Patient Participation 3rd Year 2013-2014

Patient Participation 3^rd Year 2013-2014.

Topic – Practice Communication

The practice has now been involved in the Department of Health Patient Participation service for 3 years. This is our year 3 report.

Previously our topics have been –

YEAR 1 -Patients who do not attend (DNA’s)

YEAR 2 – Prescription

This YEAR – Practice Communication

The key objective is to ensure that patients are involved in decisions about the range and quality of services provided by the practice. This is by the use of a Patient Reference Group and patient survey to bring about decisions that lead to changes in how services are delivered to patients.

Formation

The Patient Reference Group was formed after extensive publicity by the practice in the summer months of 2011. Membership of the Group is open to all patients all the time and we currently have a “virtual group” of 102 patients. This gives the advantage of offering the opportunity for expression of opinions without the constraints of attending meetings which inevitably will not be convenient for everyone. Additionally in a group of this size accommodating such numbers presents logistical problems.

Patient Reference Group - Demographics.

	Patient Population % - based on ethnicity details we have for 5800 patients	Patient participation Group %
Age groups
Under 16	22%	-
17-24	10%	-
25-34	12%	4%
35-44	14%	10%
45-54	14%	31%
55-64	12%	17%
65-74	10%	17%
75-84	6%	18%
85 & over	2%	3%
Male/Female	49% / 51%	42% / 58%
White British	86%	96%
Irish	0.1%
Mixed – White & Black Caribbean	0.05%
White & Black African	0.3%
White & Asian	0.2%
Other Mixed Background	0.4%
Indian or British Indian	2%
Pakistani or British Pakistani	9%	2%
Bangladeshi or British Bangladeshi	0.1%
Caribbean	0.1%
African	0.4%
Chinese	0.03%	2%
Any other	1%

Process

A stepped approach was adopted to take the practice and the group through the process. This is:

Step 1 form a Patient Reference Group
Step 2 Practice agree with the Patient Reference Group some areas which could be covered in a patient survey
Step 3 collate patients views through the use of a survey
Step 4 provide Patient Reference Group with the opportunity to comment on the survey findings
Step 5 create an action plan with the Patient Reference Group to implement any changes
Step 6 publicise the actions taken and subsequent achievement

Seeking Opinion

In October 2011 the Patient Reference Group was asked to consider areas that they would like to be considered for development and be suitable for consideration by patients by way of a survey.

The results from the Group were as follows:

Patients not attending for appointments made – (colloquially known as DNA’s – Do not Attend) 24%
Prescriptions – over ordering 18%
Prescriptions – ordering 8%
Patient information 10%
Using reception 4%
Getting an appointment 12%
Waiting room facilities 1%
Timekeeping 9%
Reception layout 4%
We also invited another suggestion (from each member) not covered in the above. We had 7 different suggestions but none of these came up more than once.

Year 1 Survey and Action Plan

In year 1 we took the subject “Patients who do not attend appointments” (DNA’s). We developed a patient survey and together with our Patient Reference Group, an action plan was created in an attempt to drive down numbers of DNA’s. Details of the survey, its results and Action Plan of year 1 are on our website.

Year 2 Survey and Action Plan

In year 2 it was decided to look at the next highest area of concern, Prescriptions – over ordering, prescription ordering and medication wastage.

Details of the survey, its results and Action Plan of year 2 are on our website.

Year 3 Survey and Action Plan

In year 3 group members commented on and entered into the current debate within the NHS. Group members were aware the NHS is make efforts to generate a culture of openness, transparency and candour. This in no small way has been driven by concerns of patients and the recent disasters seen in the NHS such as the Winterbourne View Hospital and Mid Staffs Hospital scandals. Whilst primary care can be said to be very different from the hospital environment, the lessons of lack of communication between the organisation and patients/carers/advocates was identified and needs to be taken forward throughout health care in England. With this in mind the proposed the topic chosen was “Improving communication with patients”.

Develop a Patient Survey

A draft survey was created by the practice in August 2013 and the group was asked to consider the style, wording and give general feedback as to its suitability. Once again specialist help from our local CCG also formed part of the input in the survey’s construction.

The Reference Group generated many interesting and thoughtful responses and there were a number of e-mail exchanges including many specific survey questions. After this consultation and some fine tuning to the Final survey on communication was rolled out from late September through October 2013. Patients were invited to complete paper versions in the two medical centres, Reference Group members were invited to complete the survey by e-mail and 3500 randomly selected patients were contacted by post and invited to complete the survey. Regretfully touch screen machines used in previous years and supplied by our local PCT were unavailable to us because of service cuts. The survey closed on 30 October 2013.

Results of the Patient Survey

Many patients were happy to take part in the survey and give us their views. These are the numbers of completed surveys:-

e-mail - 16 surveys,
postal - 517 surveys
in-surgery - 61 surveys.
Total of all responses 594 surveys

The survey, questions and results are given below. In addition there were 207 individual comments left by patients. The Patient Reference Group has seen all these comments, however we have not produced them here as the space needed would be prohibitive. If you would like to receive a paper copy of the 207 comments, then please contact the practice and we will easily arrange this.

Results of All Surveys Completed - Numbers

Communicating with reception – when you speak with our reception is what is said clearly understandable
Confusing	Quite confusing	No opinion	Quite understandable	Very easy to understand
1	3	16	191	385

Communicating with reception – The information provided by the reception staff
Not had any information	Difficult to understand	No opinion	Quite easy	Very easy to understand
15	6	23	179	346

Information – Thinking about information provided by the practice. Are poster displays in the practice useful?
Not noticed	Needs improving	Slightly useful	Useful	Very useful
38	10	54	355	110

Information – Is the practice information leaflet useful?
Not seen it	Needs improving	Slightly useful	Useful	Very useful
92	20	33	329	106

Information – Is our waiting room patient calling system clear?
Not noticed	Needs improving	Slightly useful	Useful	Very useful
11	127	29	210	182

Information – Is our waiting room Patient Newsletter useful?
Not noticed	Needs improving	Slightly useful	Useful	Very useful
104	6	50	283	131

Information – Is the practice website useful www.drpatelandpartners.co.uk
Not seen it	Needs improving	Slightly useful	Useful	Very useful
256	6	12	79	71

Information – Do you know what to do next if you had a concern, query or complaint?
	No	Some idea	Yes
	66	170	272

Thinking about your most recent consultation with the doctor, can you indicate your experience – Explaining tests and treatments:
Poor	Fair	Good	Very Good	Excellent
3	15	117	214	222

Thinking about your most recent consultation with the doctor, can you indicate your experience – Involving you in decisions about your care
Poor	Fair	Good	Very Good	Excellent
4	18	116	214	204

Thinking about your most recent consultation with the doctor, can you indicate your experience – Giving you enough time:
Poor	Fair	Good	Very Good	Excellent
14	28	134	209	177

Thinking about your most recent consultation with the doctor, can you indicate your experience – Listening to you:
Poor	Fair	Good	Very Good	Excellent
7	23	106	193	230

Thinking about your most recent consultation with the doctor, can you indicate your experience – Treating you with care and concern:
Poor	Fair	Good	Very Good	Excellent
4	21	96	179	245

Results of All Surveys Completed - Percentages

Communicating with reception – when you speak with our reception is what is said clearly understandable
Confusing	Quite confusing	No opinion	Quite understandable	Very easy to understand
0%	1%	3%	32%	64%

Communicating with reception – The information provided by the reception staff
Not had any information	Difficult to understand	No opinion	Quite easy	Very easy to understand
3%	1%	4%	31%	61%

Information – Thinking about information provided by the practice. Are poster displays in the practice useful?
Not noticed	Needs improving	Slightly useful	Useful	Very useful
7%	2%	9%	63%	19%

Information – Is the practice information leaflet useful?
Not seen it	Needs improving	Slightly useful	Useful	Very useful
16%	3%	6%	57%	18%

Information – Is our waiting room patient calling system clear?
Not noticed	Needs improving	Slightly useful	Useful	Very useful
2%	23%	5%	37%	33%

Information – Is our waiting room Patient Newsletter useful?
Not noticed	Needs improving	Slightly useful	Useful	Very useful
18%	1%	9%	49%	23%

Information – Is the practice website useful www.drpatelandpartners.co.uk
Not seen it	Needs improving	Slightly useful	Useful	Very useful
60%	1%	3%	19%	17%

Information – Do you know what to do next if you had a concern, query or complaint?
	No	Some idea	Yes
	13%	33%	54%

Thinking about your most recent consultation with the doctor, can you indicate your experience – Explaining tests and treatments:
Poor	Fair	Good	Very Good	Excellent
½ %	3%	20%	37%	39%

Thinking about your most recent consultation with the doctor, can you indicate your experience – Involving you in decisions about your care
Poor	Fair	Good	Very Good	Excellent
½ %	3%	21%	38%	37%

Thinking about your most recent consultation with the doctor, can you indicate your experience – Giving you enough time:
Poor	Fair	Good	Very Good	Excellent
3%	5%	24%	37%	31%

Thinking about your most recent consultation with the doctor, can you indicate your experience – Listening to you:
Poor	Fair	Good	Very Good	Excellent
1%	4%	19%	35%	41%

Thinking about your most recent consultation with the doctor, can you indicate your experience – Treating you with care and concern:
Poor	Fair	Good	Very Good	Excellent
1%	4%	17%	33%	45%

These results were presented to the Reference Group and from the end of October until mid December 2013 feedback and comments came in from the Group.

Action Plan

From the feedback the surgery drew together the collective thoughts and devised an action plan (below).

The aim of the plan is to reflect the collective view of all those patients who completed the survey and also the Patient Reference Group.

The plan approaches the problem in different ways.

To influence patients,
To take general action,
To take specific action.

All this is underpinned by the support of ordinary patients’ views and the Patient Reference Group views. To assess the impact of the plan we will carry out some further questionnaires.

INFLUENCE
	Action	Method of Implementation	When to implement	Resource Implications	Method of review
Raise awareness of practice leaflet	Poster	Waiting room poster advising patients to ask for a copy	May 2014 Leaflets & posters on permanent display 05/2014	Simply designed poster can be easily produced	See “Assessment” below
Patients unaware of practice website	Poster Newsletter	Waiting room poster advising patients of address Short article in newsletter reminding patients	May 2014 On display 05/2014 Spring/Summer newsletter 2014 Done & repeated on all subsequent	Simply designed poster can be easily produced None	See “Assessment” below
Raising awareness of the complaints and feedback procedures	Poster Newsletter	Waiting room poster advising patients of it and its functions Short article in newsletter reminding patients	May 2014 Permanent poster on display 06/2014 Summer 2014 newsletter Article in Autumn 2014 newsletter	Simply designed poster can be easily produced None	See “Assessment” below
ACTION - GENERAL
	Action	Method of Implementation	When to implement	Resource Implications	Method of review
Awareness of practice website	Advise in our correspondence NHS Choices Prescription message	Redesign our standard letter template to include website detail Include a link in the national NHS Choices website to our own. One month per half year, create special prescription message	May 2014 Now on footer 12/2014 April 2014 Done 04/2014 June and December each year Done June 14 & Jan 15	Full review of our letter templates will be needed. Needs some staff time and resources Need to investigate method to follow. Easily done, diarise action dates	To be a permanent change To be a permanent change Monitor patient feedback
Assistance with complaints	Leaflet	Create a leaflet available for handing out at reception	April 2014 Completed 04/14	Ensure this includes guidance on other organisations/ agencies who can help	To be a permanent change
ACTION - SPECIFIC
Patient calling system Patients experiencing difficulty hearing their call	Critically appraise present systems, strengths and weaknesses. Practice to investigate products available - Visual - Audible Practice to investigate feasibility of doctors working differently	Consider and contrast alternatives balancing costs Vs benefits Consider ways other than technology for calling the patient	A working group to research and report back within first quarter (Apr-Jun 2014) A working group to research and report back within first quarter (Apr-Jun 2014) Some work late summer 2014. Inconclusive Scheduled for Mar 15	Perception that many of these products are expensive Might impact on patient consultation time. May be more difficult and time consuming, reducing the patient time	See “Assessment” below
Appointments structure	Although not part of the “communication survey”, some patient comments indicate concern over availability mix Expanding methods of appointment booking	Data collection exercise, assessment, review and implementation to be drawn up Move ahead with some on line appointment booking	Data collection to begin April 14, assessment May, implement June 14 onwards Changes to “mix of appts made Oct 14 July 2014 Begun Mar 2015	Considerable. Data collection will involve paper and computer collection. Assessment by team drawn from across the practice Ability to do this rests with clinical software suppliers.	Review comments and feedback from patients, reception, doctors 2 months after implementation Likely -revisions and a follow-up plan. This significant change will mean only limited number of appointments to be available initially See “Assessment “ below
Patients unaware of practice leaflet	Ensure a leaflet provided to all newly registered patients	Issued by receptionist with registration form	From April 2014 Standard procedure from May 14	None	None needed
Raising awareness of website Leaflet Complaints procedure	By publicity paper	Create a short paper drawing patients attention to these. To include in our regular patient recall letters	Recall letter system under review and revision. Carried forward to 05/15. Large amount of work needed to build into a new system.	Opportune time to introduce this with manageable impact	Expect to receive patient feedback See “Assessment” below
ASSESSMENT
Practice leaflet, website, complaints procedure	Benchmark patient awareness	Assess impact of our actions	Short survey of patients		6 months after implementation (Sept 14) Completed Oct 14 & Jan 15 - Evidence of raised awareness
Patient calling system	Benchmark patient satisfaction	Assess impact of our actions	Short survey of patients		6 months after a solution has been implemented Dec 14 No equipment purchased yet. Funding issue defer to summer 2015 when cost reconsidered
Appointments Structure	Benchmark patient satisfaction	Assess impact of our actions	Short survey of patients		3 months after a solution has been implemented and should be repeated 3 months later Survey Dec 14 - inconclusive. Further survey set for Easter 2015.

Reviewing the Plan

On 19 December 2013 the Patient Reference Group were presented with the plan for their consideration. Feedback from this was very positive and the plan was approved by the Group.

The Practice would again like to thank the Patient Reference Group for all their efforts, thoughts, feedback and suggestions. This really has been a good exercise in helping our patients to have a voice in influencing how things are done at the surgery.

We would also like to express our thanks to all the patients who completed the survey.