation

When to implement

Resource Implications

Method of review

Practice protocol for DNA’s

Develop a policy setting out surgery expectations and reflecting views of our patient survey

Policy to be created in March 2012. 

Created April 2012

Will require senior admin time for creation and fine tuning.  Consideration and approval by Partners.  Consideration and approval by patient participation group

To be reviewed annually or in light of any surgery changes which may happen

Reviewed March 2012 & Dec 2013

Raise awareness of practice Protocol

Issue to all newly registered patients, a guide to the Protocol

Issue to all new patients as part of new registration procedure. March 2012

Procedure in place May 2012

Easily implemented and issued at time of registration

Reviewed annually

Reviewed April 2013. Suitable & robust

Publicity in practice booklet

Booklet contains information about missed appointments.  This should have more prominence and be more specific.  Re-wording of the text and consideration towards re-siting.

Can be incorporated into next print run of the booklet which will probably be Autumn 2012.

Will require senior admin time for creation and fine tuning.  Will need resources of the publisher and printer to consider design and form.  Requires consideration and approval by partnership.

Reviewed at each print run of the booklet in common with all other articles.

Dec 2013. Has not yet been possible –technical difficulties. Re-review May 2014

Appointment text reminders

Not possible with present clinical system

Our understanding is that modern clinical systems may have this facility available.  When the surgery has a suitable system, we will take positive steps to assess usability and our own resource implications

 

System started Oct 2013

Stand alone text reminder systems are available.  Rejected in view of prohibitive costs.

Inclusive text reminder software with modern clinical system will require surgery staff resources.  Gaining mobile telephone numbers, structuring the reminder schedules, initiating the daily reminders, reviewing suitability.

There is much we will need to learn about this topic and this can only be when we have a modern clinical system.  Review seems likely to be an ongoing exercise.

 

Reviewed Jan 2014. Success 2111 patients have registered

Reinforce

Issue appointment cards/offer appointment card by receptionist

March 2012

 

Began Apr 2012

 

Receptionist can issue a simple appointment note to over the counter appointment requests.  Some resources needed to produce a printed appointment slip

Ongoing although seems likely to continue as part of good service to patients.

Reviewed Apr 2013. Success. Popular with patients’

 

Reinforce

Verbal reinforcement.  receptionist to ask patients “can you repeat that back to me please”.

April 2012

Trialled Summer 2012

New procedure/idea needs rolling out to a collective meeting

This could be potentially contentious.  Some patients may feel this is patronising.

Weekly review with reception supervisors to assess patient reaction.

(It will be difficult to identify the impact of any single action, however since this action will use specific and ongoing staff time it should be assessed).

Unsuccessful. Patients not comfortable with this.

 

 

 

 

ACTION – SPECIFIC

Action

Method of Implementation

When to implement

Resource Implications

Method of review

Protocol for surgery response to non-attenders

A partner approved protocol to be developed setting out the practice response to patients who habitually do not attend

Immediately

Protocol to be developed and approved by the Partners of the practice

Annually

Reviewed at clinical meeting

Reviewed March 2012 & Dec 2013

Notice to non-attenders

Generate and send a standard letter to non-attender and record such action

Immediately

Started September 2012 –technical difficulties

Postal advice will require reception staff time, reviewing surgery lists daily, generating, preparing and posting letter

Telephone contact would require considerably more staff time which could not be accommodated within present resources

Ongoing but with review at one year.  (It will be difficult to identify the impact of any single action, however since this action will use specific and ongoing staff time it should be assessed).

Reviewed Sep 2013. Impact not measurable. We will continue as its a tangible action

Notice to repeat non-attenders

Generate and send a second standard letter to non-attend+ers and record such action.  Giving notice that repeat non-attendance within 12 months brings consideration to continued registration.

Immediately

Started September 2012 –technical difficulties

As above this requires reception staff time, reviewing the surgery lists daily, cross referencing with existing data, generating, preparing and posting letter

Review at one year

Reviewed Sep 2013. Has produced change in DNA patient behaviour. Success

 

 

 

ASSESSMENT

Review/reflect mechanism

Regular count of DNA’s and total appointments offered. Weekly (initially) count of both numbers to produce a % comparator.

Also required is some historical data before the implementation for comparison.

Immediately

A robust system with responsible staff (& back up) to collect the data & publicise where agreed.

This will be readily achievable after some cross staff consolation.

Data to be compared monthly & reported into Patient participation Group.

Reviewed at Clinical meeting Dec 2013 with protocol review. Decided surgery room poster provided necessary publicity.



 
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