ppg report 2014 - mhdoctors.co.ukmhdoctors.co.uk/website/d83080/files/ppg report 2014.pdf ·...

Martlesham Heath Surgery ID 83080

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MARTLESHAM HEATH SURGERY (ID D83080)

PATIENT REPRESENTATIVE GROUP’S

REPORT ON PAST YEAR AND PATIENT SURVEY RESULTS

for MARCH 2014

CONTENTS 1. INTRODUCTION .......................................................................................................... 2

2. SURVEY METHODOLOGY ......................................................................................... 3

3. SURVEY RESULTS ....................................................................................................... 4

SURVEY SECTION 1 – FEEDBACK ON FACILITIES AND SERVICES ................................ 5

SURVEY SECTION 2 – FEEDBACK ON QUALITY OF CARE ............................................ 11

SURVEY SECTION 3 – LOCATION OF GP PRACTICE AND ACCESS .............................. 19

SURVEY SECTION 4 – DEMOGRAPHIC INFORMATION ................................................. 21

SURVEY SECTION 5 – ANY OTHER FEEDBACK ................................................................ 22

4. EXECUTIVE SUMMARY OF RESULTS ................................................................. 25

5. ACTION PLAN FOR 2014/15 ................................................................................ 26


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1. INTRODUCTION The Patient Representative Group (PRG) was established in 2011 to create a communication channel between Martlesham Heath GP Practice and its patients. The aim was to provide a channel for constructive feedback and views on possible changes that would benefit patients. One of the first tasks of the PRG in February 2012 was to canvass the views of other patients via a survey and, as a result of the findings, an action plan was drawn up. An evaluation of that action plan took place a year later, in March 2013, following various changes made as a result of patient feedback. An amended action plan was produced for 2013. Four meetings were held during 2013/14 with Dr Andrew Schurr (senior partner) and Lynne Marsh (Practice Manager). Further changes have been made to the premises to improve facilities and to the service offered to patients during the past year; these are summarised against the survey questions in Section 1 of the Survey Results. The third annual survey, conducted in February 2014, undertook to assess the impact of those changes and to ask a new set of questions about the quality of the clinical services offered, in line with the sorts of questions which may be asked during a future CQC1 inspection. A third area of questioning related to the location of medical services, which would become an issue once the new housing development was built across the A12 near the BT Adastral Park site. Diversity of the patient representative group An invitation to join the group was sent out with the 2012 survey, with the aim of enhancing the group’s diversity in terms of age, ethnic origin and residential area. Responses were limited, but the three potential volunteers were contacted by phone and encouraged to join. Unfortunately, only one person has continued as a member and two existing members had to leave during 2013, so the current membership at March 2014 comprises four patients: 3 men and 1 woman, all of retirement age and all white British. A further attempt to generate interest in joining the group has been made via newsletter items in parish magazines and ‘Join Us’ messages on the 2014 survey. Flexible participation has been offered, so it isn’t necessary for all members to attend evening meetings. One person has shown an interest. Sadly, it seems harder these days to engage people in undertaking voluntary community activities. Information about patient diversity at March 2014 is reproduced in the table below. The ethnic origin of patients is limited because the ethnic origin of new patients has only been requested in recent years.

1 Care Quality Commission (for more information, see http://www.cqc.org.uk )


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Age Range Male Female TOTAL White British

Minority ethnic origin

Ethnic origin

unknown 0-‐65 2338 2350 4688 2655 262 2903 66-‐75 354 369 723 76+ 229 280 509 TOTAL NO. of PATIENTS 5920

2. SURVEY METHODOLOGY The format and content of the 2014 survey were agreed at the PRG meeting on 21st January 2014. The survey questions were grouped in four sections:

1. Facilities and services 2. Quality of care 3. Future location planning 4. About you

It was agreed to run the survey online (using Survey Monkey’s web based survey design, collection and analysis tools) and paper copies from 4th – 18th February 2014. Confidentiality

The Group decided that the survey should be anonymous, so although demographic information was sought to help with analysis, no identifying information was requested. Distribution of survey

One of the actions since 2012 has been to encourage patients to provide email addresses and mobile phone numbers for contact by email and text, where appropriate. Approximately 1127 patients are now contactable via one or both of these means and a link to the 2014 survey was sent to all of those patients as well as being available from the surgery website. The survey was also distributed to people who had signed up for the Martlesham Alert system – a local communication channel used for distributing community information. In addition, paper copies of the survey were distributed in the waiting room. Analysis

Once the survey was closed, all the paper forms were manually entered onto Survey Monkey for collation with the online results. 250 responses were received altogether, although 4 people did not complete the whole form (their online connection may have broken down). Reports were downloaded from Survey Monkey showing statistical data and text comments for each question. Charts are included in this report of the results. The open text responses for each question and at the end of the survey, were collated and have been summarised in this report. The findings were analysed by patient members of the PRG and the report contents were agreed by email and at a PRG meeting on 11th March 2014.


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Publication The report will be published on the surgery website www.mhdoctors.co.uk with links sent to all those who have registered for email or text communications. Paper copies will be available in the waiting room. 3. SURVEY RESULTS Respondents were asked to answer each question in relation to their own experience during the past 12 months as a patient, a carer or both. Only one person answered solely as a carer, so everyone else answered as a patient (208 responses) or as both a patient and carer of another patient (40 responses). One person answered on behalf of himself and his wife. Most of the questions were not mandatory, so the total number of people who answered each question, from a possible 250 respondents, is shown against each question. Of those who answered ‘Not used/don’t know’ (NU/DK), these responses have not normally been included in the charts, since those people were unable, for whatever reason, to express a view. For example, in Q1, 244 people answered this question; but 125 of them had not used the service so they were unable to say if it was good or in need of improvement. They may have added comments in the open text. In the following sections, simply to avoid duplication, items which are included in the new action plan for 2014 have not always been listed under ‘Comments and suggestions’ where no further explanation of the issue prompting the action was felt necessary. For example, some patients asked for more high backed chairs so this is shown as an action item, but not under ‘Comments and suggestions’. The PRG is grateful to patients for all their suggestions. Unfortunately, in some cases, there are reasons why some of them cannot be implemented. In order to explain these to patients or simply to provide extra information, a ‘Response’ has been provided. The PRG hopes patients will find this information helpful in understanding the rationale and some of the pressures faced by the surgery. All feedback offered by patients was fully discussed and possible solutions considered. The Action Plan itemised all those actions where improvements were felt to be doable. Statistical validity

To calculate the margin of error2 would require different calculations against each question. However, to give an idea, with a population size of 5,920 (the total number of patients) aiming for a confidence level of 95%, where 80% of the 250 responses gave the same response to a question, the margin of error is 5%. Where only 40% gave the same response, the margin of error increases to 6%. Taking into account all responses (including ‘not used/don’t know’), the results to this survey provide a margin of error of approximately 5-‐6%.

2 This survey tool was used to calculate the margin of error figures quoted: http://www.relevantinsights.com/research-‐tools. An explanation of the terms is available on the website.


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SURVEY SECTION 1 – FEEDBACK ON FACILITIES AND SERVICES Q1 Email communications to/from the surgery (244 responses -‐ 125 NU/DK = 119 ratings) This facility is available for patients who have provided their email address. To date, 381 patients out of almost 6,000 registered with the Practice have given their email addresses to reception, although this survey was the first bulk communication using this facility.

106 patients said ‘good service’, 13 said ‘still needs improvement’ Comments and suggestions: • A few people said they were unaware of this service or that they had recently signed up and this survey was the first thing they had received.

• Some people thought it would be quicker and easier if the results of blood

tests and responses to enquiries, e.g. whether vaccinations are up-‐to-‐date, could be sent by email rather than patients needing to phone reception.

2014 Action Plan:

• Create an ability to enrol for email communication via the website. • The ability to register patients’ email addresses to be further advertised

for patients who would like to receive news information with a reminder to let the surgery know of any changes to their email address.

• Send out monthly newsletters and other general information such as dates for flu vaccinations, when the surgery is closed, etc. by bulk email.

Q2 Text message reminder for appointments (239 responses -‐ 103 NU/DK = 136 ratings)

This service is available for people who request it, currently 746 patients. (It was not available in 2012.) 132 patients said ‘good service’, 4 said ‘still needs improvement’

Response: Unfortunately, this isn’t workable as emails are not secure for sending confidential information, the surgery may not always have a patient’s current email address and it isn’t possible for staff to initiate the hundreds of individual messages daily, which this would require.


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Comments and suggestions: • Some people said they find this service useful. There were 2 comments about a text alert arriving almost as soon as the person had made the appointment and that reminders are only useful if the appointment is made for several days ahead and the text alert arrives the day before.

2014 Action Plan:

• Create an ability to enrol for text reminders and news alerts via the website.

• Registering mobile phone numbers to be further advertised for patients who would like to receive text reminders for appointments and text alerts for news items with a reminder to let the surgery know of any changes.

• Check if both confirmation of appointments and reminders are being sent for same day appointments. If so, see if the reminders can be stopped.

• Conduct a separate assessment to determine if various changes made, including the use of text reminders, have reduced the number of missed appointments.

Q3 Phoning the surgery (249 responses -‐ 16 NU/DK = 233 ratings) Phone lines are staffed every weekday Monday – Friday from 8:00 to 6:25pm.

Outside these hours, callers are redirected automatically to the out-‐of-‐hours service. When callers get through to the surgery, patients are offered a short menu with 3 options: 1 Reception, 2 Secretary or 3 Practice Manager. While waiting for a response, patients hear a single message with relevant information about opening hours, etc. 202 patients said ‘good service’, 31 said ‘still needs improvement’

Comments and suggestions: • Seven people commented that it was difficult to get through at 8am to make an appointment. Two people said the phones lines are not always opened until a few minutes after 8am and when they are, it’s difficult to get through.

Response: There are two types of text alert – one is confirmation of the appointment, which arrives very soon after making the appointment, and a second alert is the reminder, which arrives the day before the appointment. The surgery will check if both are being sent for same-‐day appointments and if so, whether the second one can be prevented.

Response: There are four phone lines and two people taking calls, so in busy periods, two calls will be answered at once while two further calls are queuing. It isn’t possible to provide more than this at present.


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• Two people considered the message they hear while waiting to be too long.

• Two people commented that the service was much improved, but there were still six negative comments about the attitude of some reception staff, with some patients feeling they had to justify their need for an appointment.

2014 Action Plan:

• Open the phone lines promptly at 8am. Q4 Visiting reception (248 responses -‐ 4 NU/DK = 244 ratings)

Changes have included: staff customer service training, staff name badges, increased space and larger window for face-‐to-‐face communication. 213 patients said ‘good service’, 31 said ‘still needs improvement’ Comments and suggestions: • 28 of the comments related to the attitude of the reception staff. Several

people said that some receptionists were better than others and there had been improvement. Positive comments (5) included that some staff were extremely helpful and that they seemed happier. Unfortunately, there were still comments about the need for a friendly smile and greeting and a more caring, patient attitude towards patients.

• A couple of people said they didn’t like the screen-‐based registration system and that it wasn’t always reliable.

2014 Action Plan:

• Provide additional training for staff in how to deal effectively with ‘difficult’ situations. An external training provider may be useful in dealing with employee feelings about their job and how this affects their interactions with others.

• Review the selection criteria and selection methods for any future recruitment of reception staff to ensure customer care skills are given the necessary prominence as well as other essential attributes for the job.

Q5 Waiting room (246 responses – 4 NU/DK = 242 ratings)

Changes have included: a complete redecoration, new carpet and curtains, cleaning of chairs, lights, etc. following building work to enhance the reception area, reduce size of the play room and create a new healthcare room 226 patients said ‘good service’, 16 said ‘still needs improvement’


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Comments and suggestions: • More/less music desired – no consistent preference was expressed, so impossible to please everyone.

• The blood pressure machine was really useful. • The leaflets are informative. • More toys in the playroom area

2014 Action Plan: • More high seated chairs with arms • Space for a wheelchair with a sign designating the space for that purpose • Signage to the different consulting rooms • Advertise in the waiting room that more up-‐to-‐date magazines would be

welcomed (note: these are donated by patients) Q6 Opening hours (247 responses -‐ 3 NU/DK = 244 ratings) The surgery is open on weekdays 8.00am – 6.30pm and phones are staffed 8.00am – 6.25pm. Home visits are made after morning surgery. Prescription collection, test results and other non-‐appointment services are available from 2pm.

217 patients said ‘good service’, 27 said ‘still needs improvement’ Comments and suggestions: • A lot of comments came from patients who had difficulty attending for non-‐urgent appointments, such as flu vaccinations, during the working day. This is especially a problem for people who commute long distances to work and for people with young children at

home. 17 people suggested Saturday morning and 10 suggested evening appointments. Others said they appreciated the surgery being open until 6.30pm to collect prescriptions, etc.

• All-‐day or partial day closures were inconvenient, especially if they are irregular, so patients do not know when the surgery will be closed.

Response: Every play item has to be disinfected daily so it isn’t practical to provide a lot of toys, but parents can always bring their own books or puzzles to amuse children while waiting Response: The surgery doesn’t actually close, but phone lines are switched to an out-‐of-‐hours service on those afternoons when clinical training takes place so quick access to medical advice can be provided if required. The surgery is still open for visitors calling in to make appointments, collect prescriptions, etc.


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2014 Action Plan: • Later evening appointments – Wednesday evenings with one doctor available

6.30 -‐ 7.30pm and another 6.30 -‐ 8.30pm. • Send out email notifications and post on website when non-‐surgery periods

are known in advance, e.g. for clinical training purposes. Q7 Appointments (250 responses -‐ 2 NU/DK = 248 ratings)

Appointments are available on the day for acute medical problems or via advance booking for less urgent matters. Most appointments allow 10 minutes per consultation. Patients are offered appointments with a fully qualified nurse practitioner or a doctor, depending on their condition. This decision is normally made by reception staff. 200 patients said ‘good service’, 48 said ‘still needs improvement’

Comments: • Three people said they’d had to wait 2-‐3 weeks for an appointment.

• Inability to make appointments for the next day – one suggestion was to reserve a few appointments for the following day, which could be booked the evening before (e.g. after 4 or 5pm).

• Difficulty of seeing same doctor for follow-‐up appointments • Patients need to be given more guidance of what receptionists mean when they ask if their condition is urgent or acute.

• The practice needs more clinical staff • Use of phone appointments or Skype

Response: 50% of patients are seen on the same day and 50% within 2-‐4 days. But longer waiting times can result from patients wishing to see a particular doctor, which is a problem if the doctor is fully booked, off sick or on holiday. Response: Calls can be made at any time of day for an appointment within the next few days. It isn’t practical to release ‘same-‐day’ appointments the afternoon before as, once this becomes known, they would get fully booked and there would be fewer available for those who really must see someone on the same day, presumably who aren’t well enough to be at work.

Response: This would not make effective use of clinicians’ time. A few phone appointments are available each day, but even these can increase the time a doctor spends treating the same person if a physical examination also becomes necessary. However, future use of technology (‘telehealth’) may become practical in the future, possibly with specialists managing long-‐term conditions.


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2014 Action Plan: • Change surgery diary restrictions to allow routine appointments such as blood tests to be booked further ahead than the current 6 weeks.

• When patients are asked to make follow-‐up appointments, doctors need to advise them to make the appointment before they leave, to make sure they see the same doctor and within the prescribed time period. Reinstatement of the use of a doctor’s note to be handed to the receptionist may assist.

• Online booking of appointments to be introduced. • Patients need to be given more guidance by receptionists of what they mean when they ask if the patient’s condition is urgent or acute.

Q8 Repeat prescription process (247 responses -‐ 47 NU/DK = 200 ratings) The new computer system requires patients to register to request repeat prescriptions online. Patients are asked to allow two days for processing of repeat prescriptions, which are then available for collection or sent on the patient’s preferred pharmacy. Regular medication is reviewed periodically.

172 patients said ‘good service’, 28 said ‘still needs improvement’ Comments: • A few people described the online ordering process as fast and reliable, but ten people had experienced problems. The main issue was trying to order repeat prescriptions (7 people) which were refused as they had been marked for review. In some cases, patients knew this was not necessary

because they had just had a review by their GP or a hospital consultant.

• Three comments related to registering and setting up of passwords and five people didn’t know that repeat prescriptions could be ordered online

• Suggestions included: a confirmatory email when requesting a repeat prescription online and the facility for a password reminder or reset without needing to attend the surgery.

Response: This issue is also causing a great deal of extra work for the doctors who cannot physically review the number of prescriptions being flagged up daily as requiring reviews. In the meantime, patients having difficulty submitting repeat prescription requests online could revert to sending in paper requests. The situation needs resolving for all.

Response: It isn’t possible to send emails, but the system currently advises when the prescription request has been submitted.


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2014 Action Plan: • A review to be conducted of the entire online prescribing system with the IT service provider to make it more workable for patients and the surgery.

Q9 Information for patients (247 responses -‐ 45 not used = 202 ratings) Information for patients is produced in a variety of formats including leaflets in reception and the waiting room, notices, online newsletters, parish magazines and especially the surgery website at www.mhdoctors.co.uk.

180 patients said ‘good service’, 22 said ‘still needs improvement’ Comments: • Some positive comments about the website and leaflets being helpful.

• Too much reliance on notices posted on the surgery door – not seen unless people have reason to visit.

2014 Action Plan: Two action items previously mentioned

about encouraging patients to sign up for email and text alerts and for the surgery to make better use of these means of communication for disseminating general information have been covered under Qs 1 and 2. It is well known that communicating information within a large organisation, let alone to individuals with external links to an organisation, is difficult. It relies on people reading information as well as the originator making it available via numerous channels. The survey results are not bad, but no cause for complacency considering that 11% said ‘room for improvement’ and 18% said ‘not used’ meaning they had not accessed any information. SURVEY SECTION 2 – FEEDBACK ON QUALITY OF CARE Q10 Have you been involved in decisions relating to your care (or of someone you’re caring for)? (246 responses -‐ 122 NU/DK = 124 ratings)

This means telling patients and carers, about what’s happening and involving them at every stage of their care and treatment. Patients and carers are supported when making decisions and asked whether they agree to any treatment. 118 patients said ‘yes’, 6 said ‘no’


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Comments: • Some patients would like to receive confirmation from the surgery that

their test results had come back normal.

• There were 7 questions about who is responsible for initiating a review -‐

should the patient request this or wait to be invited?

2014 Action Plan: The previous action item dealing with patients making follow-‐up appointments also applies to this question. Q11 Have you (or someone you're caring for) been given the right diagnosis and treatment, as far as you can tell? (246 responses less 42 NU/DK = 204 ratings) This means that patients’ personal needs have been assessed and appropriate care provided to improve patients’ health and wellbeing.

185 patients said ‘yes’, 19 said ‘no’ Comments: • 13 patients described situations where they felt their problems had not been properly diagnosed, had actively been misdiagnosed or where two doctors gave different diagnoses.

• Symptoms taken at face value without sufficient probing or

assigned to general problems such as the menopause or age. • Lack of a detailed treatment plan for managing chronic pain. • Lack of contact by anyone at the surgery even though the hospital clinic rang and faxed notes to the surgery on the same day of the tests with the results marked urgent. Another patient reported that care can be fragmented if more than two healthcare professionals are involved e.g. doctor, nurse, mental health. [See also Q16]

Response: Hundreds of test results come back every day and it isn’t possible for the surgery to advise everyone. Patients are told that they will be contacted if any treatment is required, but they can phone in for the results if they want to.

Response: There are two types of review, both of which are initiated by the surgery or other health provider: (i) Some people with particular conditions are sent automatic invitations (with two reminders if necessary) to attend medical check ups. (ii) A doctor may decide he wants to see a patient again to review their treatment after a set period of time. In both cases, the patient just needs to make sure they have an appointment.


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• Better post-‐natal care for mothers beyond the first 2-‐3 months.

• More time and help needed for patients with mental health issues. • More time per appointment to allow better analysis of symptoms.

2104 Action Plan • Promote awareness of help available, e.g. pain clinic, physiotherapy, for patients suffering pain even if the underlying cause cannot be treated.

Q12 Have prescriptions been accurate? (250 responses -‐ 14 NU/DK = 236 ratings) This means as far as the surgery is concerned -‐ this doesn't relate to accuracy by pharmacists.

217 patients said ‘yes, 19 said ‘no’ Comments: • 3 errors were reported such as being given a prescription for the wrong item on a repeat prescription list or being given old medication rather than updated notes. 4 people said they had been given the wrong quantities of medication.

There were no specific suggestions for improvement other than an implied need for more care to be taken.

Response: These issues are currently covered by health visitors unless a specific visit to a doctor is necessary. This service will be linked more closely with the GP surgery very soon which should help to address this.

Response: Longer appointment times reduce the total number of appointments available for each surgery session, thus causing others to wait longer before they can be seen. Doctors frequently take longer than the stipulated 10 minutes when they feel this is necessary, but that does result in following patients waiting longer. It’s a difficult balance trying to see as many patients as possible and on time whilst giving everyone the amount of time they need and want. Inevitably, some people will be less than happy with the result.


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Q13 Have you (or someone you're caring for) been treated with compassion, dignity and respect? (248 responses -‐ 32 NU/DK = 216 ratings)

201 patients said ‘yes’, 15 said ‘no’ Comments: • 8 people reported cases where they felt they were not treated as well as they would have liked. Examples included: (i) teenage acne was too trivial

to bother a doctor with (ii) lack of effective treatment for

chronic pain (iii) patient fussing unnecessarily

about delay with a referral (iv) Two patients mentioned less respectful treatment from a nurse – ‘off-‐

hand and unsympathetic’.

There were no specific suggestions for improvement other than an implied need for a more sympathetic approach by clinical staff. 2014 Action Plan: See previous action item at Q11 recommending more support for people suffering from chronic pain. Q14. Has the care of a patient with a long-‐term condition been managed well? (246 responses -‐ 121 NU/DK = 125 ratings)

108 patients said ‘yes’, 17 said ‘no’ Comments: • Four patients with long-‐term conditions felt they had not been called in for a review of their medication and progress of their conditions for too long a period (one said years) – one said they had to initiate tests to check the effect of medication.

• Concern over whether a series of seemly unrelated symptoms could indicate a more serious underlying long-‐term condition. • Regular appointments with doctor to proactively manage known long-‐

term conditions – say every 6 months.


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2014 Action Plan: • See if letters (e.g. inviting patients for health checks/reviews) could be franked or stamped with the name of the surgery on the front, to encourage patients to read the contents and respond.

Q15. If you have been visited by the doctor at home, does this service meet your needs (or the needs of someone you're caring for)? (246 responses -‐ 218 NU/DK = 28 ratings) All 28 patients who commented said ‘yes. There were no comments or suggestions for improvement relating to home visits. Q16. Following referrals to specialist services or between different care services, do you feel your healthcare needs (or the needs of a person you’re caring for) have been well co-‐ordinated? (243 responses -‐ 73 NU/DK = 170 ratings)

141 patients said ‘yes’, 29 said ‘no’ Comments: • “This has most certainly improved over the years.”

• Several reports of failures following GP referral to hospital specialists: examples included: (i) Biopsy results lost in post

leading to delayed cancer treatment

(ii) Referral to cardiology (rapid access chest pain clinic) went missing for over 5 weeks

(iii) Lengthening waiting times to see specialists – caused by hospital waiting times – lack of information causes anxiety as well as delayed treatment

(iv) In some cases, nothing heard from the hospital following GP referrals (in one case for over a year)

(v) Poor communication of hospital test results with GPs (vi) Some cases of GP referrals not having been sent by the surgery, so not all

problems were caused by failures by hospital systems. • Although information is passed between professionals, the patient is not always told who is taking the lead in the care.

• Several months’ delays in accessing physiotherapy services.

Response: Hundreds of letters are sent out inviting patients in for review, but many people do not respond, even after two reminders. The surgery doesn’t know if these letters are even being read, but it may be worth advertising who they are from on the outside of the envelope to make it more obvious.


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No specific suggestions of improvements by the surgery as there was more of a resigned recognition that much of these problems were outside the surgery’s control. The Clinical Commissioning Group3 is aware of the problem and this issue is currently under review. Q17. Are you satisfied with the out-‐of-‐hours service offered? (243 responses -‐170 NU/DK = 73 ratings)

45 patients said ‘yes’, 28 said ‘no’ Comments: • It was difficult enough getting into the Riverside but now this has closed the service has deteriorated.

• Out of hours doctors cannot access a patient’s medical records

• 3 patients found the NHS 111 service extremely unhelpful.

Patients did not know how to improve the 111 service, but they would prefer an out-‐of-‐hours service to be provided by the GP practice, or perhaps a consortium of local practices working together.

Q18. Do you feel that Martlesham surgery provides an accessible, clean and safe environment? (243 responses -‐ 1 NU/DK = 242 ratings)

236 patients said ‘yes, 6 said ‘no’ Comments and Suggestions: • Should the phlebotomist be wearing gloves for taking blood?

3 Ipswich and East Suffolk Clinical Commissioning Group – for more information, see: www.ipswichandeastsuffolkccg.nhs.uk

Response: Under current arrangements and with current resources, this won’t happen in the near future.

Response: This is the phlebotomist’s preference and doesn’t present any health risks to patients.


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• Improved wheelchair access required, taking account of ease of opening front door as a wheelchair user, manoeuvrability through internal doors and space for the wheelchair in the waiting room.

2014 Action Plan: • Improve signage at the front door for assistance to wheelchair users entering the building.

• Space for a wheelchair user in the waiting room is covered by an earlier action item (See Q5.)

Q19. Do you have confidence in the surgery staff who provide patient care? (243 responses -‐ 14 NU/DK = 229 ratings)

219 patients said ‘yes, 10 said ‘no’ Comments: There were 12 comments suggesting greater confidence in some clinicians than others. However, the feedback was inconsistent, i.e. one doctor was praised by one patient and criticised by another.

Specific issues raised included: • Lack of review for patients on long-‐term medication. • Need for patients to chase up information and query diagnoses. • Not sure warning signs for more serious conditions would be picked up. • Lack of surgery-‐initiated checks e.g. blood pressure checks, as offered by other practices – but another patient reported they had been invited in for a health ‘MOT’. However, she described the nurse’s attitude towards such checks as dismissive.

• Cheaper medication prescribed in accordance with NHS guidelines regardless of patient preference.

2014 Action Plan: • Communicate which groups of patients are eligible for the health checks and make clear whether they will receive an invitation to attend or whether they need to request it.

Response: Letters inviting patients in certain categories for health checks are initiated by the NHS and delivered under a contract with SERCO. These are outside the control of the surgery.


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Q20. Are medical records accurate, stored safely and kept confidential, as far as you know? (245 responses -‐ 59 NU/DK = 186 ratings)

182 patients said ‘yes, 4 said ‘no’ Comments: • Most comments said respondents would not know if records were held securely, but a couple of comments described missing records or a patient’s records having been misfiled in his brother’s record.

• One person expressed concern about information not being shared with anyone without his or her consent, particularly with the greater involvement of the private sector.

• One comment said the building did not seem that secure and another was concerned about computers can crash, which would prevent access to up-‐to-‐date health records.

No specific suggestions for improvement were made. Q21. If you have made a complaint to Martlesham Surgery within the past 12 months, did you feel it was properly considered and did you get a written response within a reasonable time? (The outcome may not necessarily have been what you wanted.) Three people answered ‘yes’ to this question. No one suggested any need for improvement in this area and there were no further comments relating to these complaints. No further action planned. Q22. Have you been answering the questions above as a patient, the carer of a patient or both?

208 people answered as a patient, 39 answered as both patient and carer and 1 person answered as a carer. One person said he answered on behalf of himself and his wife.


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SURVEY SECTION 3 – LOCATION OF GP PRACTICE AND ACCESS The information in this section will be shared with the people developing the Martlesham Neighbourhood Plan as the siting of community facilities such as medical services is one of their considerations. Previously, and again in this survey, a significant number of patients expressed a wish to retain a GP surgery in the centre of Martlesham Heath -‐ see responses to Q31. Q23. Where do you live? (245 responses)

51% the patients who responded to the survey were resident in Martlesham Heath. Kesgrave (22%) and then Martlesham (14%) were the next two largest groups. Other respondents live mainly in nearby smaller villages. Q24. What is your usual mode of transport to Martlesham surgery? (Tick all that apply) (246 responses, but some ticked more than 1 box, so there were 306 ticks)

These responses give an indication of the range of modes of transport for visiting the surgery including a small number using mobility scooters or a wheelchair (5 people). A significant number of patients currently walk (111) or cycle (20) to the surgery.


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Q25. Do you always have access to car transport, should this be necessary? (246 responses)

Two thirds of patients have ready access to car transport and another 24% said they ‘almost always’ had access to a car. This leaves the remaining 9% without. Those without ready access were almost all women, spread across the age range. For this section of the community, having a medical centre (and possibly the pharmacy) sited across the A12 would

provide a real difficulty and would have a greater adverse impact on women than men. Martlesham surgery is committed to retaining a presence in the centre of Martlesham Heath, but would welcome the opportunity to expand in order to be able to offer ancillary services. 2014 Action Plan: Share these findings with Martlesham Parish Council with the aim of retaining a long-‐term presence in the current village centre of Martlesham Heath.

Q26 Where do you most often get your prescriptions made up? Discussions were held between the PRG and Martlesham Pharmacy to explore the benefits of moving some patients from eight to four-‐weekly prescribing to reduce the considerable quantity of drug waste. It was agreed that not all patients would move onto monthly prescribing, but this would be helpful in certain cases, e.g. when expensive new drugs were being tried out for the first

time or for older patients with complex lists of drugs where the patient may be unsure which ones to continue to take and which need to be on-‐going. The pharmacist offers reviews to check all repeat prescription items are actually being taken and refers patients back to the doctor for further advice if required.

It can be seen that the majority of patients (67%) use Martlesham Pharmacy. As well as the close working relationship between the surgery and the local pharmacy, this has the added benefit of bringing people into the village centre for access to the other local shops and services. Answering an earlier question about prescriptions, one patient noted ‘Great teamwork with Martlesham Pharmacy.’


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SURVEY SECTION 4 – DEMOGRAPHIC INFORMATION Demographic questions about respondents were asked in order to allow more detailed analysis of responses, where this may be useful e.g. analysing which groups would be most affected by relocation of services or which groups were more or less satisfied with the services provided. Q27. What is your gender? (246 responses)

Q28. What is your age? (246 responses)

Q29. Do you have children or other dependants that you provide regular and frequent care for? (Please tick all that apply) (65 responses)

Q30. What is your ethnic origin?


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SURVEY SECTION 5 – ANY OTHER FEEDBACK Q31. If you wish to give us any other feedback, please write it here: 62 respondents provided responses under this section, the vast majority of which gave positive feedback on services provided. Most suggestions for improvement were made against particular topic questions asked earlier. However, 9 people took the opportunity to reiterate this feedback at the end of the survey, including the following:

• It would be useful if the system could issue reminders to patients about regular checks (e.g. 6-‐monthly blood tests) or relevant clinics (e.g. flu clinic) rather than relying on the patients to remember.

• I feel that hospitals & surgeries could communicate & share information re patients and then let patients have the details easily & speedily. This does not seem to be happening & matters which should be urgent are allowed to pass without informing the patient as soon as possible. The key is greater liaison & communication with patients and carers.

• Would like the nurses to operate an evening appt. find it difficult to make an appointment which suits after school. I work in a school so getting time off is not an option, unfortunately.

• I think the main issues with the surgery are customer service, I think that extra effort to make people feel more welcome and to be a bit more approachable would be good.

• Generally just concerned about the prescribing and follow up care for those with mental health difficulties in our community.

• Examples quoted of better websites from other practices. 7 comments related to the possibility of Martlesham Heath surgery moving to join a new medical facility eventually being provided across the A12, examples included:

• This surgery is needed in Martlesham Heath. If there is a need for another one over the A12 then another should be placed there.

• This is a 100% service on the Heath and a very busy Surgery. I have been with this Practice for 25 years in which time I have been very satisfied with all aspects of service and treatment and referral to hospital and for this I am very pleased after having a great deal of treatment over the years. Please stay where you are with the amount of patients in this area. You are desperately needed as we get older -‐ please stay. 2000 houses will need a separate surgery. Age now 82 I need you!!

• I wish for many reasons that the surgery should stay where it is. I realise that medical centres could provide extra facilities but having been in a few at various times I find them soulless places. I know people who have downsized to Martlesham Heath because of the locality of the services ie


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surgery, pharmacy, local shops etc. All within a few minutes walk. Thank you.

• The surgery looks very smart and welcoming after the alterations. I have found staff at all levels to be helpful and highly professional in their approach. As an older patient I would be very sorry if the surgery was to move. I have a sensory disability and prefer to make appointments etc. at the surgery. This would be much more difficult if the surgery relocated. Thank you to all of your staff.

Because Dr Schurr is retiring at the end of March 2014, 14 respondents took this opportunity to thank him for his care and wish him well, including the following:

• I greatly appreciate the good service I have had from MH surgery, particularly from Andrew Schurr. What a disappointment that he is retiring!

• I just wish to say that I hope a medical facility is maintained at Martlesham Heath. I am sorry that Dr Schurr is retiring. I will really miss him and wish him a long and happy retirement. Thanking him for all his care and attention.

• The care and service received from the staff at this practice is outstanding. In addition to being excellent medical staff they treat each person as an individual, with dignity and respect. Dr Schurr has cared for my family since he started working in Martlesham 20 years ago. The continuity of care this provides allows us to deal with difficult matters knowing he understands our family’s particular needs, rather than just the medical facts.

• I am very very sad to hear that Dr Schurr is leaving I do however wish him all the best for his retirement -‐ he deserves it and is probably the best GP I have ever seen.

The previous survey questions invited suggestions about areas for improvement, so most respondents who wished to leave positive feedback did so at the end of the survey. Several of these were people who had experienced surgeries elsewhere and were able to make a comparison:

• Both my husband and I (having moved with work 12 times and experienced many different NHS services) we consider Martlesham GP surgery to be the best we have ever encountered. The Doctors have been caring & first class in dealing with some difficult health issues. The reception staff & nurses have all been extremely helpful and done all that they can to provide for all our needs. It would be difficult to imagine a more complete service in all areas -‐ we are delighted to have been recommended to this practice by our doctor in North Suffolk prior to our move here!

• Best I've ever used really impressed with level of care.

• Having recently transferred to the Surgery as part of a relocation I have been extremely impressed by the overall standards of care and service.


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My main experience of the surgery has been with the Practice Nurse (JB) who I have found extremely helpful and open with me, this has gained my trust very quickly and is very important to me.

• I have had far better service from this surgery than I did from my previous one. Thank you to all the staff including the Doctors of course.

• Very pleased to be with this particular surgery, having been to others with other family members. Very happy with the doctors and nursing staff and support staff at the surgery. Very sorry to see Dr Schurr leaving!!!!

Other positive comments received included the following:

• I have found ALL the doctors, nurses & office staff to be friendly & helpful

• Dr Tobias is very friendly and approachable.

• Receptionists are always helpful and professionally friendly. We have always appreciated the care given by doctors and nurses. Thank you very much.

• Have always been very happy with attention to my problems! I think this surgery must be one of the best in Suffolk. One can almost always see a nurse or doctor at short notice which is of great comfort when you are feeling unwell. I say -‐ well done and thank you Martlesham Surgery. Please don't move!!

• Very good and responsive Surgery. Minor improvement to website would assist & where to collect repeat prescriptions (on line). Apart from that -‐ excellent!

• There have been a lot of changes in the past year or so -‐ almost always for the better. I feel we are very lucky to have such an excellent GP Service. Thank you to all the doctors, nurses and staff who work here.

• Both I and my wife feel that the service provided at Martlesham Heath Surgery is excellent, and we have both been looked after very well. We particularly appreciate the opportunity to be seen by one of the nurses, and then referred to the doctor if necessary.

• You are all truly fantastic and have helped our family tremulously from receptionists, Doctors, nurses and secretary. Nobody we have had contact with have ever given any cause for concern and are always happy and helpful and caring whilst remaining professional. You should all be very proud of providing such a high level of service in a very difficult area of the NHS such as general practice!

• I feel very lucky I have had access to such a good GP surgery for the last 30 years and hope it will continue to grow and improve as it has done over those years.


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4. EXECUTIVE SUMMARY OF RESULTS

Overall, the results of the 2014 patient survey showed that the vast majority of patients are happy with the services provided by Martlesham GP surgery. Section 1 dealt with the practical issues such as communicating with the surgery, appointments and repeat prescriptions. 97% was the highest percentage of ‘good’ ratings for text reminders for appointments and 93% was close behind for the refurbished waiting area. 80% was the lowest percentage of ‘good’ ratings, which related to the appointment system. All the others were in the range 85-‐90%, so generally the results were very good. Inevitably in a busy GP Practice, there are competing pressures for resources, mainly in terms of doctors’ time. In an ideal world, everyone would get through first time on the phone and be offered quick appointments with their preferred doctor or nurse practitioner at a date and time to suit the patient, with prompt appointments on arrival. Unfortunately, things don’t always work out like that and the pressures of demands which can’t be met are felt by surgery staff as well as patients waiting for medical advice and treatment. The 2014 Action Plan aims to make further improvements in a number of these areas, including a weekly evening surgery. Section 2 of the survey asked a new set of questions about quality of care. 8 of the 11 questions resulted in over 90% of respondents answering ‘yes’ when asked if the care met the expected standard. In the areas with lower ratings, 14% of patients and carers felt that the care of patients with long-‐term conditions needed improvement and 17% felt that their care needs had not been well coordinated between different care providers. The lowest rating of all was in connection with out-‐of-‐hours service where 37% said this service needed improvement. Some of these matters are outside the surgery’s control, but are being looked into elsewhere. Section 3 of the survey asked about issues to do with location of the premises. As in previous surveys, there are a significant minority (9%) for whom a move away from the centre of Martlesham Heath would cause access problems as they do not have ready access to car transport. Most of these are women across the age range. 45% of those who responded currently walk to the surgery or use a mobility scooter or wheelchair. 8% usually cycle to the surgery. These findings will be shared with Martlesham Parish Council and its Neighbourhood Planning team. Finally, many patients took the opportunity to thank Dr Schurr, who has been the senior partner for many years, for his care and to wish him well for the future. The PRG would like to add their thanks to him for welcoming their feedback and suggestions on behalf of patients.


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5. ACTION PLAN FOR 2014/15 Communicating with patients

1. Create an ability to enrol for email/text services via the website

2. The ability to register patients’ email addresses and mobile phone numbers to be further advertised for those who would like to receive news information and reminders for appointments, with a reminder to let the surgery know of any changes to email addresses/mobile phone numbers.

3. Send out monthly newsletters and other general information such as dates for flu vaccinations, when the surgery is closed, etc. by bulk email

4. Check if both confirmation of appointments and reminders are being sent for same day appointments. If so, see if the reminders can be stopped.

5. Send out email notifications and post on website when non-‐surgery periods are known in advance, e.g. for clinical training purposes.

Appointments

6. Conduct a separate assessment to determine if various changes made, including the use of text reminders, have reduced the number of missed appointments.

7. Later evening appointments – Wednesday evenings with one doctor available 6.30 -‐ 7.30pm and another 6.30 -‐ 8.30pm.

8. Change surgery diary restrictions to allow routine appointments such as blood tests to be booked further ahead than the current 6 weeks

9. When patients are asked to make follow-‐up appointments, doctors need to advise them to make the appointment before they leave, to make sure they see the same doctor and within the prescribed time period. Reinstatement of the use of a doctor’s note to be handed to the receptionist may assist.

10. Online booking of appointments to be introduced.

Patient contact with reception 11. Open the phone lines promptly at 8am.

12. Patients need to be given more guidance by receptionists of what they mean when they ask if the patient’s condition is urgent or acute.

13. Provide additional training for staff in how to deal effectively with ‘difficult’ situations. An external training provider may be useful in dealing with employee feelings about their job and how this affects their interactions with others.

14. Review the selection criteria and selection methods for any future recruitment of reception staff to ensure customer care skills are given the necessary prominence as well as other essential attributes for the job.


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Physical facilities and accessibility

15. More high seated chairs with arms 16. Space for a wheelchair with a sign designating the space for that purpose

17. Improve signage at the front door for assistance to wheelchair users entering the building.

18. Signage to the different consulting rooms

19. Advertise in the waiting room that more up-‐to-‐date magazines would be welcomed

Prescriptions

20. A review to be conducted of the entire online prescribing system with the IT service provider to make it more workable for patients and the surgery.

Health checks, reviews and support

21. See if letters (e.g. inviting patients for health checks/reviews) could be franked or stamped with the name of the surgery on the front, to encourage patients to read the contents and respond.

22. Communicate which groups of patients are eligible for the health checks and make clear whether they will receive an invitation to attend or whether they need to request it.

23. Promote awareness of help available, e.g. pain clinic and physiotherapy, for patients suffering chronic pain, even if the underlying cause cannot be treated.

Location

24. Share the findings (of section 3 questions) with Martlesham Parish Council with the aim of retaining a long-‐term presence in the current village centre of Martlesham Heath.

ppg report 2014 - mhdoctors.co.ukmhdoctors.co.uk/website/d83080/files/ppg report 2014.pdf ·...

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