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DAPDUNE HOUSE SURGERY

Dapdune House Surgery

Dapdune House Surgery,

Wharf Road,

Guildford, GU1 4RP

Practice Manager: Mr. Peter Lambourn

T: 01483 400200

Local Pat ient Part icipat ion Report March 2014

Da Dapdune House Surgery Local Patient Participation Report 2014 | 2

Executive Summary The following report outlines the results of the first year requirements for a Local Patient Participation Report to satisfy the PP-DES 2013 – 2014 as directed by; THE NATIONAL HEALTH SERVICE ACT 2006 The Primary Medical Services (Directed Enhanced Services) (England) (Amendment) Directions 2011 Insertion of new direction 12A - “Patient Participation Scheme”. The survey results in this report have been collated since 1st April 2013, and continue on from results in the 2013 Local Patient Participation Report.

Dapdune House Surgery,

Wharf Road,

Guildford,

GU1 4RP

Practice Manager: Mr Peter Lambourn

Number of GP Partners Number of GP Registrars

8 2

Number of patients 12017

Dapdune House Surgery engaged with NETbuilder to provide its comprehensive managed survey solution, NBSurvey. This enabled the collection of views from patients in multiple locations across various demographic groups and facilitated the canvassing of patients’ opinions via a suitable input channel, from in-practice touch screen kiosks / laptops, to virtual online surveys. The Surgery has a virtual Patient Reference Group (PRG), and a Patient Participation Group (PPG). Patients are invited and encouraged to give their feedback via surveys on various aspects of the practice in a number of ways. PRG members currently number ~ 137 and recruitment is an on-going process. The PPG consists of 14 members who meeting on a two-monthly basis.

Results Summary

Item Total

Number of Surveys 4

Number of Responses 515

Number of Input Channels 3

Summary Outcomes & Action Plan – PPDES Year 3 Results

Year 3 of the PPDES has delivered additional benefits to the Surgery, as we are now able monitor trends from the last 3 years. We have taken action not only the results of the 2013 Survey, but also from participation with the expanded Patient Participation Group. Data has been collected through a mixture of established surveys, such as the Overall Satisfaction Survey, and new surveys such as the Website Survey. Whilst the results from the Overall Satisfaction survey are generally good in absolute terms, there are decreases in satisfaction across the board, and we aim to address this decline by identifying and tackling the root causes. Several of the actions from our action plan last year have been


implemented: increases in PRG memberships, re-invigoration of the relationship (though the PPG); increasing number of patients using the surgery website. In contrast, we aimed to improve patient access to their usual GP, and this we have not achieved. We will need to address this again this year, although with increasing numbers of part-time GPs, and several changes in GPs in the next 18 months, this will be a challenge. Where we cannot achieve it, we will aim to smooth the change through effective communication plans. During 2014/2015, we intend to increase the use of online services, increase participation in our local patient surveys, and most importantly analyse the reasons for the decline in overall satisfaction and arrest that decline. Further detail is in the action plan at the end of the report.


CONTENTS

Executive Summary 2

Results Summary 2

Summary Outcomes & Action Plan – PPDES Year 3 Results 2

About The Practice 6

Services at the Surgery 6

The Partners 7

The Practice Staff 7

Practice Nurses 7

Community Midwives 7

Community Nurses 7

Health Visitors 7

Opening Hours 8

Extended Hours 8

Making & Cancelling Appointments 8

Home Visits 8

When the Surgery is closed 8

Local Survey Methodology 9

The NBSurvey Methodology 9

Input Channel Evaluation Criteria 13

Patient Reference Group and Patient Participation Group 16

PRG Membership 16

Membership 16

PRG Recruitment & Representation 16

PPG Membership 16

Membership and Recruitment 16

PPG profile 16

PRG Agreement of Priorities 17

Results, Outcomes & Findings 18


Summary Information 18

Survey results by Input Channel 18

Summary of Demographics Survey 18

Representation of Registered Patients 19

Survey Results 19

Discussions & Action Plans 23

Summary of Year 1 Outcomes & Action Plan 23

Implementation of Year 1 Outcomes and Action Plan 23

What Dapdune House Surgery did 23

Dapdune House Surgery’s outcomes 24

Year 2 of the PPDES – Discussions 24

Year 2 of the PPDES - Action Plans 24

Implementation of Year 2 Action Plans 25

Year 3 of the PPDES - Action Plans 25

Summary of the PPDES 2011-2014 26


About The Practice At Dapdune House Surgery, we are a friendly, hardworking, dedicated and professional team

focused on the provision of top quality health care to our patients in the Guildford area. Our

doctors and nurses provide a full range of general medical services.

Services at the Surgery

Ante Natal Appointments: Held by a midwife on Monday, Tuesday and Wednesday

afternoons.

Post Natal Appointments: Can be made with their doctor during normal surgery times.

Child Immunisation Clinic: Held two Tuesdays in the month, run by the practice nurse.

Child Health Clinic: Held on Thursday afternoons by appointment.

Children’s’ Development Review Sessions: By appointment with the Health Visitor.

Cervical Smear Appointments: Available on request with the practice nurse.

Family Planning Appointments: The full range of family planning advice is available to both

male and female patients. This is run by our family planning nurse. Appointments for coil,

implant and cap fitting, as well as oral contraception, can be made at this clinic.

INR Clinics: Run by one of the doctors and a practice nurse.

Diabetic Clinics: Held two Tuesdays in the month, run by Dr Jump and Dr Rimmer, the

Practice Nurse, Podiatrist and Dietician. Our diabetic patients are seen twice a year or more

frequently if required.

Ann Dawe, our practice nurse, is specially trained to promote respiratory care and deal with

Asthma & Chronic Chest Disease. Telephone advice about asthma problems is available.

Minor Operations & Cryotherapy Clinics: Appointments are made after discussion with the

patient's own doctor in normal consultation hours.

Travel Vaccinations: Routine vaccinations and those required for foreign travel are given by

the Practice Nurses.

Flu Immunisation & Pneumonia Vaccination Clinics: Appointments can be made in

September for vaccinations in October to December. Patients with asthma, diabetes,

heart, kidney or chest diseases and people over 65 are encouraged to attend.

Non NHS Examinations: Medical examinations can be arranged by appointment for special

purposes e.g. elderly drivers’ medicals, pre-employment medicals and insurance

medicals.


The Partners

Dr David G Eyre-Brook (m) MB BS (London 1977 Westminster) MRCGP DRCOG

Dr Anthony F Rimmer (m) MB ChB (Liverpool 1979) DA DRCOG

Dr Diane Ackerley (f) MA (Oxon) MB BS (London 1981 King’s) MRCGP DCH DRCOG

Dr Ian F Cunliffe (m) MA (Oxon) MB BS (London 1982 St Thomas’) MRCGP DRCOG

Dr Allison E Jump (f) MB ChB (Leeds 1982) MRCP

Dr Caroline Karanjia (f) MB BS (London 1983 Guys) MRCGP DCH DRCOG

Dr Fiona H Groom (f) MB ChB (Glasgow 1985) MRCGP DRCOG

Dr Caroline Sharpe MB ChB (Birmingham 2002) MRCGP DRCOG

The Practice Staff

Practice Nurses

Nurse Ann Dawe SRN (Guy’s Hospital 1978) DN RM

Nurse Angie Tolan RGN

Nurse Louise Kettle RGN RM

Nurse Denise Matthews RGN

Community Midwives

The Midwives are involved in all aspects of maternity care, holding Ante Natal and Booking

Clinics at the surgery. The booking in appointment is a lengthy first appointment during

which all information and guidance is provided. The appointment is followed up with short

check-ups with the midwife and GP. The community midwife visits the patient at home with

their baby, providing continuity of care. The Midwives can be contacted at the Royal Surrey

County Hospital, St Catherine’s Ward – 01483 464147.

Community Nurses

A team of community registered nurses and health care assistants visit house bound patients with

nursing needs. They provide: wound care management and pressure ulcer prevention, care of IV

central lines (including chemotherapy pumps), and intravenous medication, chronic disease

management, continence care, palliative and end of life care. They can be contacted on 01483

563595, or at weekends and Bank Holidays on 01483 782300.

Health Visitors

The health visitors at Dapdune Surgery work closely with a qualified nursery nurse, and run a

weekly baby clinic. Post natal clinics are also offered. The health visitors can be contacted by

leaving a message on their answering machine on 01483 400221.


Opening Hours

The surgery is open from 8.30 am to 6.30 pm every weekday. Note: Telephone lines are closed between 1pm -2pm

Extended Hours The surgery offers extended hours appointments on Monday and Thursday evenings. These appointments (pre-booked only) run from 6.30pm to 8.00pm.

Making & Cancelling Appointments We would like patients to be seen by the doctor with whom they are registered. This will help to ensure that the GP that is consulted is familiar with their medical history. Appointments and cancellations can be made:

in person

by telephone - 01483 400200

online using our internet booking service

by automated telephone booking service We also offer an online service to order repeat prescriptions.

Home Visits

Home visits are available for patients who are too ill to visit the surgery.

When the Surgery is closed

If patients telephone the surgery they will hear a recorded message. When the surgery is closed,

ring 01483 400200 for further directions to the Out of Hours service, which is provided by Harmoni

(0300 130 1305).

https://dapdune-house-surgery.appointments-online.co.uk/


Local Survey Methodology The Practice engaged with NETbuilder to provide its comprehensive managed survey solution, NBSurvey. This enabled the collection of views from patients in multiple locations across various demographic groups. Surgery staff then canvassed patients opinions via an input channel most suited to them, from paper surveys and in-practice touch screen kiosks / laptops, through to virtual online surveys. Findings from previous studies carried out by NETbuilder exposed that, multiple short surveys with a maximum of 8-10 questions each are more effective than one long survey running continually throughout the survey period. Each survey was customised using the investigational design and measures e.g. using a short survey (The Access Survey) to measure the effectiveness of patients requesting an appointment. Additionally, short surveys encouraged patients to give feedback for the areas relevant and important to them.

The NBSurvey Methodology


Step Description Surgery Comments / Experiences

Continual Development of Patient Reference Group (PRG)

The PRG is a representative group of patients from the practice. They are responsible for providing feedback to surveys and collaborating with the practice to analyse the results and agree realistic change opportunities.

Recruitment of members to the PRG remains an on-going process. There are currently 137 members of the PRG. Patients are invited to join when registering at the Practice.

Expansion of Patient Participation Group (PPG)

The PPG is a smaller group who are more closely engaged and consulted on key matters on a periodic and as required basis

The PPG consists of 14 members, with meeting times varied to allow a representative cross section of the patient population to attend.

Determine Priority Areas

Key areas include but are not limited to the following:

Access

Overall Satisfaction

Seeing a Doctor

Seeing a Nurse

The Reception

The Surgery Environment

Demographics

Specialised Clinics (e.g. Flu, Vasectomy)

The PRG and other patients completed the Patient Priorities Surveys to prioritise the areas (above) to determine the order in which key areas are addressed by the practice. Patients are also given the opportunity to provide comments regarding other areas they would like to see addressed.

The surveys conducted during 2013/14 are a continuation of surveys run in previous years, adjusted to take into account the Patient Participation Report 2013, and views of the PPG. The surveys we ran in 2012/13 were:


Seeing a Doctor

Reception

Seeing a Nurse

Surgery Environment

Continuity of Care This year we repeated adjusted versions of the following surveys which were available in year two:


Seeing a Nurse

Continuity of Care

Website Survey As the survey numbers suggest, a particular focus was recently placed on the Seeing a Nurse Survey after the NHS England survey, run by survey specialist Ipsos MORI , indicated that this was an area that deserved particular attention.


Design & Build Surveys

The practice works closely with NETbuilder to design and build the surveys. Each survey is designed to measure the patient’s view of the identified key areas. The majority of surveys contained between 8-10 questions. Patients are able to choose to complete the surveys they believe are relevant to them and ignore those that are not.

The practice continues to collaborate with NETbuilder and the PPG to update the questions in the 2013/14. survey to establish changing trends and open up additional ones for comment PPG members have recently provided useful comments on the survey questions and these will be incorporated when the surveys are updated based on the outcome of this report. We will then work with both NETbuilder and the PPG again in 2014 to agree the next set of surveys and agree the questions for 2014/15

Decide on Input Channels and Publish Surveys

The practice worked closely with NETbuilder to agree which input channels are suitable for the surgery and patients. Input channels available are:

Surgery Kiosk

Web Portals

Laptop

Paper

Face to Face Each survey can be used on (published to) one or more of the input channels listed above.

We continue to use those input channels that have been successful. A further analysis will be conducted following this report, in order to decide whether adjustments are required.

In-surgery Kiosk (We have one Kiosk in both waiting rooms): to capture patients from all demographics visiting the surgery

Web Site: open to all practice patients

We have also continued to use a paper survey option, with results input into the Reception area kiosk. This has proved particularly successful for a focused campaign such as the Seeing a Nurses Survey, and for those who prefer a more traditional means of completing a survey.

Advertise Feedback Channels

Inform patients of the available input channels and current surveys, in order to create a greater number of participation responses. Types of promoting include but is not limited

The Surgery produced links via the website frontpage. The survey is available on the web site, and internal posters publicise the on-site terminals. Receptionists encourage


to:

Encouragement slip given by the doctor

Posters

Leaflets

News Letters

Encouragement from all Practice Staff & PRG

Surgery Website

Notice Board

patients to complete the surveys at the kiosks were available. Paper surveys were available for those unfamiliar with electronic facilities. Various clinics were provided with information leaflets.

Capture Patient Experience

Patients complete surveys using the available input channels as listed above.

Patients need encouragement in order to complete the surveys on the terminal and online. The unchanging appearance of the terminal does not help. In some areas, numbers have been disappointing and hence sample sizes are small. Staff continue to provide help and encouragement with the terminal when necessary. The Surgery website provided an effective portal for those patients wishing to contribute but not frequent visitors to the Surgery. Paper surveys remain an effective way of gathering survey data.

Produce & Distribute Reports

Results in the form of reports are produced for each individual survey and distributed via the Practice Website, Practice Meetings, Surgery Notice Board, PPG consultations.

Early results from this year’s surveys have been distributed to the PPG via e-mail for comment. The 2013 report was placed on the Surgery website, and given the increased uptake of patients accessing the Dapdune website it provides an effective communication path. The core question results from the GP Practice Survey, commissioned by NHS England and run by survey specialist Ipsos, were also publicised on the website.

Collaborate with PPG to Analyse Results

The Practice Manager will discuss & analyse the survey results with the Practice Doctors and then discuss

Findings from the results of the surveys run in 2013/14 have been acted on on an ongoing basis


Input Channel Evaluation Criteria

Input Channels should be thoroughly evaluated for their suitability for use by patients belonging to a practice. The following table describes the advantages and disadvantages of each input channel currently supported for practices.

Input

Channel

Advantages Disadvantages

Paper Surveys

Suitable for a large percentage of

patients across most services

Known and trusted media for many

Production, deployment and

collection of surveys required

Data input required

with the PPG at the next meeting in April 2014 to decide on actions to be taken.

throughout the year, and have informed discussions with the PPG. Feedback from the PPG on early results from this year’s survey is awaited. Attempts made in 2013 to create a real PPG were successful, and with a vibrant and representative membership, two-way engagement is expected to become more productive. Members of the Dapdune PPG have been invited to engage with the wider Guildford & Waverley Patient Group.

Agree Action Plan Detailed action plans are created on the basis of the report at the end of each year of the PPDES.

An agreed action plan between the PRG & Surgery was created after the previous 2 years results, according to the outcome of the analysis. A further action plan has been created following this year’s results. Details are provided in the section Discussions & Action Plans below.

Implement Change Practice must obtain the agreement of its local CCG to its proposals for any significant change, e.g. change of opening hours. Approved changes can then be implemented.

Details provided in the section Discussions & Action Plans below.


patients

Public Web Surveys

Instant feedback

Fast deployment of survey

Easily changeable

Limited to patients with internet

access

Limited to patients with the ability

to use technology

Email Surveys

Instant feedback


Easily changeable

Excellent for tracking feedback for

specific treatments (e.g. specialised

clinics)

Limited to patients with internet

access


to use technology

Limited to patients with email

accounts

Limited to patients who have

provided Trust with email addresses

Phone Surveys

Instant feedback


Easily changeable

Excellent for tracking feedback for

specific treatments

Limited to patients with telephone

access


to use a telephone

Additional cost to practice

Touch Screen Kiosks

Immediately and conveniently

accessible before and after

appointments

Instant feedback


Easily changeable


and willingness to use a touchscreen

kiosk

Requires suitable physical location

Touch Screen Tablets / Laptops

Instant feedback


Easily changeable


accessible before and after

appointments

Portable

Fashionable


and willingness to use a touchscreen

tablet

Requires overnight charging

Standard Desktop

Instant feedback


Easily changeable


accessible following treatment


and willingness to use a desktop PC

Requires suitable physical location

Requires protection from being

damaged, lost or stolen

Face to Face interviews

Instant feedback (proving tablet

used to input response)

Canvasser must be independent

Additional resource required



Easily changeable


accessible following treatment

Patients able to converse with a

person, puts at ease

Rapport building

Patients may be reluctant to give

honest answers to canvassers


Patient Reference Group and Patient Participation Group

PRG Membership

Membership

Members of the Patient Reference Group are recruited principally from patients registering at Dapdune House Surgery. It is not a selective group: patients who register at the surgery and who express an interest in becoming a member of the PRG are accepted. It is a ‘virtual’ group, where patients are invited and encouraged to give their feedback on various aspects of the practice by using the PRG Web Portal, the Dapdune website and the Practice based survey terminals should they be at the Surgery.

PRG Recruitment & Representation

In order to ensure that members of the group are fully representative of our registered patients, the Surgery uses the following means to recruit:

The practice website

Posters on full view in reception and waiting areas

Leaflets available on reception desk

Leaflets in consulting rooms for GP’s to recruit individuals, in particular those who may not be aware of the PRG in the methods already mentioned or are unable to access them in any way

On new patient registration forms The current number of PRG Members is ~ 137 and recruitment is on-going using all the methods listed above. Note: Feedback is not solely reliant on the PRG; surveys are also completed by other Patients from the Practice via the surgery kiosks, web portals and paper surveys. Furthermore, feedback is often received from individuals via the phone and letter.

PPG Membership

Membership and Recruitment

Members of the PPG are drawn primarily from PRG members who have expressed a particular interest in being more actively engaged in the running of the surgery, or are recommended by GPs. The aim is for the group to be small (and therefore manageable) and representative of the patient population. Recruitment is therefore more focused than for the PRG.

PPG profile

The ages of the members of the 14 strong group range from 30 year old to over 80, with the majority in the over 50 bracket. In order to make sure that the views of younger, working members can also be heard, the PPG has agreed that meetings should alternate between during the working day and the evening.


PRG Agreement of Priorities

The Practice referred to the Patient Reference Group for agreement of priorities by organising a Patient Priorities Survey. The Patient Priorities Survey asked which of the following were considered a priority area to look at; Access (getting an appointment), Overall Satisfaction, Seeing a Doctor, Seeing a Nurse, The Reception and The Surgery Environment. The results were:

The Results show that Patients prioritised the areas as follows:

1. Access (Getting an appointment) (95.00%) 2. Seeing a Doctor (90.00%) 3. Overall Satisfaction (82.50%) 4. Seeing a Nurse (75.00%) 5. The Reception (40.00%) 6. The Surgery Environment (27.50%)

These surveys were then made available to all patients during year one (2011/12) by the variety of input methods shown in the table above. We then repeated the following Surveys in year two (2012/13) to get a result comparison

1. Overall Satisfaction 2. Seeing a Nurse 3. The Reception 4. The Surgery Environment

We then also added 2 new surveys to get feedback on areas that we had previously not surveyed to ensure that all elements of the surgery experience were surveyed:

1. Continuity of Care 2. Website Survey


Results, Outcomes & Findings Summary Information

Item Total

Number of Surveys 4

Number of Responses 515

Number of Input Channels 3

Survey results by Input Channel

Input Channels

Survey Ground Floor

Reception Kiosk

1st Floor Waiting Room Kiosk

Website Total

Continuity of Care 4 3 11 18

Overall Satisfaction 52 32 23 107

Website Survey 17 15 19 51

Seeing a Nurse 322 8 9 339

Total 395 58 62 515

Summary of Demographics Survey

The following report provides a summary of the demographics for patients that have completed surveys during year 1 of the PP DES. It is planned to run the demographics survey every 3 years, so a follow up survey will be conducted in 2014. Patients surveyed included both PRG Members and other practice patients. The Summary of the demographics is:

36. 36% of the patients were female and 63.64% of the patients were male

The breakdown of age category of the patients were; 0% under 18, 11.36% 18-30 years old, 15.91% 31-40 years old, 18.18% 41-50 years old, 40.91% 51-65 years and 13.64% old Over 65

The breakdown of employment status was; 20.27% Full-time education, 9.09% Unemployed, 4.55% Permanently sick or disabled, 4.55% Other, 20.45% Fully Retired, 59.09% Employed

Of those who answered ‘Employed’ 70.37% worked 30 hours or more per week

59.09% of patients said they have long standing conditions including age related conditions

The breakdown of long standing conditions reported were; 31.03% Other 55.17% Physical, 6.90% Psychological/emotional, 6.90% Deafness/hearing impairment, 0% Blindness/partially sighted, 0% Learning difficulties

79.55% of patients said that they were not a parent or legal guardian of children under 16 years currently living at home

97.73% of patients were ‘White’, 2.27% ‘Asian or Asian British’, 0% ‘Other’


95.45% of patients were ‘Heterosexual or Straight’, 2.27% ‘Would prefer not to say’, 2.27% ‘Gay/Lesbian’

36.36% of patients were not religious, 56.82% were religious, 6.82% Preferred not to say

The patients who said they were religious described their religions as; 96.00% ‘Christian’, 4.00% ‘Other’

Representation of Registered Patients

During year one we confirmed that early feedback was not being provided by a wholly representative group of our registered patients as there was missing representation from the following:

Ethnicity. We were under represented from Irish and Chinese patients. However, based on our clinical system search there are very low percentages (0.4% and 0.5%) respectively of these groups.

Age. There was poor response from those aged 65 and over (13.64%) An analysis of the profile of the PRG indicates that this is still the case. Whilst the age profile of the PRG has improved, the ethnicity profile has not. The following steps have been taken in an attempt to increase representation:

Reception staff members promote the PRG on new registration forms from both of these ethnic groups. On-going recruitment for the PRG will actively request representation from these and other under-represented groups. We are aware that the very low percentage ethnic representation of both groups has changed little over the last 12 months and it remains challenging to achieve a balanced representation.

Surgery staff members have actively sought alternative methods to recruit the over 65 age group to the PRG. Specifically, this has been done on a face-to-face basis at reception, principally during the registration process.

The increased numbers of those signing up to the PRG provide a better basis for achieving a more balanced representation over time.

To make the PPG and the PRG more representative, there is a need to recruit more younger people (under 30) and engage a more ethnically diverse group. For the PPG, this will need to be balanced against the need to keep the group small. The focus for 2014/15 will be to continue to build the PRG numbers and to press on with the steps above.

Survey Results

Detailed reports for each survey can be found on our website www.dapdune.co.uk. Opportunities to discuss the results have been given to the PPG, and a more detailed analysis and discussion will follow. The key outcomes for each survey are highlighted below.


Please note that the reports found on the website display the latest feedback captured and therefore may contain more results than are summarised in this report.


95.28% of patients said they were happy with the care they get at the surgery

80.19% of patients said they would recommend the surgery to someone who has just moved into the area

80.37% of the patients said that they were always treated with respect and dignity whilst in the surgery

77.57% of patients indicated that the staff worked well together for their care Although overall satisfaction percentages remain high, it is a matter of concern that they have declined across the board since last year. 1.19% less people said that they were happy with the care they got at the surgery this year (2013/14); 12.35% less would recommend the surgery; 6.2% less said they were treated with dignity and respect; and 11-98% less indicated that staff worked well together for their care.

Continuity of Care

50% of patients said that their consultation required a follow up plan

22.22% of the follow up plans were for ‘Blood Tests’, 22.22% were for ‘Referral’ and the remaining 55.56% said that the reason was ‘Other’.

77.78% of patients said that a care plan was agreed with the clinician and that they are clear what will happen next.

When asked if a written follow-up care plan would be helpful 44.44% of patients said ‘Yes’ and 55.56% of patients said ‘No’

83.33% of patients said that it was ‘Very Useful’ to see the same Doctor or Nurse for the same problem and a further 16.67% said it was ‘Fairly Useful’

When asked how successful they had been in seeing the same Doctor or Nurse for the same problem patients said that 66.67% of the time they were ‘Very Successful’ and a further 16.67% of the time they were ‘Somewhat Successful’

This is the second year we have run this survey. The participation numbers are low, so any analysis of trends needs to be treated with caution. The number of patients who said that a care plan was agreed and that they were clear what would happen next has declined by 8%, whilst the number of patients who would find a written follow-up care plan useful increase by 20%. Seeing the same doctor for the same problem remains important to our patients, with percentages rising by 2%, but our 4% less patients said we have been ‘Very Successful’ in achieving this.

Seeing a Nurse

When seeing a nurse, patients gave their reasons for having a consultation as: . Routine check-up - 43.37%


. Other - 22.29% . On-going problem - 19.28% . One off problem - 10.84% . To ask for advice - 4.22%

Patients rated nursing staff as good or satisfactory on the following areas: . Asking about symptoms – 99.66 % . Explaining tests and treatments – 99.68% . Giving patients enough time – 100% . Treating patients with Care and concern 99.69% . Involving patients in decisions about their care – 99.66% . Listening – 100% . Taking problems seriously 99.34%

98.79% of patients said that they had confidence in the nurse they saw

99.40% of patients said they would be happy to see the nurse again Compared to the reasons given last year for the patients visit to the nurse the number of patients visiting the nurse for a routine check-up has increased again 39.53% to 43.37%. The number of patients visiting for on-going problems has increased from 16.28% to 19.28%, whilst patients visiting to ask for advice have increased from 2.33% to 4.22%. The patients’ rating of the nurses as good or satisfactory remains high; only explaining tests and treatments declined slightly. More patients also reported that they were confident in the nurse they saw and that they would be happy to see the nurse again.

Website

78.85% of patients surveyed said they had visited the surgery’s website

The patients who said they hadn’t visited the surgery’s website gave the following reasons

. No Internet access – 9.09%

. No computer access – 18.18%

. Not able to use a computer - 9.09%

. Not aware of surgery website – 54.55%

. Other – 9.09%

70.73% said they found the website easy or very easy to use

85.37% said the website is a good reflection of the surgery

95% of patients found the information on the website useful or very useful

52.5% of patients who’ve used the website have used the online booking system

71.43% of patients that had used the online booking system said it was easy or very easy to use

30% of patients that have used the website have used the online repeat prescription service.

Of these patients 83.33% said it was easy or very easy to use

60% of patients have used the SMS reminder service


This is the first year the website survey has been run. The results are relatively encouraging, with

only 2 areas of concern:

. That 54.55% of patients who had not used the website were not aware of the website.

. That only 52.5% of patients who use the website had used the online booking system.


Discussions & Action Plans

Summary of Year 1 Outcomes & Action Plan

Dapdune House Surgery staff members have worked with the virtual PRG to establish and prioritise a series of surveys for use by the patient population. The numbers of patients taking part in the surveys (701 from 8 surveys) has been sufficient to enable surgery staff to evaluate and note forming trends. Results of the first three surveys, covering Access, Doctors and Overall Satisfaction, distributed to the PRG, have been evaluated and action plans derived from the data. These action plans, detailed towards the end of the report, will form the basis for continual improvement in the three areas noted. Further recruitment to the PRG will be on-going and closer liaison is envisaged. This has been a very positive experience for those involved in the development of the PPG DES for Dapdune House. First and foremost, the real-time nature of the survey reporting has facilitated prompt change where appropriate. Longer-term plans for the evolution of patient services have also been enabled and will help to guide staff to focus resources where required. We acknowledge that work is required to engage more closely with the PRG and, to that end, we are considering the formation of an actual PRG to help identify areas for improvement.

Implementation of Year 1 Outcomes and Action Plan

What Dapdune House Surgery did

Having posted the findings of the Year 1 Report on our website and to the PRG, we received only limited feedback. However, the findings of the surveys were also discussed internally and this provided an appreciation of how our patients perceived the Surgery from a variety of points of view. As a starting point we were encouraged to note that, through the Overall Satisfaction survey, over 96% of patients said they were happy with the care they got at the surgery. However, we acknowledged that there was room for improvement as confirmed by the development of the first action plan, which resulted in partial success. For example, whilst we were unable to improve the availability of nurses’ appointments online because of technical and procedural constraints (this will remain an aspiration), we did establish that our patients were, overall, content with the involvement they had in their care. Of note we took the results of the initial surveys into account when developing a robust and flexible training organisation to improve overall performance. Aside from the surveys, we have reacted to patients’ requests for improvements received via other channels. As an example, we have increased the number of hand sanitisers available to patients and made small improvements to waiting areas, which include redecoration of the 1st floor waiting area and the addition of notice boards in the ground floor waiting room.


Dapdune House Surgery’s outcomes

We believe that the outcome stemming from the 1st year’s work with the PPG DES was positive for both patients and staff as it provided the base-level information required to establish an informed patient/practice relationship. Soon after the first year’s report was delivered we tried to establish a ‘real’ PRG but not enough volunteers were forthcoming and we eventually decided to maintain the virtual PRG approach. Concurrent to this activity, we were frequently asked to provide representatives of our virtual PRG to take part in the wider patient participation of the emerging Guildford and Waverley CCG. Whilst representation has been achieved it will remain our aspiration to (providing there is the desire from patients) create a real patient group in addition to the virtual PRG. Requests for recruitment to the virtual PRG remain a part of the registration process.

Year 2 of the PPDES – Discussions

Throughout 2012-13 we have continued to collect data using a variety of surveys. This has allowed us to benchmark progress in relation to year 1 and to gain greater insight into our patients’ perceptions and requirements. We found that, in year two, patients were less inclined to use the touch screens for surveys without more encouragement from the receptionists. To off-set this, greater use was made of paper surveys and further internal advertising may be required to optimize the use of the touch-screens. In addition to new surveys; to measure the effect of our surgery website and gauge continuity of care, we have also been able to report on feedback from 3 surveys run last year, which include: Seeing a Nurse, The Reception and Surgery Environment. In the case of the former two surveys; Website and Continuity of Care, each has provided good indicators of changes that may result in improved service to our patients. The website survey, whilst proving popular has clearly shown that only 47% of patients are aware of the Dapdune Website – clearly we can, and should, do more to advertise its use, particularly as more patient access will be conducted through IT in the future. The Continuity of Care survey has confirmed that patients still prefer a regular doctor or nurse to whom they would like to have consistent access. Given that 70% of patients were successful in achieving this access, there appears to be scope for improvement. In general, our adopted ‘evolutionary advance’ borne out of last year’s results remains our intent as, overall, the surveys indicate that we should not make any radical changes. This approach is particularly supported by the results of our Overall Satisfaction survey, which show that a high percentage of our patients are happy with the care they receive from this surgery.

Year 2 of the PPDES - Action Plans

Taking all the previous responses to our surveys and last year’s action plan into account, we have identified several actions that we believe should be addressed over the 2013/14 period. In conjunction with our action plan we intend to re-invigorate interaction with our virtual PRG which, for Dapdune Surgery appears to be the most effective means of patient/surgery communication.


Furthermore, we will continue to seek volunteers to join the virtual PRG, thereby ensuring the group remains proportionate to registered patient numbers. The following actions form the basis of our plan for the 2013/14 period: 1. Endeavour to increase take-up of patients using the Surgery Website by improving advertising of the site wherever appropriate. 2. Given that 81% of our patients prefer to see their regular GP and that 70% are successful in doing so, we will work towards increasing these percentages in order to support continuity of care at the Practice. 3. We will continue to develop our training organisation with a view to improving overall services to our patients. 4. Improve online appointment availability. We will again take forward last year’s action to review and improve the availability of nurses’ appointments to patients booking online.

Implementation of Year 2 Action Plans What Dapdune House Surgery did Through an integrated action plan, involving GPs, nurses and receptionists, the website was advertised actively for the first 6 months after the Year 2 report was issued. Website awareness doubling in the period under report is a pleasing result. Throughout the year, we have tried to make sure that continuity of care remains close to the top of our priority list. Balancing this with best access to care is always a challenge, and with a greater number of partners reducing from full time to part time, a satisfactory balance has been hard to achieve. We have however recognised this, and are currently finalising an action plan that should give us the best compromise solution from the perspective of providing the best possible patient care. With regard to training we now have in place a comprehensive training regime that incorporates periodic individual online training, weekly clinicians training, and quarterly collective training. We focus these sessions on emerging matters of interest and concern. We have revised our online booking system, and had a campaign for the last 2 months to remind people of this facility. As anticipated, this has resulted in an increase in online bookings, but there is more to do. The failure to incorporate online bookings for nurses is a consequence of the specific (rather than generic for GPs) nature of nurses appointments. We will however review this again, with a view to improving availability.

Year 3 of the PPDES - Action Plans

This action plan has drawn on both the results of this year’s survey, previous action plans, and feedback from the PPG on the survey results. The following actions form the basis of our plan for the 2013/14 period:


Action Who Deadline

Increase the number of patients using online systems (the website, the online booking system, and online repeat prescription)

PM/PPG Discuss at PPG meeting 22 Apr 14 Reassess 31 Sep 14

Increase the participation rate in Local Patient Surveys.

PM/PPG Discuss at PPG meeting 22 Apr 14 Reassess 31 Sep 14

Analyse, through more detailed surveys, the reasons for the decline in overall satisfaction results.

PM/PPG Discuss at PPG meeting 22 Apr 14 New survey by 31 May 14

Refocus the surveys in line with suggestions from PPG members

PM By 31 May 14

Focus on enabling patients to see their usual doctor, given the continuing importance of continuity of care to our patients.

PM By 30 April. Continuity of care action plan being developed. Will be briefed to PPG on 22 Apr 14

Investigate, with the PPG, the value of a Practice Newsletter.

PM/PPG Discuss at PPG meeting 22 Apr 14

Investigate again the practicalities of booking nurses appointments online.

PM Report to PPG on 22 Apr 14

Review procedures for nurses explaining tests and results, as this was also highlighted as a possible area for improvement in the MORI Ipsos poll

PM By 31 May 14

Conduct a survey of patient population demographics.

PM By 31 July 14

To engage the PPG more actively on patient related topics.

PM Immediate. Review at each PPG meeting.

To increase the ethnic diversity of the PRG. PM Action plan by 30 April. Review 30 September.

Summary of the PPDES 2011-2014

Involvement in the Patient Participation Directed Enhanced Service has once again been a positive experience for Dapdune House Surgery. The most significant achievement has been the expansion of the PPG, which should allow us to achieve more focused engagement with our patient population. The expansion of the PRG has also been encouraging. The information gained from our surveys gives us a good indication of some areas on which we need to focus in the coming year, in order to improve our patient services. We continue to improve our understanding of the patients’ requirements and, with the advantage of a short track record, can start to analyse trends. In this regard, we must balance the wish to change our surveys, in order to look at new areas, with drawing on the benefit of assessing trends through repeating similar questions. Our patient population is increasing month on month, and this is a positive reflection of the service we are delivering, but it also brings challenges which we will need to monitor with the support of our PPG and PRG. Whilst NETbuilder has been of significant assistance in drawing together these results,


we need to investigate how we can re-invigorate the surveys to achieve greater participation in 2014-5.

dapdune house · pdf filedapdune house surgery engaged with netbuilder to provide its...

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