PATIENT PARTICIPATION DES 20111-2013

BACKGROUND

Springfield Medical Centre SMC has been participating in the Patient Participation Directed Enhanced Service (DES). It is a two-year DES which is effective from 1 April 2011 until 31 March 2013. The DES applies to England only.

The purpose of the Patient Participation DES is to ensure that patients are involved in decisions about the range and quality of services provided and, over time, commissioned by their practice. It aims to encourage and reward practices for routinely asking for and acting on the views of their patients. This includes patients being involved in decisions that lead to changes to the services their practice provides or commissions, either directly or in its capacity as gatekeeper to other services. The DES aims to promote the proactive engagement of patients through the use of effective Patient Reference Groups (PRGs) and to seek views from practice patients through the use of a local practice survey. The outcomes of the engagement and the views of patients are to be published on the practice website.

This article/report sets out the progress that Springfield Medical Centre as made during the year ending 31 March 2012.

Springfield Medical Centre – Statistics

Patient population at 31 March 2012	6512
Opening Hours	Daily 0830-1830 Extended hours Tuesday until 1945
Access in Core Hours	Manned 0800-1830 daily Closed lunch 1300-1400 but duty clerk
Out of Hours	SELDOC 1830-0800 plus 24 hour cover at weekends
Extended Hours	The practice offers extended hours every Tuesday with 2 doctors from 1830-1945
Appointments	Standard 10 minute appointments Bookable up to 10 days in advance Same Day Appts Doctor call back triage service
PPG Meetings held in 2012	19 May 2011/ 19 October 2011/ 15 December 2011/29 March 2012

Component 1 Setting up the Patient Reference Group

From the outset SMC has made every effort to conform to the parameters of the PPG DES and one of the fundamental principles was to create a reference group which fully represented the practice list in terms of age, ethnicity with the added nuance of groups with specialist needs. To this end a spreadsheet was constructed listing by age groups <15, 15-24, 35-44, 45-54, 55-64 and >65 then by 4 groups Asian, Black, White British, White Other.

Ethnicity	15-24	25-34	35-44	45-64	>65	Total
Asian	1.65	5.7	2.7	1.5	0.3	11.85
White Brit	4.5	6.6	2.15	0.9	0.4	14.55
White Other	9.2	29.5	13.8	7.7	0.7	60.9
Black	2.9	3.6	2.8	2.7	0.7	12.7

Following this each group was targeted by MJOG messages to those with mobile phones and through flyers (including invitation to join the group) and reception notices. The resultant group of 15 met for their inaugural meeting at SMC on Thursday 19^th May. At this meeting there was further explanation of the reason for the setting up of a PPG and the roles that were to be filled. It was emphasised that this was to be a patient led committee and although SMC were willing and able to provide administrative support any attending staff would have no voting rights.

Composition of Current Patient Reference Group

The assembly of the patient reference group has been a challenging task and although every effort has been made to create a group that reflects the patient mix the following have offered their services and now form the SMC PRG.

Age	Gender	Ethnicity i.e.Black/British; Black/African etc	Relevant social factors i.e. employed, unemployed, hard to reach group etc.	Is the patient currently registered at your practice? Y/N (Please select from the drop down box)
27	M	Asian		Yes
32	M	Black African		Yes
18	F	Black British		Yes
27	F	Black British		Yes
50	F	Black British		Yes
60	F	Black British		Yes
77	M	Black/African		Yes
33	F	Mixed		Yes
39	M	Mixed		Yes
43	M	White British		Yes
70	M	White British		Yes
82	F	White British		Yes
29	F	White Other		Yes
36	M	White Other		Yes
41	F	White Other		Yes

What is apparent from this when comparing against the practice list is that the group is not truly representative. The majority of the list at SMC is White Other in the 25-34 age group representing almost 30% of patients whilst the PRG has only a 7% representation. There is a need to target that group to get more members but that is in itself a problem. That group is made up of mainly Portuguese speaking patients who seem to live as a self contained but isolated group in the local community. We have employed a Portuguese speaking receptionist and hope to raise awareness of the PPG so that their voice can be heard. An invitation will go out to these patients in Portuguese to encourage a sub group or even virtual group to ensure better cognisance of their concerns and issues.

Similarly the average age of the PRG is 44 years when the mean average of the Springfield group is some 12 years below that. Targeting and getting younger people involved was the thrust of a campaign held in December 2011 which proved successful to some degree as the previous participation tended to be much older patients with gripes the new composition is much more relevant and constructive. Efforts will continue to be made in 2012 to balance the PRG to reflect the list statistics.

Component 2- Agreeing Areas of Priority

The next meeting was held on Wednesday 19^th October 2011. At this meeting there was a general debate about the priorities which patients thought were essential to good customer relations. This was well attended and there was a lively debate. The main issue was language as less than half of the participants had English as their first language. The following areas were agreed as priorities to be put to patients to seek their views:

Telephones – lack of a Queuing system

Appointments - timings – distribution – lack of options

Prescriptions – The system and why 48 hours

Quality of Reception Staff

Quality of Clinical Care

Quality of Customer Experience

Health and Wellbeing and Special Groups

Component 3 – Collate Patient Views via a Survey

The third meeting was held in December 2011 and was a disaster as far as participation was concerned with only 3 members attending. It was decided that the meeting was not quorate but a decision was taken that a patient survey based on the issues raised should be distributed to gauge a wider set of views.

Example Survey agreed by PRG

This survey was conducted using the following methods:

Printed surveys given to patients in reception

Use of students and work experience staff to actively canvass patients for responses
Setting up of a web based data collection site through Health Unlocked
Surveys distributed to Patient Reference Group Members

The survey distributed was as follows:

This is a survey on your time at Springfield Medical Centre. Please tick (ü) the box when you see multiple choice answers.

Patient Information

Questions	Answers
Date of Birth	_ _ /_ _ / _ _ _ _
Gender	Male Female
Date of visit	_ _ / _ _ / _ _ _ _
Time of day of the visit	Morning Afternoon Evening
Ethnical background	White: Black: Asian: Mixed Race:

About the Medical Centre

Questions	Answers
How often do you visit?	weekly Monthly Yearly
How was your experience at Springfield Medical Centre?	Excellence Good Fair Poor
Do you prefer appointments in the morning, afternoon or evening?	Morning Afternoon Evening
Was it easy to book an appointment with the health professional?	Yes No Add comment: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Appointment by phone
Did the receptionist introduce him/herself when you were booking your appointment?	Yes No
Were you told that you’re able to book appointments two weeks?	Yes No
Did the receptionist offer to get the doctor to call you back?	Yes No
Did the receptionist tell you about the walk-in clinic if there wasn’t an appointment available on the day?	Yes No
Have you used the repeat prescription service?	Yes No If yes, tick (ü) below In person By Fax By E-mail
Did the receptionist tell you it’ll take up to 48 hours for your medication to be ready?	Yes No
Would you recommend your family and friends to Springfield Medical Centre?	Yes Maybe No
Did you spend enough time with the health professional during your appointment?	Yes No Add comment: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Did the professional listen to your questions and answered them properly?	Yes No
Do you trust in what the health professional told you in your appointment?	Yes No
Did you receive any printed or written information?	Yes No
How clean was the Medical Centre?	Very clean Clean Not Clean
How was the behaviour of the staff at the Medical Centre?	Very Friendly Friendly Not Friendly

General comments about Springfield Medical Centre

Things Springfield Medical Centre should continue doing:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Things Springfield Medical Centre should stop doing:

Things Springfield Medical Centre should start doing:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

A simplified more focussed version as shown below was distributed to the Patient Reference Group

This is a survey on your time at Springfield Medical Centre. Please tick (ü) the box when you see multiple choice answers.

Patient Information

Questions	Answers
Age group	Under 15 15-25 25-50 50- 65 65+
Gender	Male Female
Date of visit	_ _ / _ _ / _ _ _ _
Time of day of the visit	Morning Afternoon Evening
Ethnical background	White: Black: Asian: Mixed Race: Other; Please state; ………………………………

About the Medical Centre

Questions	Answers
Was the service at springfield medical centre good or bad?	Good Bad
Was it easy to book an appointment with the health professional?	Yes No
Appointment by phone
Was the receptionist co-operative to your needs?	Yes No
Were you told that you’re able to book appointments two weeks in advance?	Yes No
If there were no appointments on the day and your requirement was urgent, did the receptionist offer to get the doctor to call you back?	Yes No
Have you used the repeat prescription service? How did you access the service?	Yes No If yes, tick (ü) below In person By Fax By E-mail Add comment; _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Was the doctor useful in answering your questions?	Yes No
Do you trust in what the health professional told you in your appointment?	Yes No
Was the Medical Centre clean?	Yes No
Was the Medical Centre reception staff helpful?	Yes No

General comments about Springfield Medical Centre

What do you like about Springfield Medical Centre?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What would you change?

Results

A total of 140 survey forms were distributed to patients and 119 were returned completed. The breakdown of responses was as follows:

Number by Ethnic Group	Black 30/White 71/ Asian 6/Other 12
Split by Male/Female	Male 23% Female 77%
Telephones Unsatisfactory	62%
Appointments System Issues	58%
Satisfied Generally	71%
Satisfied with reception	86%
Satisfied with Clinical care	91%
Overall Satisfaction	78%

The results of the survey showed:

A need for a review of the telephone system was necessary to prevent patients from being disconnected when waiting to get through thus losing place id queue and often with the added frustration that when they did get a connection that the appointments were all taken.

A need for a better distribution of appointments to allow for:

Early and late workers
Extension of pre-bookable appointments to allow next day as well up to 14 day as at present
Additional urgent appointments for children
More efficient use of interpreter services to cut down on double appointments when alternatives were possible
More general appointments availability on Fridays

Increased opportunities for specialised activities – chronic illness, age related, babies and toddlers, group counselling and therapies.

Component 4 - Discuss Findings, Agree Action Plan and Seek Agreement to Implement

Minutes of PRG Meeting – Thursday 29 March 2012-03-30

Present:

Representatives of Lambeth Link

PRG Members

Practice manager

Details of findings

There was a general discussion of the findings of the patient sampling survey.

Appointments

Whilst on the surface it appeared that there was a trend for patients at SMC to require morning appointments that were scheduled after 0930 (as an example it was shown that the largest number of DNAs had occurred over the last 3 months for appointments arranged between 0900 and 0930) there was agreement that some patients particularly working parents needed an early appointment so that they could then proceed to work without too much disruption to their employers.

There was confusion over how appointments could be booked and many patients were under the impression that they must call at 0830 in the morning irrespective of urgency of need. Many were unaware that SMC offered pre-bookable appointments up to 2 weeks in advance. Many did not understand why they were being asked for a reason for the appointment particularly if there concern was something of a personal nature. Staff asked this question to determine if the appointment was for a clinical consultation or an administrative requirement and to apply some superficial triage to gauge urgency.

There was some concern that children might not be seen when appointments were not available. Concern about chronic illness sufferers and a specific example of a person on palliative care who preferred to come into the surgery rather than being seen at home as a matter of personal choice.

It was felt that the appointments system need to be reviewed and better intelligence gathered before a new regime could be established

Telephones

· The telephone system was a cause for grave concern and was seen as the most harmful aspect of customer relations. The current system holds the caller for up to 3 minutes and then exits with the message “All of our operators are busy please call back later”. Appointments are at a premium at 0830 each morning so that by the time the caller eventually gets through appointments for that day were often all taken. Protestation that the caller had been trying to get through since 0830 were fruitless as the response was “We have no control over who gets through and we have been taking calls continuously since 0830 when the phone lines opened”.

· When appointments were not available patients seemed unaware of what options there might be for dealing with their problem and were often offered the same option to call back at 0830 the following morning to begin the lottery over again.

· Delays were also incurred by complicated conversation with some patients ringing at 0830 to discuss routine matters (sometimes at length) that could have been raised after the “initial rush”.

· There was general agreement that there should be better education for patients and staff alike and that a queuing system as employed by many financial institutions would be preferable to the current system.

Feedback

· There was general concern that as in so many other areas that there was very little feedback from meetings such as this. There should be more to advice patients of how their comments had influenced the thinking and practices of the medical centre through posters, flyers, newsletters and information sheets.

· Evidence that patient participation had brought results would encourage even more input from patients in the future

· SMC should work on developing ties with the community and should be another hub in the community for the sharing of ideas that assisted not only the sick but also the worried well and the wellbeing of all citizens.

· SMC could run interest group meetings and arrange for short briefing which could be developed to promote the PPG. These groups could as simple as walking groups, young mother, the elderly, diabetic, nationality specific – in particular Portuguese as the largest population in the practice.

ACTION PLAN

Serial	ITEM	Action and Planned date
1	Investigate a telephone Queuing system that would inform caller where they were in Q and would not cut off	PM by 1 June 2012
2	New Telephone system to offer information service	PM by 1 June 2012
3	Survey larger group of patients with regard to appointment times	PM and PRG by June 2012
4	Publicise successes via posters, flyers, news sheets	PM and PRG - immediately
5	Investigate Specialists Group	PM, PRG and Lambeth Link – by June 2012
6	Publicise appointments system via Posters and Flyers	PM by 30 April 2012
7	Promote and Encourage PPG participation – make increased use of Health Unlocked survey by gathering email addresses from patients	PM and reception by June 2012

Agreement

The attendees endorsed this action plan and the practice manager promised to seek agreement from all PRG members by a follow up letter to be distributed with the minutes.

Patient comments are welcomed by completing the contact us form under the “Patient Participation Group” link on our website www.springfieldmedicalcentre.co.uk

Sign Up For Our Patient Survey

Dear Patient,

patient survey We would like to know how we can improve our service to you and how you perceive our surgery and staff.

To help us with this, we are setting up a virtual patient representation group so that you can have your say. We will ask the members of this representative group some questions from time to time, such as what you think about our opening times or the quality of the care or service you received. We will contact you via email and keep our surveys succinct so it shouldn’t take too much of your time.

We aim to gather around a hundred patients from as broad a spectrum as possible to get a truly representative sample. We need young people, workers, retirees, people with long term conditions and people from non-British ethnic groups.

If you are happy for us to contact you occasionally by email please click the link below to open the sign-up form and complete all the fields.

complete the form Complete the Patient Survey Sign-up Form Online

If you prefer, you can download the sign up form as a pdf document, print it out, complete it and return it to the practice.

download the pdf form Download the pdf version of our sign up form

We will be in touch shortly after we receive your form. Please note that no medical information or questions will be responded to.

Many thanks for your assistance

The information you supply us will be used lawfully, in accordance with the Data Protection Act 1998. The Data Protection Act 1998 gives you the right to know what information is held about you and sets out rules to make sure that this information is handled properly.

SpringfieldPatient Reference Group

Termsof Reference

1. Membership

Dr Eric Cajeat

Dr Neel Basudev

Art Matthews – Practice Manager andSecretary

Patient Elected Chairman – TBC

Patient Members x 24 – TBC

2. Frequency

The Springfield Patient ReferenceGroup (SPRG) will meet quarterly.

3. Purpose of the Springfield PatientReference Group

The SPRG hasbeen established to ensure that patients are involved in the decisions about arange and quality of services provided and over time commissioned by their practice.

It aims toencourage patients to influence how the practice is run to ensure that everyeffort is made to comply with patient wishes. The SPRG will be a key asset in selecting services, prioritisation ofprovision of services and reviewing feedback through Patient Surveys. The SPRG will determine the content ofPatient Surveys so that they reflect issues which are current and relevant whenassessing the quality and fullness of services offered.

The SPRG willbe formed from volunteers from the patient community and must be asrepresentative as possible taking cognisance of age, gender, social and ethnicbackground, disability and special needs.

Following thefirst meeting a chair person will be elected and it will be important that thisperson is committed to achieving optimum results. The chair person will be assisted by the SPRGsecretary who shall provide all administrative support and access to thosepersons or agencies that are responsible for the provision of services.

4. Responsibilities of Springfield PatientReference Group

The SPRG isresponsible for:

· providing leadership and energy for the programme of work

· assessing the developmental needs, prioritise the gaps andagree how the gaps will be met

· ensuring that SpringfieldMedical Centre where possible meets the agreed aspirations

· ensuring that a meaningful and thorough Patient Surveyquestionnaire is developed

· collating the patient views through the survey

· ensuring that requirements are documented, discussed andprioritised and monitor the delivery of the requirements

· ensuring that there is proper feedback to patientshighlighting what had been requested and what has been delivered

· ensuring that contacts are made with other localorganisations such LINks, HealthWatch and voluntary organisation who may beable to facilitate support for Springfield’smarginalised or vulnerable groups, such as elderly patients or patients withlearning disabilities

· discussion of factors that influence services provided bySpringfield Medical Centre and establishing a focus on things that really makea difference to the patients satisfaction with those services both clinical andnon-clinical

· assist in the development of an Action Plan to address allissues and to monitor and review regularly to check progress.

· Assist in the compilation of the Local Patient ParticipationReport in line with the standards set out in the Department of Healthguidelines and which must be supplied to local Primary Care Trust (PCT)

5. Reporting

The SPRG will report to practice patientsvia newsletter, publications on the practice notice board and web site and byformal reports to the PCT

6. Ways of working

Agendasand supporting papers will be circulated in advance of meetings. Minutes of themeeting will be circulated to all members within 5 working days.

7. Quoracy

The minimum number of members requiredin order to take decisions is six members of which 2 must be practice clinicalreps, locality reps or practice managers. If a member can not attend a representative should be sent.

8. Evaluation and Review

The SPRG Terms of Reference will bereviewed annually to ensure effectiveness.

Dateagreed: October 2011

Reviewdate: September 2012

Our Patient Participation Group [PPG]

The overall aim of our group [PPG] is to develop a positive and constructive relationship between patients, the Practice and the community it serves, ensuring the practice remains accountable and responsive to all its patients needs.

Our group key roles are:-

1. Create and improve two-way communication between patients, the Practice and the community it serves.

2. To bring a sense of partnership between Practice and patients.

3. Provide an avenue for patients’ input in the way facilities and services are planned and executed, to add humanity to, and influence those services.

4. Provide constructive two-way feedback on patient and community needs, concerns and interests.

5. Support the Practice in good health promotions, preventative medicine and health literacy

6. Collect patient opinions and experiences to help the practice to evaluate its services.

7. Communicate to the practice community and/or the wider community information about the practice.

Our Patient Participation Group Membership

All registered patients are welcome to join the PPG although, in the interests of effective decision making, membership of the core is limited to 24. Specialist sub-groups may be formed to deal with specific topics utilising individual skills and interests. Our group meets regularly approximately every 10-12weeks. If you would like to be part of this vital team please sign up by asking for a form at reception or call the practice manager on 0203 049 4609.

Contact Us

Contact the Patient Group with your feedback, suggestion, comment or question. Please do not use this form for complaints - these should always be directed to the Practice Manager

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Further Information

Patient Group Final Report 2011/12

Survey Report