Title: PATIENT PARTICIPATION REPORT
Author: Any Authorised Employee
Last saved by: Anna Jennings
Company: Westminster PCT

fitzRovia medical centre Patient Participation Report - e87066
Date Published: 

Validate the survey and action plan through the Patient Participation Report

Survey
Please describe how the priorities were set

The Practice Manager met with the PPG on 30^th July 2014 to discuss the following:

1.	Update on the possible relocation to Fitzroy Place Development
2.	This  year’s patient satisfaction survey and the priorities for next year
3.	A&E attendances
It was agreed that these issues were so topical to the running of the surgery that the survey should be centred around these issues

Please describe how the questions were drawn up

The practice and the Patient Participation group agreed that the survey should be similar to previous ones to allow for comparison, however the wording should be clearer and tailored to practice specific issues such as awareness of different services and opening times available at the practice as well as continued efforts to educate patients on the most appropriate ways to access medical care.

Priorities agreed were:

•	Access – 
1.	physical access to the practice
2.	innovative ways of improving access to doctors and nurses
•	Awareness of strains on NHS services due to inappropriate use of emergency services

Please describe how the survey was conducted

As in previous years, in order to reach the maximum number of patients it was agreed to offer different ways of accessing the survey. This was made available on line via the website; all patients for whom we had email addresses were sent the link and asked to complete the survey.

Paper versions of the survey were made available at reception to offer to patients ad hoc as they visited the practice. All the patients coded as “housebound” were also sent a survey together with a stamped addressed envelope to ensure their views would be included. 

Admin staff and the Bengali Link worker were also on hand to support and help any patients who expressed problems in completing the survey.

What were the survey results?

The survey results

•	Of the patients surveyed, 25% attended the surgery once or twice a year, 30% three to four times, 26% five or six times with the remainder 17% attending seven or more times.

•	Nearly 87% of the patients rate the appointment times at the surgery good to excellent (a 9% improvement from last year) 11% rate them as fair and remainder 2% rate them as poor or very poor (down from 7%). 

•	When asked about different opening hours option 40% of the patients were satisfied with the current arrangements, 43% suggested early morning clinics (up from 24% last year), 22% wanted lunch times (again 5% more then previously), 15% wanted evening surgeries and only 14% wanted week end opening, (last year this was 30%). This may reflect the fact that patients are rather happy with the practice opening hours, but also that they may elect to attend A&E at the weekend as it is “convenient”.

•	The waiting times for a routine appointment with any health care professional was 5 days or more for 28.% (down from 55%) of the patients, followed by same day for 24%! 22.27% were seen the next working day,  5.5% were able to be seen within two working days and 12% between three and four days.  8.4% stated that waiting times do not apply to them; this may reflect patients who attend our urgent clinic (possibly inappropriately) or those who attend specific clinics such as the substance misuse or anticoagulation where the appointment intervals are recommended by the clinicians.

•	For urgent appointments around 65% (an improvement of 12%) get seen on the same day all of the time or most of the time. 30% never needed to be seen urgently and only 2.5% answered never.

•	Considering the levels of satisfaction with opening hours and access to urgent medical care, 32% of the patients had attended A&E in the last six months, followed by 11% using Out of Hours services and 8% the walk in centres. 57% did not need to use any of the emergency services.

•	We also asked what services patients attended the surgery for, the majority was to see a doctor but all other services provided such as Ambulatory Blood pressure monitoring, Anticoagulation, IAPT, Smoking Cessation, Substance Misuse and travel clinic as well as all of our chronic disease monitoring clinics (diabetes, COPD, asthma, etc) were included in the list of options chosen.

•	Finally the vast majority of our patients (81%) are now aware that we are open till 8:00pm on Thursday evenings and appointments with both doctors and nurses can be booked, all of these patients rated the extended hours offered excellent to good, 11% of the patients never used it. This is also true for our urgent clinic open to every patients presenting between 8:30 and 10:00 every morning with 98% being aware of it.
•	Our patients are satisfied with the telephone access at the practice in general (only 3.4% rate it as poor or very poor), as well as the ability to speak to a health care professional for advice and guidance, 66% rate it excellent to good.  Knowing how to access the Out of Hours Services was only slightly better than last year with 29% (by 1%). 27% of the patients consulted have used NHS111 in the last year reporting various degrees having their needs met.

•	When asked about access to the lower and upper floors in the surgery 75% of patients reported no difficulty at all whilst the remaining 25% found it fairly difficult to physically impossible. The main problems highlighted were negotiating the steep stairs for the elderly and those with physical disabilities; young mothers with babies and toddlers.

•	All of our patients named the tranquil and beautiful location of the square as well as the exquisite Georgian architecture as the thing they most like about the building.  Main dislikes included no lift, too many stairs, not enough room in waiting areas and reception as well the décor looking very tired.

•	The most appreciated features that would come with the move to a purpose built site were rated as :
1.	Improved facilities 
2.	On site community services 
3.	Easier access to the surgery for the elderly and disabled
4.	Lift 
5.	Disabled parking

•	Finally, 35% rate their overall experience with the Fitzrovia Medical Centre as excellent (up from 29.5% last year). 45% very good, 14% good and 3% fair.  One patient out of 235 rated us as poor and nobody rated us as very poor.

Action plan
How did you did you agree the action plan with the PRG?
The PRG met on 19^th March 2014 and discussed the findings of the local patient survey.  Following the discussion, the action plan was agreed.
What did you disagree about?
Nothing
Are there any contractual considerations to the agreed actions?
Not currently, although if the Practice did  eventually move, we would be have to be open from 8am to 8pm seven days a week which means all of the staff contracts will have to be changed.
Please include a copy of the agreed action plan

ACTION PLAN

The survey results are very positive, particularly with regards to patients’ satisfaction with the opening hours and access to medical care here at the surgery.  The surgery has been working very hard to try and accommodate our patients’ needs by allowing emergency access early in the morning via the urgent clinic, access to telephone advice as well as telephone consultations and opening late in the evenings for those who need to come in after work or school. In recent years the surveys had highlighted the fact that significant numbers of patients were not aware on how to access the services on offer, so it is good to see that the continued efforts to educate the patients are starting to pay off. The patients love the current location on this beautiful square but support the need to move to new, more suitable and accessible premises to allow for growth and improvement of facilities.

In spite of all these effort in terms of access to the practice, we have experienced a marked increase of A&E attendances, even when the practice is open. We have had a lot of staff “illness” of late, when surgeries have had to be cancelled at the last minute and although this can account for some of the increased A&E attendances, we feel that the proximity to A&E (0.3 miles – less than 5 minutes away from the surgery) makes it very “convenient” for the patients to just present there. A&E is not incentivised not to see patients for minor ailments that should be dealt with by a doctor or even a chemist. None of our patients have taken advantage of the local week end opening surgeries, which indicate that they are happy with our opening times or that they are not prepared to see other GPs.

Main areas for improvement were:

Fitzroy Place Development
Unfortunately there is not much we can do to expedite the process or even to just bring about a final decision. We know that our patients and the representatives are very keen for us to move to better premises so we will keep liaising with the developers, NHS England and the CCG. 
What we plan to do   
If the move does not go ahead will have to agree on a deadline in order to start planning the extent of the refurbishment of the practice and how much it is going to cost. This will entail a reconfiguration of the first floor to create an extra consulting room as well as looking at new chair lift options etc. Our list continues to grow with an increase of 700 patients in the last year alone, we need to maximise whatever little space there is in order to cope with increasing demand. The PPG suggested that it may be worth organising some fund raising events or contact local businesses for some sponsorship. 

Innovative ways of improving access to doctors and nurse
We are very pleased to see that the patients are happy with the access arrangements; however, the PPG felt that although this has greatly improved, the current system does not really allow patients to see their clinician of choice and this is not ideal in terms of continuity of care. They also felt that the use of telephone consultations should be encouraged as it would be an effective way of saving both patients and GPs time for those simple matters such as medication reviews, referrals and simple queries. The PPG felt that maximising the use of telephone consultations will in turn free more appointments for routine appointments with a doctor of choice.

What we plan to do   
1.	Continue to raise awareness of telephone consultations – the reception staff will encourage patients to book these if they are responding to requests for medication review etc.
2.	Update the practice leaflet for patients to manage expectations and educate them on the alternative options and also to keep them posted on changes to the way we work and all the different clinics run within the practice. As the outside of the surgery is due for a refurbishment in the next couple of months, the surgery will look at designing a new display to replace the current brass plaque. The display should include opening times, website address and a comprehensive list of different services provided, including the Duty Doctor role and how to contact.
3.	We will continue to provide clear communication of numbers of appointments each month as well as DNAs numbers. A poster highlighting the numbers of “wasted” appointments will be displayed at reception and on our website every month.
4.	When attending the urgent clinic, patients will be able to ask for their doctor of choice, this will be added to the clinical system screen so that if doctor is in urgent clinic they may be able to see them although this may not always be possible.
5.	The PPG suggested that the surgery should focus on advertising more the services we provide; it would be a good idea to provide more information on the outside of the surgery. 

A&E attendances
There is great a need for patients’ education when it comes to A&E attendances especially as we have a large transient population who are not always aware of how to access the appropriate services.  The wording of an awareness flyer was agreed with the group. This should highlight how much it does cost to attend the A&E department as well as how best served the patients would be if the budget for this goes to genuine medical emergencies. The patients also requested that the leaflet and the website are updated regularly to ensure that all the other services delivered by the Fitzrovia Medical Centre are more widely advertised to improve awareness. The PPG were not aware that the Duty Doctor has emergency appointments in the afternoons so it was agreed that this should also be advertised more widely. They felt that sometimes it is difficult for the elderly to get up early enough to be seen in the urgent clinic.

What we plan to do   
1.	We will continue to publicise this services by adding the information to all repeat prescription requests, on the practice leaflet and onto our website.
2.	The surgery already writes to all patients who have attended the A&E department whilst we are open if their attendance is considered inappropriate, we will add our awareness flyer to all such letters.
3.	Continue to encourage patients to use the Duty Doctor line for help and advice, the Duty doctor clinics in the afternoon have some emergency appointments to be allocated to genuine emergencies.

Local patient participation report

Please describe how the report was advertised and circulated

The report has been uploaded into the patient information screen at reception and on the practice website. Copies have also been made available at reception

Please include a copy of the report and link to your practice website

http://www.fitzroviamedicalcentre.co.uk/

Opening times

Please include opening hours and out of hours arrangements in the report

Leaflet