1. Patient Participation Group DES Report March 2014-15 LIMES MEDICAL CENTRE By: Karan Madaan (Practice Manager)

2. What is the Patient Participation Group (PPG) and its purpose? ― The patient participation group at Limes Surgery was initially set up in 2010, as we want to understand the views and suggestions of our patients on the services we offer. The group reviews areas like access, staff training, complaints, practice procedures, changes in CCG &NHS and more. To gather the views of patients and their opinions on the services that are provided by the Practice The group meets two to three times a year to review the areas. The group is open to all patients to join and encourages involvement and attendance from all areas of the practice population. ― The group’s primary aim is to establish close working relationships between patients and the practice. This will be a relationship of open and honest communication leading to a health centre offering services as close as possible to the needs and desires of its population. ―Continued efforts have been made in the practice to recruit new members as the old PPG members served and gave feedbacks for a continued 3 years, to have more feedbacks and Improve the service we provide it was decided by the Partners and Practice Manager to advertise and encourage new Patients to Join. The original group formed in 2010 had just four members, however, we have seen an increase, to Six members at present. Whilst differences are still evident in both the ethnic and age profiles of our group, in comparison to our practice population, efforts continue to eliminate this. Clinicians continue to ask patients to become members, whilst current members speak to fellow patients to encourage them to join. Practice will consider changing PPG again this year to have new members on board with fresh views and Feedbacks.

3. The aims and objectives of the PPG is to; Provide Practice staff and Patients at Limes Medical Centre with an opportunity to discuss topics of mutual interests and to involve patients with the decisions regarding their care. To provide an opportunity for Patients and Staff to make positive suggestions and give constructive feedback about the practice and the quality of patient services offered and improve the quality of care we provide. To provide necessary means that will encourage patients to take more responsibility for their own healthcare. To include members that represents the diversity of the practice population. To ascertain views about our patient experience through the use of patient survey’s

4. ENGAGEMENT OF PATIENT REFERENCE GROUP To engage patients to take part in the Patient Group the practice the following action was taken to invite patients from all ages ethnic background Poster displayed in waiting room/Notice Board Face to Face invite by admin and clinical staff to Letters Word of Mouth Patients contacted by telephone Tried hard to indentify and involve all minority ethnic groups, was able to reach out to Indian, Asian, white British population had difficulties with Polish and Eastern European ethnic group Made effort to involve the Polish and Eastern European ethnic group, offered to book interpreter but they seemed not interested and did not attend when invited to meetings. Information is available on our website. Contact sheets were devised and given out by the clinicians and also put out on reception for patients to complete.

5. Profile Of PPG Group AGESEXETHNICITY 78 FWhite British 36 MAsian ( Pakistani) 39 FWhite British 75MWhite British 46M Asian ( Pakistani) 40M Asian ( Indian)

6. The PPG has met formally one time during 2014- 2015 in Feb 2015 and previously in October 2014, The Meeting was conducted through Email as I had to cancel & reschedule the meeting 3 times because of non availability of PPG members due to their work and other commitments, in order to Go ahead with the PPG meetings I decided to get patients feedback via email. We plan to continue to meet with the group through email, written or telephone communication as necessary between the formal meetings. 16 th October 2014 – Online Meeting. Introduction : All members were informed in advance and the reason of conducting the meeting this way, all members agreed except Mr DA who mentioned his he is not as proficient and confident in using the computer. After discussing with Mr DA it was only fair to give him the option of writing down their comments and handing it to me to compile them in minutes. Practice Manager explained the PPG significance to PPG panel for panel to have a good idea of what it required. Followed by Discussion on how to agree With PPG areas of priority. Patient Priorities and issues & ideas to improve service Mr SM raised a question about having a bi – lingual receptionists to understand other languages except English this was raised by him in last PPG meeting as well and he wanted to get an update on this. The practice Manager informed Mr SA again that there is one Asian background receptionist who could speak other languages but as majority of staff is part time it is a bit of problem with that particular receptionist availability and also the practice has good tie ups with interpreting services for any such needs. Another Member Mr DA suggested that when attending the Practice, Patients will need to be In and out as soon as possible but having the time to be spend with Doctor to discuss his/her Problem the patient would like to know the waiting time for see a G.P. sometime Patients get frustrated seeing other patients who came after them going to see G.P before them. KM said this maybe true sometimes as there are 3-4 G.Ps seeing patients at one time so the G.P a patients is waiting to be seen is running late will get seen later then other patient whose G.P is running on time, however, to get an better insight of when they will be seen, patients can speak to a receptionist to see on the screen and let the patients know. PATIENT GROUP MEETING

7. Continue Minutes 16 th Oct 2014 ―Mr M and Mrs B were happy with the level of service they received from the Practice in all aspects from reception through after seeing their G.P, However, Mrs B suggested to avoid wait in long ques we can have two separate lines one dedicated to arriving patients for booked appts and other for prescription and other queries and sign above each desk to help patient at bust times and this will also help in easing of patients who come in and out of the front door as long ques restricts the movement. Mr A and Ms B also seemed to be happy and satisfied with the level of service they have received on the day of their visits, however, they Mr A made a point about the lack of appointments when needed. KM explained the appointment system to Mr A in detail and explained the pressure on G.P Practices to accommodate their patient population depending on the problems. Mrs B mentioned about access via telephone, that they have to wait for several minutes to get through to the Front line staff. KM explained Mrs B that there might have been a delay in answering phones only because we were short staffed in the past due to staff leaving and annual/ sick leaves also the amount of calls the reception had to take but this will improve once all staff is back. PPG panel seemed happy with the appointment system as was not fussed as long as they were attended by a G.P when needed. ― It was also suggested not to make the survey too lengthy with too many questions as the patients gets bored easily. Patient Survey Actions taken to Improve: Balance between same day and book ahead appointments Km said in the last Year survey a low score in book ahead appointments was found so in order to improve the practice now has a fair balance between same day appointments and book ahead appointment also Practice will offer 50% of its book ahead appointments to be booked online. Telephony -Volume of incoming calls Km moved on discussing about Volume of incoming calls were found to be high at the Practice due to Patients having issues in getting an appointment with the doctor of choice, lack of overall capacity, too heavy a focus on emergency or same day appointments or other which lead to patients ringing again and call volume going higher. Trying to educate people on when to call has much of an impact though modest improvements have been made by encouraging those patients ringing about the results of tests, where calls are often longer.

8. continue -Number of lines There were no problems with the number of incoming Phone lines -Number of people answering calls We ensure that during the 'peak period' for incoming calls the duty reception staff are to dedicate their time to ensuring that the phone is answered promptly. During the less busy periods, when it is possible for some of them to undertake other tasks, we ensure that at least some are in a position to answer calls promptly when they do come in. We have more experienced receptionists who with time have developed an effective approach that succeeds in both sounding welcoming, helpful and supportive while steering the conversation to handle different call-types in a time-efficient way this also helps in bringing down the average length of incoming calls. Discussion on how to determine questions used in the survey Karan followed on by then explaining the purpose of having this meeting and importance of the questions determined in the survey and getting patients feedback, He went onto read out various questions, eg how long do patients have to wait before they can get an appointment with the GP on their choice. Mr SM said that he did not have any problems getting appointment at the practice, although he and his family prefer to see their own or regular G.P s which could take some time but then he added by saying that if they need to seen then it really doesn’t matter who they are seeing as long they are attended. Mrs SB added by saying she is very happy with the service in the practice and would like to thank all staff for that. The patients were happy with the questions mentioned in two surveys Karan presented. It was suggested not to make the survey too lengthy with too many questions as the patients gets bored easily. Another suggestion included the telephone access to be improved as it sometimes takes a lot of time to get through to reception- Reception supervisor informed the patient panel about the changes they have brought and strict guidelines they have implemented in answering the phone, the patients would feedback on this in the next meeting. KM introduced FFT to the PPG members: It asks people if they would recommend the services they have used and offers a range of responses. When combined with supplementary follow-up questions, the FFT provides a mechanism to highlight both good and poor patient experience. This kind of feedback is vital in transforming NHS services and supporting patient choice

9. PATIENT GROUP MEETING – 2 ND 24 th February 2015 – face to face Members of our PPG were invited The agenda items under discussion were: Patient Survey and Results discussed -- Ideas to improve service and Action plan to work on for next year was discussed -- Patient priorities and issues -- Sign off action plan template with PPG. Family and friend test Results. Any other business regarding Practice Premises, telephone system etc. – No concerns raised Patient’s priorities and issues including themes from complaints – If any complaints come in, there is an opportunity to discuss the theme generally and a possible realistic resolution.

10. Identifying & Agreeing the Priority Areas Priority Areas Agreed with PPG Priority areas were agreed with the Group as below. 1. Ques on front desk and Ques restricting front door for patient entering and leaving in busy time. 2.Bi – Lingual receptionist to understand other Asian Languages 3.Time of delay in seeing a Doctor – waiting time 4.Lack of appointments when needed. 5. Access via telephone – wait before phones get answered.

11. Sample size – 37 Opportunistic sample All aspects of the daily running of the surgery and feedback from PPG on were included in the questionnaire Duration – November 2014 – Feb 2015. Clinicians Involved – Dr M.Price, Dr S. Partridge, Dr M. Ahmad, Dr T. Daniel & Nurse Lai, Sarah & Khatoon. Collating Patient Views

12. RESULTS Key – 1 = Poor, 2= Fair, 3= Good, 4= Vey Good, 5= Excellent. Question 1 :

13. RESULTS Key – 1 = Poor, 2= Fair, 3= Good, 4= Vey Good, 5= Excellent. Question 2 :

14. RESULTS Key –1 = Poor 2= Fair 3= Good 4= Vey Good 5= Excellent Question 3:

15. RESULTS Key –1 = Poor 2= Fair 3= Good 4= Vey Good 5= Excellent Question 4 :

16. RESULTS 1= (0-5 minutes) 2= (10-15 minutes) 3= (20-25 minutes) 4 = (30-35 minutes) 5= (40+ minutes) Question 5 :

17. RESULTS Key –1 = Poor 2= Fair 3= Good 4= Vey Good 5= Excellent Question 6 :

18. RESULTS Key –1 = Poor 2= Fair 3= Good 4= Vey Good 5= Excellent Question 7 :

19. RESULTS Key –1 = Poor 2= Fair 3= Good 4= Vey Good 5= Excellent Question 8 :

20. RESULTS Key –1 = Poor 2= Fair 3= Good 4= Vey Good 5= Excellent Question 9 :

21. RESULTS Key –1 = Poor 2= Fair 3= Good 4= Vey Good 5= Excellent Question 10 :

22. RESULTS Are You aware of the online appointments system using the internet. Key – 1 = Yes 2 = No

23. Friends and Family Test Results Nov 2014 – Feb 2015 – 187 survey collected through – Patient survey questionnaire, FFT leaflets and MJOG Patients reminder service. Key –1 = Extremely Likely 2= Likely 3= Neither Likely or Unlikely 4= Unlikely 5= Extremely Unlikely 6 = Don't Know. Question 11 :

24. ACCESS Monday 8.15am – 06:30 pm Tuesday 8.15am – 06:30 pm Wednesday 8.15am – 06:30 pm Thursday 8.15am – 12:30 pm CLOSED AFTERNOON Friday 8.15am – 06:30 pm **Extended Monday and Tuesday Evening Surgery 6:30-8:30 PM ACCESS TO SERVICES Patients are able to book up to 4 weeks in advance with the clinicians of their choice. Doctors/ clinicians advise and attend to patients queries over the telephone and do home visits after there morning clinics.

25. Summary Patients keen on reducing waiting times to see doctor whilst in surgery (35%) Positives -Happy with consultation -Happy with receptionist -Able to see a doctor within 48hrs Negatives -Waiting times Get through over the phone Informing patients of any delays to surgeries Reception cant always meet patient demand Ques on front desk at Busy Times

26. ACTION PLAN Waiting Times – Continuously notify patient of delays via the electronic message board and verbally at regular intervals. Capacity – Consider increasing the number of same day appointments. Access via telephone – Consider new telephone system which includes call positioning feature to notify patients. Increase patient education - Continue to help reduce pressure on appointments, More patient education leaflets, Remind patients on consultation lengths. Look into recruiting Female G.P for Female population and Problems and improve Patient access. Revise this in 12 months and engage & develop PRG