burvill house prg 12-13 reportburvillhousesurgery.org.uk/website/e82023/files/burvill house...
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Burvill House Surgery Local Patient Participation Report 2012/13
Introduction
This report sets out to describe the development of the Burvill House Surgery Patient
Reference Group during 2012/13 following its inception in 2011. This includes a
review of the survey undertaken in 2011/2 and agreeing the survey for 2012/13,
undertaking a review on the outcome of the latest survey, looking at how the issues
raised in 2011/12 had been addressed and what further work might be needed and
agreeing an Action Pan with the Patient Group.
Ongoing Development of Burvill House Patient Reference Group (PRG)
a) Practice Profile
The Practice is continuing to develop the group so that it is as representative as
possible of the Practice Population.
The practice profile is unchanged since 2011/12 although there has been a slight
increase in list size from 9203 to 9327. Table 1 below shows the split on age/sex and
from data held on the Practice clinical system we are able to produce information on
the ethnic diversity of patients who use the practice. This data is detailed in Table 2
below.
Table 1 Age/sex demographics
Age 0-16 17-24 25-34 35-44 45-54 55-64 65-74 75+ Total
Male 1047 453 913 720 599 440 263 259 4694
Female 955 445 891 619 614 439 293 420 4633
Total 2002 898 1804 1339 1213 879 556 679 9327
Table 2 Ethnicity
Ethnic Group Number Percentage of Practice
White British 5852 63%
Other White 1067 11%
Asian 810 9%
African/Caribbean 600 6%
Other 656 7%
Not known 342 4%
9327
b) On going recruitment of PRG
The practice continued with the strategy used in late 2011 and looked to recruit
members in the following ways:
• Posters in the surgery
• Flyers attached to outgoing correspondence and prescriptions
• Clinicians speaking to individual patients about the PRG
• Using the website to make patients aware of the group and of the ability to
contribute by email only.
A small number of new members have been recruited this year.
c) PRG profile
The profile of the group has changed slightly this year with some younger members
joining the group and also some from different ethnic backgrounds. There is now a
better mix of age and ethnic diversity than in 2011.
Once again as part of the survey we asked patients if they would be interested in
joining the PRG. Unfortunately this has only produced one positive response.
Agreement of Priorities for the Patient Survey and discussion of 2012 action plan
The PRG met in November 2012 with Duncan Ferguson, The Practice Manager, to
start discussions on the priorities for the survey in 2012/13 and also to discuss the
Action Plan from the previous year.
Subsequent meetings were held in December and February to take forward these
discussions and agree the questions for the survey.
a) Action plan outcomes
Parking
The Practice has written to the council to request the relaxation of the double yellow
lines. Unfortunately the Council has not agreed to this citing the need for access of
emergency vehicles and a turning circle for them as the prime reason.
The practice has had more success with Gracemead House. They are happy to keep
their car park unlocked (previously it was locked at 5pm) and allow access to patients
to this parking. This will be reviewed as the needs of the residents of Gracemead
House change.
When the practice leaflet is next updated details of off site parking will be included.
Appointments
The appointment system has been changed following last years action plan and
routine appointments are now bookable 3 days ahead and all appointments are made
available at 8.30am
On line booking service is now available and since July 2012 nearly 700 patients have
signed up for the service.
The telephone greeting message has been changed to encourage patients to contact the
surgery for administrative matters after 11am and therefore leave the lines clearer for
patients requesting appointments.
A mobile phone has been purchased and patients are advised of its number so they
can text in to cancel appointments. The details are included on the text message they
receive to remind them of appointments. The uptake on this was initially quite slow
but we now get 2 or 3 cancellations by text each day.
Posters have been put up in the surgery advising of these changes. The posters gained
favourable comment at a PCT visit during the year.
Waiting times in the surgery
Patients have been made more aware of the length of their appointment and clinicians
have been more pro-active in managing patients’ expectations within the constraints.
Additionally receptionists have advised patients that the appointment is for 10
minutes.
Both these strategies have been used to reduce patient expectation that multiple
problems can be dealt with in an appointment and thus reduce the incidence of late
running.
All clinical staff are monitored on starting times and this has helped in time-keeping.
Patients who are attending the emergency surgeries are advised of a time to come
down to the surgery and are also advised that there may well be a wait to be seen.
Communication with patients
Due to space issues the privacy booth has not been accessible as would have been
wished. However work currently being undertaken will release space in mid 2013 to
allow this to happen. At this stage the availability of this booth will be more heavily
promoted.
When results are given by receptionist the patients are told that the “the doctor says
that your result is…….”. This should make it clear that the result has been seen and
commented on by a doctor.
When the receptionists ask for the nature of the problem when a patient requests an
emergency appointment it is made clear that this is information is being passed on to
the doctor. Phrases such “Can you tell me what the problem is so I can let the doctor
know” are used.
b) Agreement of priorities
The Practice and the PRG both felt that many of the priorities from last year were still
important and that it would be useful to gauge opinion as to whether the changes that
were included in the action plan had improved the patient experience.
It was therefore agreed to retain many of the previous survey questions and add in
some additional questions specifically aimed at changes that had been made as a
result of the 2011/12 survey. The survey was increase to 21 questions from 18 last
year (3 questions were removed and 6 new questions inserted).
The main priorities which the survey addressed were:
• Appointments
• Knowledge of practice services and processes
• Reception staff
• Clinical care
• Other comments
The Survey, its collation and sharing of the results with the PRG
a) Methodology of the survey
The PRG together with the Practice used last years’ survey as a starting point. New
questions were added to the survey to gauge whether the Action Plan form 2011/12
had improved services eg Question 7 which asks how the new appointment system
compared with the old one. Other questions were added as a result of the experience
of members of the PRG eg Question 11 “Do you know how to contact a Doctor when
the surgery is closed?”
The survey consisted of 21 questions and room was provided at the end for patients to
make positive and/or negative comments about the surgery and the services provided
and to make suggestions about how they could be improved.
As with last year it was agreed that the survey should be completed by patients when
attending the surgery and also sent to a randomised list of patients by post. By the use
of this randomised list it was felt that a more representative group of patients would
be reached and not just those using the services of the surgery during a specific
period.
The randomised list was produced using the EMIS clinical system and about 250
questionnaires were sent out to patients. The survey was sent with a covering letter
explaining the survey and giving patients the opportunity to join the PRG.
A stamped addressed envelope was included with the survey to encourage its
completion and return.
The surveys were handed out in the Practice over a 3 week period in February 13 and
patients were asked to complete and return the survey into a designated box so as to
promote anonymity.
The results of the survey were collated onto an EXCEL spreadsheet by a member of
the Practice administration team. At the same time she separated all the returned
forms that contained comments on them for a separate collation exercise.
Duncan Ferguson, the Practice Manager, analysed the data from the spreadsheet and
produced Appendix 2 showing the results. He also collated the forms containing
comments to produce the “word cloud” detailed in the summary of results.
b) Summary of the results of the patient survey
The survey produced a return of 287 questionnaires (last year 247) although not all
patients every question in the survey. Around 50 of the returned questionnaires were
those sent out by post, which was a pleasing return rate.
The response rate is in excess of the accepted guidelines of 25 per thousand patients
which would have required a response number 235.
The statistical results of the survey are provided in Appendix 1 of this report.
There are a number of questions that are worth particular note and these have been
detailed below. Where the question was asked last year details of the previous
response are also included for comparative purpose:
1) Can you usually get an appointment when you want one?
For urgent appointments 81% said yes (73% last year)
For routine appointments 72% said yes (67% last year)
For advance appointments 79% said yes (68% last year)
The results show a clear improvement on performance from 2011/12.
2) How do you find our new appointment system compared to the previous
system
51% of patients thought it was an improvement and only 7.5% thought it was worse.
From the 280 response the following results were received
Better 144
The same 115
Worse 21
0
20
40
60
80
100
120
140
160
Better Worse
Appointment
system
3) How easy do you find it to talk to a Doctor when you have an urgent medical
problem?
92% said it was average or better
From the 281 responses the following results were received
Very easy 61
Easy 122
Average 76
Difficult 18
Very difficult 4
0
20
40
60
80
100
120
140
Very
easy
Average Very
Difficult
Ease of
speaking to a
Doctor on
phone
regarding an
4) Were you aware of the Extended Hours opening
34% of respondents were unaware of Extended hours opening
From the 284 responses the following results were received
Aware 187
Unaware 97
0
50
100
150
200
Aware
Extended
hours
5) Do you know how to contact a Doctor when the surgery is closed?
49% of respondents said they didn’t know how to contact a Doctor
From the 284 responses the following results were received
Yes 145
No 139
136
137
138
139
140
141
142
143
144
145
Yes No
Contact a
Doctor when
surgery is
closed
6) Were you aware of the on-line appointment booking and prescription service?
43% of patients were unaware of this service
From the 282 responses the following results were received
Yes 162
No 120
0
20
40
60
80
100
120
140
160
180
Yes No
Online
appointments
and
prescriptions
7) How helpful are the receptionists?
90% rated them as helpful or very helpful (85% last year)
From the 287 responses the following results were received
Very helpful 135
Helpful 124
No opinion 23
Unhelpful 3
Very unhelpful 2
0
20
40
60
80
100
120
140
Very
helpful
Unhelpful
Helpfulness of
receptionists
8) How do you rate the care you were given by the Doctor
89% rated the care as good or very good (85% last year)
From the 281 responses the following results were received
Vey good 148
Good 101
Average 27
Poor 4
Very poor 1
0
20
40
60
80
100
120
140
160
Very
good
Average Very
poor
Care from
Doctors
9) Overall how do you rate the Doctors at Burvill House
91% rated them as good or very good (87% last year)
From the 281 responses the following results were received
Very good 144
Good 111
Average 21
Poor 3
Very poor 2
0
20
40
60
80
100
120
140
160
Very
good
Average Very
Poor
How do you
rate the
Doctors
The outcome of the survey was very positive about many areas of the Practice and it
evidences year on year improvements in almost every question. These include the
clinical care provided, helpfulness of the staff, security and confidentiality of medical
records and the accessibility of doctors
The answers to the survey together with the comments provided in the space allocated
at the end of the survey highlighted some areas that need some addressing:
• Waiting times
• Communication
• Reception area/Privacy
In addition to the questions in the survey we asked for comments in a space provided
and have collated the most common themes in the “Word Cloud” below
c) Demographics of respondents
As part of the survey we asked patients to indicate their age/sex, ethnicity and
employment status and these have tabulated below.
Sex
Male Female Total
103 162 265
Everything is
good keep as it is Wait too long in
the surgery to
be seen
All trustworthy and
understanding
More privacy
at reception
A TV in waiting
area – Sky Sports
or Children’s
TV
programmes!! Best
surgery
in
Hatfield
Age
Age Range Number Percentage Practice
Profile
Number
Practice
Profile
Percentage
Under 25 22 8% 2900 31%
25-34 36 14% 1804 19%
35-44 44 17% 1339 15%
45-54 50 19% 1213 13%
55-64 45 17% 879 9%
65-74 30 11% 556 6%
75+ 38 14% 679 7%
Total 265 9327
Ethnicity
Ethnicity Number Percentage Practice
Number
Practice
Percentage
White British 190 66% 5852 66%
Other White 22 8% 1067 11%
Asian 16 6% 810 9%
African/Caribbean 8 3% 600 6%
Other 10 3% 656 7%
Not
known/divulged
41 14% 342 4%
Total 287 9327
Employment status
Occupation Number Percentage
Employed – Full time 85 30%
Employed – Part-time 23 8%
Unemployed 24 8%
Retired 82 28%
Self-employed 19 7%
In Education 15 6%
Not stated 39 13%
Total 287
A comparison of the practice age spread against the surveys returned reveals some
variation with the practice demographics. This can be partly explained by the fact that
no surveys were sent or handed out to the under 18s and that age group account for
approximately 20% of the practice population.
There is also a variation in the population aged over 45. This is reflective of the
greater use of primary care by that age group and would be reflective of patients
attending the surgery.
The differential between male and female (40% male 60% female) can also be
explained by a number of factors:
• Females attending the practice more frequently than males for specific female
clinics eg Cervical cytology clinics and ante-natal clinics
• Females attending with children for routine matter eg immunisations as these
appointments are traditionally during working hours.
• Greater use of primary care by females which is a general feature of healthcare
• The figures are not unrepresentative of the use of the Practice’s services.
The ethnicity of those returning the surveys is roughly in line with practice ethnicity
data eg 66% of the population are White British and this is the same percentage as
returned surveys. The figures for the smaller categories are relatively small and due to
the size of the survey are not statistically valid.
The percentage of surveys completed by retired population 28% mirrors the
comments above regarding the greater use of the services by the over 45 population.
d) Informing the PRG of the results
The results of the survey were circulated to the PRG via email so that they could have
an opportunity to think about the results before the group met with the Practice
Manager to discuss the results and to agree an Action Plan.
Discussion of results of the survey and agreement of Action Plan
A meeting was agreed with the PRG for Monday 18th
March to discuss the results and
agree an action plan.
Before meeting with the PRG the Partners and Practice Manager discussed the
outcome of the survey and highlighted areas where action could be taken and also
reviewed the results in the light of the changes undertaken in 2011/12 Action Plan.
a) Review of Action Plan 2011/12
The Practice was pleased to note the general improvement in patient satisfaction in
virtually all areas of the survey.
Appointments
The changes that were made to the appointment system seems to have been well
received by patients with only 7% regarding it as a retrograde step. This is reflected in
the improvement in access with patients reporting higher percentages in booking
emergency/routine and advance appointments.
There was also a high satisfaction rate with the ability to talk to a doctor on the phone
regarding an urgent medical matter with only 8% rating this as difficult or very
difficult.
Parking
There were far fewer comments regarding the lack of parking at the surgery in the
comment box this year compared with 2011/12. This is probably the result of a
number of factors:
• Patient acceptance of the change in parking arrangements
• New patients being unaware of previous arrangements
• Better awareness of the alternative parking facilities available.
Waiting Times
Dissatisfaction with the amount of time patients have to wait at the surgery to be seen
has decreased. This year 45% rated the waiting times as good or better compared with
37% last year. Only 11% rated it as poor or worse compared with 16% last year.
Whilst the practice was pleased to see this improvement it feels that there is still work
that can be done in this area and is suggesting that this is included in 2012/13 Action
Plan
Communications
The concerns raised in 2011/12 regarding how information was communicated to
patients particularly with regard to results and the request for information by reception
staff when booking emergency appointments appear to have been addressed.
The level of satisfaction with reception staff has increased from 85% to 90% and 87%
of patients indicated they were comfortable with the questions asked by receptionists.
This has increased from 83% in 2011/12.
Unfortunately due to space constraints the accessibility of the Privacy Booth has not
moved forward, however work that is ongoing should release space over the next
couple of months. There were some comments about privacy at reception in the
survey so this is an area that will be suggested to the PRG as part of the 2012/13
Action Plan
c) Agreement of action plan with PRG
The Practice highlighted three areas for discussion with the PRG for consideration in
the Action Plan for 2012/13 which were
• Communication
• Reception Area
• Waiting Times
The practice “brain stormed” the areas and came up with issues and solutions for the
PRG to consider including in the Action Plan and these are listed below
Communication
The survey produced evidence that patients were not as well informed as we would
wish in certain areas:
• 34% unaware of Extended Hours surgeries
• 49% unsure how to contact a doctor when the surgery was closed.
The Practice wishes to highlight services and changes within the surgery to patients. It
is looking to do this via the following methods:
• A periodical newsletter available to patients in electronic and print format
• A more streamlined and focussed notice board with up to date and relevant
patient information and information about staff.
Reception Area
Patients still have some concern over privacy at reception and the Privacy Booth is
underutilised.
• 63% of patients are happy or very happy with the level of privacy which is the
same as 2011/12
The practice would propose removing one of the screens separating the waiting room
from the reception area and opening up the area to allow an “airport” style queue
using a barrier and having a clear area between the reception desk and the queue. This
would enhance the privacy of patients and also ensure the Privacy Booth was kept
clear and more easily accessible.
Waiting Times
The Practice is aware that at times patients may have to wait for periods that they feel
is too long to be seen in the surgery. The survey indicated that only 45% rated the
wait as good or very good (an improvement on 2011/12 of 37%) and 11% rated this as
poor or very poor (an improvement on 16% in 2011/12).
The practice is planning to continue the work of the last 12 months to improve the
patient experience and to manage the patient expectation. This is planned through
further work in the following areas:
• Increased awareness of length of appointments and realistic expectation of
what can be achieved in that time
• Further use of catch-up slots
• Disable the waiting time function on the automated check-in which can
produce misleading information
• Encourage staff to make patients aware of delays.
• Continue to monitor time-keeping
Duncan Ferguson, the Practice Manager, met with the PRG on Monday 18th
March to
discuss the results and formulate an action plan.
Duncan Ferguson took the group through the survey question by question and
provided the meeting with copies of the results and comparative data with the
previous survey as well as the demographic information.
The PRG were pleased with the results and commented that there was clear
improvement in patient satisfaction in many areas which had been the subject of the
previous year’s Action Plan.
The PRG were particularly pleased to see the high satisfaction scores in the questions
about helpfulness of staff and the questions around clinical care. One member
commented that the “Very Poor” and “Poor” responses were so small that it was
likely that the all these responses came from a very small handful of patients. The
Practice was able to confirm this as the surveys that had the most negative feedback
had been kept to one side for analysis.
The PRG was happy to agree with the Practice on the three areas that it had
highlighted and agreed the following Action Plan
Communication
The PRG was not surprised that often patients were unaware of developments within
the Practice and the NHS generally. This was particularly true in the present ever
changing climate The group felt that a clearer and more structured form of
communication to patients would be useful. Whilst patients received Practice Leaflets
when registering these were often put to one side and mislaid and became out of date.
The group were very supportive of a newsletter and would be happy to be involved in
agreeing its content.
• A newsletter to be produced 2-3 times per year with up to date information
about the practice and using this media to address issues arising out of the
survey eg how to access a doctor out of hours
• A PRG dedicated notice board to keep patients aware of current developments
• A board giving details about the staff and their different roles including
pictures where appropriate
Privacy/reception area
Some members of the Group have had concerns about privacy although these have
not always been strongly supported by evidence in the survey. The PM showed the
Group the changes that were envisaged in reception area to help provide more privacy
and they were supportive of the ideas below.
• Change the layout to allow an “airport” style queue and enhance privacy at the
reception desk
• Investigate whether the glass frontage on reception can be altered in some way
to minimise the sound reflection, perhaps with holes in the glass to allow
sound to pass through more easily.
• Promote the Privacy Booth and ensure clear access.
Waiting Times
The Group was sympathetic to the challenges in this area. One member commented
that he was not “bothered about having a delay because clearly someone had need
more than their allotted 10 minutes and at some point he might need the same”. Of
course it was realised that not all people have the same altruistic view. The Group felt
that it was a strength of the surgery that patients felt valued, were given time and did
not feel rushed in and out. At the same the need to manage expectations and run a
service in a reasonably time efficient manner was desirable.
The group were supportive of the ideas listed below.
• Continue to manage expectation by education on length and realism about
what can be covered in an appointment
• Keep patients informed about delays
• Monitor performance
Practice Opening Times
As a result of the survey we have not changed our opening times.
You can call the surgery on 01707 269091 from 8.30am to 6.30pm. For emergencies
between 8.00am and 8.30am that will not wait until 8.30am please ring 01707 276556
The surgery opening times are Monday to Wednesday and Friday 8.30am to 6.30pm.
Thursday 8.15 to 6.30pm
We also offer Extended Hours arrangements as follows:
Every other Saturday 1 doctor and 1 nurse – the surgery is open from 8.30 am until 12
noon
Alternate Tuesdays and Thursdays there are 2 nurses and at least one Doctor available
with appointments from 6.30pm to 7.30pm and reception open until 8pm
Outside of these hours emergency medical care is provided by Herts Urgent Care
(HUC) and they can be contacted on 111 if calling from within Hertfordshire or
03000 333 333 if calling from outside Hertfordshire..
Appendix 1
Burvill House Patient Survey 2012/3
Results of Survey
Question 1
How do you rate the opening hours of the surgery - 280 responses
Very good 92
Good 147
Average 37
Poor 4
85% rated as Good or better (last year 79%)
Question 2
Are you aware of Extended Hours surgeries – 284 responses
Yes 187
No 97
34% unaware of Extended hours
Question 3
Can you usually get an appt. When you want one?
Urgent appt 267 responses
Yes 217
No 50
81% said yes (73)
Routine appt 269 responses
Yes 194
No 75
72% said yes (67)
Advance appt 256 responses
Yes 212
No 44
79% said yes (68)
Question 4
How do you rate the amount of time you wait in the surgery – 287 responses
Very good 32
Good 98
Average 124
Poor 30
Very poor 3
45% rated Good or better (37)
11% rated poor or worse (16)
Question 5
How helpful do you find the receptionists – 287 responses
Very helpful 135
Helpful 124
No opinion 23
Unhelpful 3
Very unhelpful 2
90% rated them as helpful or very helpful (85)
Question 6
Were you comfortable with the information you were asked to provide by the receptionists
– 284 responses
Very comfortable 95
Comfortable 152
No opinion 28
Uncomfortable 7
Very uncomfortable 2
87% said comfortable or very comfortable (83)
Question 7
Do you find our new appt system better – 284 responses
Better 144
Same 115
Worse 21
51% rated it better
7% rated it worse
Question 8
How easy do you find it to talk to a doctor when you have an urgent medical problem – 281
responses
Very easy 61
Easy 122
Average 76
Difficult 18
Very difficult 4
8% said difficult or very difficult
Question 9
Are you aware of Online booking and prescriptions = 282 responses
Yes 162
No 120
43 % unaware
Question 10
How confident are you that your records are kept secure and confidential = 284 responses
Very confident 100
Confident 130
No opinion 44
Unconfident 10
81% confident or very confident (81)
Question 11
Do you know how to contact a surgery when the surgery is closed = 284 responses
Yes 145
No 139
49% didn’t know
Question 12
Are you happy with level of privacy at reception - 277 responses
Very happy 37
Happy 137
No opinion 71
Unhappy 30
Very unhappy 2
63% were happy or very happy (63)
12% were unhappy or very unhappy (18)
Question 13
How do you rate the Out of Hours arrangements – 230 responses
Very good 30
Good 107
Average 84
Poor 8
Very Poor 1
60% rated them as good or very good (60)
Question 14
Are you aware of the complaints procedure – 271 responses
Yes 74
No 197
73% unaware (78)
Question 15
If you have made a complaint how satisfied were you with how it was handled = 129
responses
Very satisfied 11
Satisfied 23
No opinion 90
Dissatisfied 2
Very dissatisfied 3
Of those who had an opinion 87% satisfied or very satisfied (76)
Question 16
How do you rate the service you received from nurses etc – 279 responses
Very good 140
Good 114
Average 20
Poor 5
91% rated Good or Very good (92)
Question 17
Did you feel the doctor listened to you last time you saw one – 276
Yes 261
No 15
95% said yes (94)
Question 18
How do you rate the medical care you received from the doctor - 281 responses
Very good 148
Good 101
Average 27
Poor 4
Very poor 1
89% rated as good or very good (85)
Question 19
Do you think you were given the right treatment for your condition promptly – 268
responses
Yes 240
No 28
90% said yes (88)
Question 20
Overall how do you rate the doctors at Burvill House – 281 responses
Very good 144
Good 111
Average 21
Poor 3
Very poor 2
91% rated them as good or very good (87)
Question 21
Would you recommend the surgery to others – 265 responses
Yes 249
No 16
94% said yes