1. Introduction
In August 2011 a notice was placed in the practice newsletter inviting patients to join the "Patient Reference Group". Patients were also given flyers when they attended their doctor or nurse appointment, notifying them of the “Patient Reference Group”. An extract from the newsletter notice is listed in the next paragraph.
“We aim to gather around 100 patients from as broad a spectrum as possible to get a truly representative sample. We need young people, workers, retirees, people with long term conditions and people from minority ethnic groups”.
2. Patient Group Profile
About 17 patients responded to the notice and together with the 10 existing patient group members, they were invited to a meeting on 22 September 2012. Only 7 patients were able to attend but the meeting went ahead. Also in attendance were practice staff made up of doctors, nurses, phlebotomist, practice manager, deputy practice manager and reception manager.
| Patient Group Profile | |
|---|---|
| Gender | |
| Male | 13 |
| Female | 14 |
| Age | |
| 30 - 44 | 4 |
| 45 - 54 | 2 |
| 55 - 64 | 9 |
| 65 - 80 | 12 |
| Ethnicity | |
| Black Caribbean | 3 |
| Black other non-mixed origin | 1 |
| White British | 23 |
3. Key Areas of Priority
Amongst other issues, the “Patient Participation Enhanced Service” was explained to patients. We discussed the need to promote and engage patients through the use of a Patient Reference Group and to seek the views of the surgery population through the use of local patient surveys. We had a discussion about what the patients thought the key areas of priority at the practice were. Patients gave their thoughts and the following key areas were highlighted and agreed upon for the patient survey:
- Introduction of GP Telephone Consultations / Triage
- Satisfaction with Provision of Services
- New Service Provision
- Harmoni Saturday and Sunday Urgent Care Service
- Online Services Awareness
- Home Phlebotomy Service for housebound patients
4. Patient Survey
The patient survey questionnaire was compiled by the practice and agreed by the patient group before being distributed to patients. The questionnaires were handed out to patients as they arrived for their appointments and also appeared as a “pop up” on the practice website. Two hundred and forty seven patients participated in the survey over a 2 month period in November and December 2011.
| Patient Demographics | |
|---|---|
| Gender | |
| Male | 80 |
| Female | 157 |
| Age | |
| Under 25 | 15 |
| 25 – 45 | 119 |
| 46 – 64 | 74 |
| Over 65 | 33 |
| Period Registered at Practice | |
| Less than 1 year | 39 |
| 1 – 3 years | 38 |
| 3 – 5 years | 28 |
| More than 5 years | 137 |
The results were collated and analysed using the “Survey Monkey” website. A copy of the results were distributed to the patient group members and the practice team before the next patient group meeting was held. This enabled everyone to come prepared to discuss the findings and help develop an action plan.
5. Action Plans
At the patient group meeting on 26 January 2012, the patient survey results were discussed and summarised. Most of the comments were positive, however, there were a few concerns highlighted in survey. It was agreed at the meeting that the following key issues, highlighted in the survey, would be focused on.
Telephone Consultations
One of the questions in the survey was whether patients were in favour of a GP Telephone Triage Service. 86.2% of respondents were in favour but they were keen for the triage service not to replace face-to-face consultations with the GP. Very often GPs are able to deal with certain requests over the telephone, e.g. doctor’s certificate, repeat medication requests, medical reports, etc. Should a patient need to be seen, a GP appointment will be arranged for that day. It is hoped that by introducing telephone consultations, more appointments would be freed up giving better patient access. The patient group members were eager for the telephone consultation service to be tried and if
successful, offered to patients on an ongoing basis.
Plan
- The practice will meet during the month of February to look at the operational issues and how best to proceed with telephone consultations.
- It is hoped that the telephone consultation service be introduced before the end of March 2012.
- Telephone consultations last an average of 3 minutes compared to face-to-face consultations, currently averaging 16 minutes. As a result of the change, the number of advanced appointment slots would increase.
- Before implementing the telephone consultation service, the practice will publicise the impending changes on the website and in the waiting room.
Appointment System
The surgery recently increased appointment capacity by an extra 4 sessions per week to help deal with patient demand. The current appointment system favours emergency (on-the-day) access as opposed to advanced access (within 1 week). This setup is to help reduce the burden on an overstretched Accident & Emergency Department at St George's Hospital.
Current Appointment System
40% of slots released 6 weeks in advance
40% of slots released on-the-day (8.00am)
20% of slots reserved at the end of surgery
Extras are seen at the end of morning and evening clinics. It is also important to note that patients are not turned away if they want to be seen, although waiting times may be longer as doctors will see these patients after their routine clinics.
Plan
- Patient Education – Draw up a flow chart of the current appointment system, to be publicised in the waiting room, newsletter and practice website.
- Reception Training – Ensure all receptionists are re-trained regarding how the appointment system works and to ensure that they are all relaying the same message to patients.
- The practice will introduce a telephone consultation system, where patients will be given the option of speaking to a GP over the telephone. Refer to telephone consultations above.
- Publicise the Harmoni out-of-hours walk-in service at Balham Health Centre on week-ends and bank holidays. (Website, newsletter, posters in waiting room)
- Release the 20% of slots (normally reserved at the end of surgery) 6 weeks in advance. This would increase advanced appointment access by an average of 30 slots daily.
Telephone Access
The survey also highlighted difficulties in getting through to the receptionist on the telephone and receptionist manner, although patient group members had not experienced the latter.
Action Plan
- Ensure adequate staff cover during the peak periods.
- Explore changing the telephone routing system so that admin queries are diverted to the Administration Team, e.g. choose & book queries, insurance reports, etc.
- To arrange customer care refresher training for all receptionists.
Phlebotomist (Blood Tests) – Long Waiting Times
The following were highlighted as reasons for the long wait to see the Phlebotomist:
- The service is a walk-in clinic; therefore most patients tend to come in the mornings between 8.00am and 10.00am. (Most patients did not want to change to an appointment system –survey 2010).
- The practice also provides Phlebotomy to other surgeries in Wandsworth, therefore the high demand.
- On Tuesdays, the midwives based at Balham Health Centre refer patients to the Phlebotomy clinic for antenatal bloods.
Action Plan
- Display waiting times in the waiting room so patients are aware of delays and could decide to return at a less busy time.
- Design a patient information leaflet about the Phlebotomy Service, include what to expect and potential waiting times.
- Train up a 2nd member of staff to assist the current Phlebotomist with taking bloods, especially during busy periods.
Donavan Sunkur (Practice Manager)
Published: 09 March 2012