Download PPG Annual Report 2013-2014 - Hilltop Medical Practice Online

Hilltop Medical Practice Patient Participation Forum
Annual Report
Component 1: Establish a PRG comprising only of registered patients and use
best endeavours to ensure a PRG is representative.
Hilltop Medical Practice is a small but growing practice with a population of 2544 patients,
1179 females and 1365 males of Mixed Ethnicity which is reflective of the Brent area.
Working patterns of patients are also mixed with some in full time employment, self
employed and unemployed.
When we first advertised the PPG we put messages on our Jayex board, messages on the
right side of the FP10 prescriptions, had notices on the noticeboard and also by word of
mouth. Receptionists would promote the event as would the doctor. The dates of meetings
are also promoted on the practice website as are minutes of meetings and annual report.
After a MJOG text message to ALL patients, we had interest from 50 patients with a wide
range of age groups, ethnic groups and social groups but due to work/education
commitments they have been unable to attend meetings. We also tried an evening forum
which was unsuccessful.
We therefore settled on afternoon meetings as these had a better turnout. We did not deter
those that could not attend- they were encouraged to email to the Practice generic email,
could leave messages in the practice suggestion box anonymously or write in. we have
ensured any ideas they have for the practice surveys or agenda of each meeting have been
taken in to consideration. We send out MJOG texts to all patients and to those who have
shown an interest in the past and ask them to let us know if they can attend and if they have
any issues they wish to be discussed.
Our PPG is comprised of 7-10 regular patients, mostly in the 40-75 age group but there have
been attendances and input from 17 patients during the year.
In our most recent PPG Meeting the group consisted of three in the 40-50 age group, three
in the 50-60 age group and one whom is over 75. Two of the group are retired, three are
employed and two are unemployed. Ethnicities were Afro-Carribean and white British. The
full PPG consists of individuals who are white British, African, Carribean , Indian ,Middle
Eastern, Lithuianian. We are hoping to recruit some South American participants who are
the other ethnic background not represented. Whilst the majority of patients were men, we
had representation from eight women (out of 17).
In the whole PPG Group we have a wide range of patients with different health factors;
including diabetes, epilepsy, mental health issues, rheumatoid arthritis, learning disabilities.
We also have a representation from a carer. We are continuously asking patients with other
health problems if they would be able to attend. We are aware that we could do with
representation form younger patients eg under 25s and also from young mums.
We advertise each meeting in and around the practice; on the notice board, on the website
and where suitable over the phone when patients have called. We are also calling patients in
and taking an opportunistic approach when they come in to the practice. During the writing of
this report, we have realised that we could also improve by asking the opinion of our
housebound patients
Hilltop Medical Practice Patient Participation Forum
Annual Report
Component 2: Agree with the PRG which issues are a priority and include these in a
local practice survey.
In our June 2013 meeting with the PPG, we discussed with the group which issues they
thought were important. An action plan was drawn up and it was agreed that we would give
feedback at the following meeting at which time the priorities for the PPG could be further
streamlined and the questions could be reviewed.
Action plan agreed
by PRG 2013-2014
At the following meeting the action plan was reviewed (see below) as some progress had
been made.
Action plan PPG no2
2013-2014.doc
The PPG reviewed their previous Priorities in view of progress made and decided on themes
that needed to be addressed in the Practice survey.
They also took into account


complaints we had received from patients- these were either written or verbal and
had been collated during the year and also discussed at our complaints meeting
issues the staff had raised.
We had also been visited by CQC and were awaiting feedback from them.
The questions to be included in the practice survey were circulated to the PPG and
feedback requested so that we could remove or add to these.
It was decided amongst the group that the priorities would remain:




Access – patients being able to access appointments when they needed for
either routine or urgent medical issues, this was obviously an ongoing issue.
Doctor/nurse – Any issues patients had with the doctor/nurse they had seen
while at the practice and if they were pleased with the outcome of the
consultation
Reception staff – did they find the staff helpful? Were they greeted in the
appropriate way?
Waiting room - Was the practice waiting room clean and tidy? Posters etc in
date. Are patients happy with the refurbishment or was there more to do. Is this
a good and healthy environment?
Hilltop Medical Practice Patient Participation Forum
Annual Report
Component 3: Carry out the local practice survey and collate and inform the
PRG of the findings
The surveys were produced by an independent company CFEP with independent analysis.
The questions included had been previously viewed and agreed by the PPG as identifying
their concerns.
Over the period of 2 weeks, 179 surveys were collected by patients attending the practice.
These were distributed to patients in the reception area by the receptionist before
consultations with the doctor. 125 of these were generic practice surveys pertaining to the
practice and doctors in general and 54 were relating to Dr N Ghosh-Chowdhury in particular
when discussing the feedback for the clinician. The filled in forms were anonymous and were
then sealed in an envelope by the patient and put in a box provided by the company. This
was to assure patients of confidentiality and that their care would not be compromised by
doing the survey. The questionnaires were then sent to the Company for analysis.
The PPG agreed that emailing questionnaires was time consuming, we had not had any luck
with any email feedback so far and it would be labour intensive trying to find patients to
contact unless they had requested email communication. It would be very time consuming
to call patients and ask over the phone (without seeming to coerce answers); also it would
not be cost effective to send to all our patients by post. By giving the survey to patients in
person it was an efficient way to identify patients who had indeed had contact with the
Practice.
Practice Survey
We discussed the methodology and analysis with the PPG and evidenced this in the report
to assure them of the credibility of results.
We ensured the areas discussed with the PPG were covered in the survey and that patients
had their say. The report was circulated within the PPG and adequate time given to peruse
and discuss the findings. If requested either a hard or electronic copy would be given to take
home.
Hilltop Medical Practice Patient Participation Forum
Annual Report
Component 4: Provide the PRG with an opportunity to comment and discuss
findings of the local practice survey. Reach agreement with the PRG of
changes and manner of delivery of services. Where relevant, notify NHS
England of the agreed changes.
A meeting was held after the survey results had been analysed to discuss the findings. The
report itself was circulated within the group and copies supplied either electronically or hard
copy if requested. We would then use the results to stimulate discussion about
developments and areas for improvement.
Please see the Summary of the results below- the actual report itself has been inserted
above.
IPQ - Hilltop Medical
Practice - 39307 - Poster.pdf
In general the survey had a positive outcome (and was above or met the national average).
87% of patients rated the Practice good, very good or excellent. This is confirmed by
feedback on NHS choices which was pleasing and was commended by the CQC inspector
who also saught feedback from patients in the waiting room during inspection. 73% were
satisfied with the doctor/nurse they had seen and 76% happy with the reception staff.
Patients were happy with the Clinical Care given and from the service provided by the
clinicians. This was reiterated by the PPG who were very supportive of Dr NGC.
Some of the issues raised by the survey were around the subject of access and the inability
to see the doctor when required, when the patient may feel that their needs are urgent. We
discussed how access is driven by two factors, the Patients and the Practice.
As a practice we have a very flexible approach, keeping a constant check on our waiting
times. We pride ourselves on never having a patient wait for than 10 days to see a Doctor.
As soon as this threshold is passed our solution is to employ a locum to come in in order to
provide additional access. As the Practice has grown we have called in two additional
doctors on a regular basis to provide additional appointments and also access to a male
doctor when required. Doctor NGC is also doing an additional chronic disease clinic with
longer appointment times to ensure that good clinical care is provided for those who have
additional needs. This was well received by the PPG and will help reduce waiting times
dramatically. This of course, only addresses the routine appointments.
We discussed how we have same day appointments available in addition to this. These are
on a first come first served basis and are usually well used. We never turn away a sick child
under 5. When our capacity is full, we advise patients to attend the Walk in Centre in
Wembley and in addition are working closely with our Locality in the Piloting of the Locality
Hub. These are additional Primary care appointments provided in the same building on a
Monday and Friday (busiest days) for either a doctor or nurse and additional Saturday
morning appointments for those that cannot come during the week. Patients are fully
utilising these appointments and feedback so far has been good.
Hilltop Medical Practice Patient Participation Forum
Annual Report
This stimulated the idea of weekend opening in general, which has been discussed in the
local and national media. We do have appointments on a Saturday with the locality hub,
which has been discussed above, and we will now ensure patients are aware of these when
they need to see a health professional over the weekend. We also have the services of the
Walk in centre. We need to promote the appointment options we have.
Discussion was had about the introduction of telephone consultations or perhaps changing
the configuration of our appointments. Introduction of this may impact on the availability of
routine appointments. The PPG were very happy about the 10 day interval and did not want
to jeopordise this. There was also discussion about the introduction on online appointment
booking and repeat prescription ordering. The PPG needed to be reassured that this would
not jeopordise those that did not want to participate in this. They accepted that this would be
useful for some patients who may be working or unable to attend or call the surgery. They
accepted that this was natural progression of the digital/ electronic age and would monitor
these incentives.
We also discussed the opening times of the Practice and whether this should change. The
PPG did not support this and were happy with current times. The discussion was had about
seven day surgeries but it was pointed out that this would not mean that DR NGC would
necessarily be seeing patients seven days a week. The PPG commented that they preferred
to see their usual Doctor (DR NGC) for continuity and therefore the seven day service was
not a priority.
The other factor was Patients and DNA rates- we have approximately 60 wasted
appointments each month. The PPG was staggered to hear this. This is all despite MJOG
text reminders, Posters on the notice and Jayex board, on the Patient leaflet and a DNA
policy whereby each DNA is followed by a letter asking the patient to call to cancel if an
appointment is not used. Further warning letters are sent if more appointments are missed
until after 4 DNA the patient is advised that they are to be removed. Dr NGC accepted, that
perhaps, the Practice could be more strict in actually removing these patients as we are not
always sticking to this and are at times too lenient. There was further discussion about
repeat offenders, common courtesy in cancelling appointments, effects on others and why
DNA occur. Whilst incidents can occur, there seemed to be no excuse for 4 DNA. This was
included in the Action plan.
The PPG also wanted to discuss issues about the waiting room and environment. This was
very important to the PPG. They explained that people feel unwell and are vulnerable when
they attend and are uncomfortable for both the receptionist and themselves when agitated
and aggressive patients attend. The youths and empty cans are no longer an issue and the
waiting area is now warm. However, at times there are agitated individuals who attend either
to register or book appointments and it was felt that their behaviour was not acceptable at
times. The PPG were concerned about the welfare of both Staff and other patients. The
Zero tolerance Policy was discussed and the PPG suggested that this be promoted more
and enforced more rigorously.
Health promotion was also a priority with request that the notice board continues to be
updated with current health promotions local or national. Up to date information should be
available in reception. The Jayex board is put to good use with information going across for
Hilltop Medical Practice Patient Participation Forum
Annual Report
patients who are waiting to see a doctor, this can have information about health promotions,
DNA figures and useful information.
The renovations were well liked.
Component 5: Agree with the PRG an action plan setting out the priorities and
proposals arising out of the local practice survey. Seek PRG agreement to
implement changes and where necessary inform NHS England
After a lot of discussion with the PPG we came to an agreement regarding the changes the
practice need to implement to keep the practice running as well as we have. One of the
major problems faced is that of DNA’s, up to 60 appointments a month are wasted through
DNA’s. Members of the PPG feel this has a huge impact on the access issues - Dr NGC
explained the DNA policy and the reason why we have it in place.
Whilst the Surgery continues to enforce our DNA Policy (reminders sent out after every nonattendance) there is still a steady DNA Rate. All Forum attendees agreed that this should
remain a priority. The group had a long discussion regarding reasons and explanations for
patients non-attendance at appointments and the impact it has on others when it comes to
access.
PPG decided that ‘3 strikes and you’re out’ rule would be much better. They thought 4 were
far too generous especially when an MJOG message is sent to each patient, and patients
can easily call to cancel appointments. The PPG think one missed appointment is
understandable if a patient has no way of contacting us or something comes up, but three
times is far too many. Most people have mobile phones and can phone in to cancel. It was
decided patients will be given a period of 12 months to have up to 3 DNA’s. The practice is
also to ensure that the DNA Policy is displayed on the Notice Board. We need to keep
information on the Jayex Board up to date. We will be adding on to MJOG messages to call
surgery if not able to attend appointment.
Patients were happy with opening hours and appointments so we will not be making any
changes to those. We will just keep on top of the waiting times to ensure the wait is not too
long.
Patients advised us to keep the notice board in reception up to date with any developments
or incentives both within the Practice or within the NHS. The different ways to access
appointments should be publicised so patients are aware of what is going on. There was
increased concern about the Shaping a Healthier Future Initiative and the effects of this
locally to the configuration of Central Middlesex. Patients wanted to be informed so that they
could attend any Public meetings if possible. They were not happy with current
representation and did not feel empowered enough to make their voices heard.
The PPG felt the locality PPG was not representative of them and wanted to attend the
public meeting themselves. We will keep them informed of when this is taking place.
Hilltop Medical Practice Patient Participation Forum
Annual Report
Regarding, locum doctors, patients have requested when a good locum comes with whom
they feel comfortable with, they will let us know and so that we can make sure we request
them again when a locum is needed.
Action Plan for 2014-2015
Priorities
Proposed Change
Person Responsible
Timeframe
Access to
Appointments
Enforce a stricter
DNA Policy- amend
current protocol to
reflect access as a
priority.
Practice to amend
and enforce
3 months
Practice Staff
3 month
3 chances instead of
4.
Access to
appointments 2
Practice to promote
the availability of
other primary care
services to patients
who may be in need
and continue to
monitor access
ensuring that there is
an acceptable
waiting time.
Local Changes to
Healthcare Service
Provision-
Practice to improve
Practice
communication about
any changes in local
services or service
design eg Changes
to Central Middlesex
and A+E.
Hilltop Medical
Practice PPG to be
allowed to represent
themselves
3-6 months
Practice noticeboard
to be continuously
updated. Public
meeting to be
publicised and PPG
members allowed to
attend and represent
themselves directly.
HealthCare
Practice should
maintain and
Practice
3-6 months
Hilltop Medical Practice Patient Participation Forum
Annual Report
Promotion
educate patients at
every opportunity,
timing this with
national promotions.
Eg Leaflets, Jayex
Board, Website
information.
Ensure a safe and
welcoming Waiting
Environment
Practice to be better
at promoting a Zero
tolerance policy.
Practice
6 months
“Know your Practice”
Suggestion made for
a “Hilltop Medical”
Social event. To
promote sense of
Community and for
patients to know their
Doctor and allied
Professionals.
Practice to liaise with
PPG.
1 yr
Component 6: Publicise the Local Patient Participation Report on the practice
website and update the report on subsequent achievement
Updates from Previous Action Plans
Previously, You said
We did
The outcome was
Increase the number of
Emergency appointments
Updated our appointment
system
Increased number of Same
day emergency
appointments-currently 6/day
Let us know about Locality
Patient Forum Meetings so
that we can attend
PPG Chair informed
whenever there is a Patient
forum meeting for Brent
Hilltop Medical Practice
Patient Forum would like to
represent itself at Locality
Patient Meetings rather than
being represented by an
unknown individual.
Please provide better gritting
We wrote to the Estates
There was better gritting
2012-2013
Hilltop Medical Practice Patient Participation Forum
Annual Report
outside the building in Winter
as it is unsafe when icy.
Department requesting this.
Winter 2012 and 2013.
Luckily there was a warmer
winter 2013.
Draughty waiting area in
reception
Both the Practice and the
PPG Chair write to Estates
department. Outlining our
concerns and issues.
There was complete
refurbishment of the waiting
area, heater installed and
screen put up to prevent
draughts
Please advertise the DNA
rate so that we can see how
bad the problem is and make
up our mind whether this is a
problem
The DNA rate is monitored
weekly and the figure
publicised on the Jayex
board for all to see while they
wait for their appointment.
Patients are also asked to
cancel if they do not need
their appointment.
Patients do now ring to
cancel their appointment and
even let us know if they are
running late.
Too long to wait for routine
appointment
We constantly monitor our
waiting times and bring in
additional help if needed. We
also make use of the
Locaility Hub pilot to offer
additional access to a GP on
Mon/Fri/Sat
Waiting times are rarely over
10 days.
How can we reduce our DNA
rate and improve our waiting
times?
We publicise the DNA rates
The DNA rate has
on the Jayex board. We send unfortunately stayed stable
MJOG text messages 48
after an initial drop.
hours in advance reminding
patients of their appointment
The Local pharmacy does
not answer their phone and
we have to go further to get
our medication
We contacted the Pharmacy
in question who added an
additional line and fax .
NO further issues. The
Practice is also now offering
online repeat prescribing and
electronic prescribing service
which will make ordering and
collecting repeat medication
much easier.
Please educate others to
cover their mouth in the
waiting area to prevent
spread of infection.
This is a Community
education issue. General
good health and hygiene
Posters were put up in the
Practice. Individual patients
We will try to carry on with
general health and hygiene
promotion.
2013-2014
Hilltop Medical Practice Patient Participation Forum
Annual Report
can not be identified without
causing offense.
There are young youths
loitering outside the main
building which make us feel
uncomfortable. The empty
alcohol cans outside the
building are not a good
promotion of health.
We wrote to the Estates
department outlining your
concerns.
No further issues of loitering.
Cleaners are more vigilant
and no more cans seen
outside.
Publish results and Agreed Action Plan:
The patient participation report is being published on the Practice website
www.thehilltopmedicalpractice.co.uk. Results of the survey are displayed in the practice
waiting area including all clinical rooms. Hard copies are retained at reception and will be
made available upon request. A copy report will be submitted to North West London GP
contract team.
Practice Opening Hours
The Practice Opening Hours remain unchanged over the Past year.
Appointment System
We operate a mixed appointment system as follows:


daily routine appointments can be booked in advance
Urgent same day appointments / booking on the day
Currently patients can book up to 2 month in advance. All clinical sessions are
entered onto the computer up to 2 months in advance to allow for patients to
pre-book within this period.
When a patient contacts the practice to make an appointment they are asked
whether they have a preference for a particular doctor or the next available
appointment. If a patient need to be seen within 48 hours and the doctor of their
choice is not available they are offered a choice of other doctors but if they
prefer to wait to see the doctor of their choice we either book the patient or
leave a message for the doctor to call the patient back.
We are flexible with our appointments and try to accommodate patients as best
we can.
Patients can contact the practice via telephone or face to face. We have just
implemented EMIS ACCESS with the facility to book appointments and order
Hilltop Medical Practice Patient Participation Forum
Annual Report
repeat medications on line. We in turn can also contact patients using the same
mode plus via text messaging using MJOG (with consent)
We use GRIP and language Line for booking interpreter in other languages
including sign language.
We are also fully engaged with the Locality Hub Access system which provides
additional access to primary care physicians. These provide additional
appointments on a Monday and Friday (busiest days in the week) for both the
Doctor and Nurse and there are also additional Saturday morning GP
appointments. All based in Hillside Primary Care Centre.
Our opening hours are advertised on our website, practice leaflets and posters
in the reception area.
Practice access and opening hours
Monday
09.00-19.00
Tuesday
09.00-19.00
Wednesday
09.00-14.00
Thursday
09.00- 19.00
Friday
09.00-19.00
Patients can also access GP services in the Harness walk in centre in Chaplin
Road which is open 7 days/ week , 365 days a year. 8am- 8pm
Out of Hours:
Patients can access the following services when the surgery is closed.
LCW is the service covering the surgery when the practice is closed at
weekends and Bank Holidays. Please contact them for emergencies only
Tel: 03000 333 777.
Patients can also contact – 111 for medical advice and information or 0203 402
1111 if for some reason 111 is not accessible.
Hilltop Medical Practice Patient Participation Forum
Annual Report
Health information, opening hours and out of hours service information can all
be obtained on the practice website www.thehilltopmedicalpractice.co.uk or
NHS Choices website http://www.nhs.uk
Summary
The Patient Forum has enabled the Practice to reflect on our service and focus
on priorities and objectives for the future. We hope that our patients have gained
some value in helping to develop their Practice in this ever changing NHS. Their
support and suggestions for development are greatly received.
We would like to thank all of our patients who have taken time to attend our
meetings, provide feedback and have completed surveys. Your contributions
help us work towards a better service for you.