Standard Reporting Template NHS England (Wessex) 2014/15 Patient Participation Enhanced Service Reporting Template Practice Name: Practice Code: Shanklin Medical Centre J84010 Signed on behalf of practice: Jason McLean Date: 10 March 2015 Signed on behalf of PPG: Virtual Group Date: 10 March 2015 1. Prerequisite of Enhanced Service Develop/Maintain a Patient Participation Group (PPG) Does the Practice have a PPG? YES Method of engagement with PPG: Face to face, Email, Other (please specify). Virtual Group Communication by email Number of members of PPG: 367 1
Detail the gender mix of practice population and PPG: % Male Female Practice 50.47 49.53 PRG 45 55 Detail of age mix of practice population and PPG: % <16 17-24 25-34 35-44 45-54 55-64 65-74 > 75 Practice 11.9 10.5 9.3 9.3 14.6 15.4 15.5 13.5 PRG 1.1 6.3 6 11.1 18.5 26.9 22.8 7.3 Detail the ethnic background of your practice population and PRG: White Mixed/ multiple ethnic groups British Irish Gypsy or Irish traveller Other white White &black Caribbean White &black African White &Asian Other mixed Practice 84.86 0.40 0.00 9.46 0.02 0.04 0.07 0.34 PRG 80.60 0.40 0.00 17.4 0.00 0.40 0.00 0.00 Asian/Asian British Black/African/Caribbean/Black British Other Indian Pakistani Bangladeshi Chinese Other Asian African Caribbean Other Black Arab Any other Practice 0.13 0.02 0.11 0.11 0.11 0.04 0.07 0.13 0.00 4.08 PRG 0.80 0.00 0.00 0.00 0.00 0.40 0.00 0.00 0.00 0.00 Describe steps taken to ensure that the PPG is representative of the practice population in terms of gender, age and ethnic background and other members of the practice population: During 2013/14 we changed our process to include registering for the Shanklin Medical Centre Virtual PRG (vprg) as part of our standard patient registration procedure. This means that every new registering patient, regardless of demographic, was invited to be a member of the vprg. We continued to advertise the group on our website, in surgery displays and by messages on our prescriptions. 2
By February 2015, this approach ensured that the patient group had grown from 12 members (when there was a physical group) to 367 members within the virtual group. In general this had a closer match to the demographics within the practice than the previous year s profile. Are there any specific characteristics of your practice population which means that other groups should be included in the PPG? e.g. a large student population, significant number of jobseekers, large numbers of nursing homes, or a LGBT community? YNO 2. Review of patient feedback Outline the sources of feedback that were reviewed during the year: Friends & Family Test Healthwatch Reports MORI survey Suggestions Box Patient Comments How frequently were these reviewed with the PRG? 5 times in 2014/2015 3
3. Action plan priority areas and implementation Priority area 1 Description of priority area: Referral to Treatment Times. This covers the time from which a patient is referred by the GP to the time in which they are seen for treatment. Patients had commented that there seemed to be long wait times for certain procedures, so we spoke to the CCG to see what actions could taken. The background was as follows: You may be aware that within the NHS there is a national target that a patient should, if possible, not wait any longer than 18 weeks from the point from when they were referred for a procedure to the treatment taking place. The Isle of Wight CCG (Clinical Commissioning Group) is aware that this target is not being met by some of the Hospitals that they currently commission to provide the treatment, notably some of the mainland providers. GPs and the CCG recognise the importance of patients having treatment as soon as possible. It is clear that in some cases alternative hospitals have shorter waiting times for the same procedures. This means that in some cases, patients would be able to be treated more quickly if they were willing to have the procedure done at a different hospital. I hope you agree that this makes sense, however there is a layer of complexity involved and we want to seek your views on the best way forward. The current situation is that Hospitals are required to report to the CCG the percentage of patients that have been seen within the 18 week target, by specialty. e.g. cardiovascular, orthopedics etc. This means that they are also aware of the percentage of patients that are not seen within 18 weeks and are still awaiting treatment. The challenge is that by law, the CCG is not allowed 4
any patient identifiable data, so all they get is a number. There is also no requirement for hospitals to report to GPs about the number of patients that are seen or not seen within the 18 week target What actions were taken to address the priority? The CCG and GPs want to ensure that, where patients are not likely to been seen within the 18 weeks, they are offered the opportunity to choose a different hospital for their procedure if they wish to be treated sooner. To do this, the CCG would need to be allowed to know specific patient details in order for patients to be contacted and offered the choice of a new provider. This could be achieved if, at the point of being referred by your GP for treatment, patients were asked and agreed to consent to the Hospital passing through the details of any patients that were not likely to be seen with the 18 weeks to the CCG giving the CCG the ability to contact the patient to see if they would like to make a change. The vprg were asked for their views on this matter with the results that all respondents agreed to this principle. The anonomised full content of responses was shared with the shared with the CCG, who in turn were going to seek the views of the wider population across the island and secondary care. Shanklin Medical Centre followed up this matter with the CCG in November 2014 and they confirmed that St Mary s Hospital had contacted patients who were likely to exceed the 18 week target and in the majority of cases they all chose to remain on the waiting list locally. Result of actions and impact on patients and carers (including how publicised): Given the above information, the CCG have yet to take forward any definitive plans to address this. However, Shanklin Medical Centre is committed to ensuring that patients are seen in the quickest time possible and actively offer mainland referrals to patients where suitable for both patients and carers. vprg informed by email. Update display in surgery. 5
Priority area 2 Description of priority area: Shanklin Medical Centre currently prescribes all repeat medication on a 28 day basis for the majority of our patients; as do all the GP surgeries. This has been in place for many years as it was recognised that by prescribing this way, the amount of medicine wastage was less and therefore was of benefit to the NHS economy. Over recent times we had been hearing that many patients do not like having to follow the process of requesting medication monthly and then collect from the pharmacy etc. We are therefore considering moving to prescribing repeat medication on a 3 month basis. We still need to consider wastage and cost, so we feel we that it may only be viable to prescribe this way for patients who are on long term stable medications, as opposed to those that may need adjusting within 3 months. What actions were taken to address the priority? Shanklin Medical Centre consulted with patients, pharmacists, GPs and the medicine management team at the Trust. Patient feedback was shared internally and it was noted that there was great variation in the way people wanted their dispenses and in what quantities. After careful consideration, it was decided that various options would be available: 1 Greater use of online system alongside pharmacy managed prescription service 2 GP discussion with appropriate patients on long term stable medication to move to 56 or 84 day prescribing 3 Trail of batch prescribing for long term stable medications, with dedicated pharmacist. 6
Result of actions and impact on patients and carers (including how publicised): Increased use of Vision registrations. Increased number of patients with 56 day prescribing Batch prescribing trailed with over 100 patients, with varying success. vprg informed by email. Update display in surgery. 7
Priority area 3 Description of priority area: From the FFT patients had commented that they were unaware if there were hand sanitisers for patients. It was felt that these should be prominent in any GP surgery to ensure patients used them. What actions were taken to address the priority? Shanklin Medical Centre reviewed the use of hand sanitising by patients and it became clear that the facility at the reception desk was not being used. The Practice Manager asked a random selection of patients attending the surgery for their views and they stated that they were unaware of availability at reception, however this may be due to the patients then engaging with the receptionists. It was also stated that if patients used the check in system, they would not go via the reception desk. The Practice purchased large freestanding sanitisers, one located at the main front entrance, with a further located in the first floor waiting area. Result of actions and impact on patients and carers (including how publicised): Clear use of new facilities and positive comments from patients. vprg informed by email. Update display in surgery and clear presence of new equipment. 8
Progress on previous years If you have participated in this scheme for more than one year, outline progress made on issues raised in the previous year(s): Action 1: Audit of GP capacity mapping availability within a 48 hours period and sufficient annual appointments. Findings: Full published national data is only available up to 2008, however by mapping the trend in GP appoints is was possible to forecast anticipated demand for GP appointments for future years. From 2003 to 2008 there has been an average increase in demand for GP appointments of 3%. Assuming this was to continue this would produce an average consultation rate of 3.9 appts in 2013 and 4.1 in 2014. Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Ave all consultations 4.71 4.96 5.14 5.22 5.37 5.45 N/a N/a N/a N/a N/a N/a Ave GP consultations 3.1 3.2 3.25 3.3 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.1 3% 3% 3% 3% 3% 3% Based on our practice list size in 2013 of 11,288 this means a requirement of 44,000 appointments. We recognised that the age demographics also impact on consultation rates. The average over 65 population percentage in the UK is approx 17.5%. Our practice demographic is 29%. We could therefore assume that our 3200 patients over 65 would consult more with a GP, well above the average consultation rate in the UK. Taking a crude calculation of the % difference in the UK average and Shanklin Medical Centre of 65% increase in consultation rate, this would mean the over 65s would consult with a GP on average 6.43 time per year. Re casting the anticipated demand this would now mean 8,088 patients consulting 3.9 time per year and the over 65s (3200) consulting at a rate of 6.43 times. An estimated total requirement of 52, 119 GP appointments. 9
Action 2 Action GP Face 1: to patient education on use of urgent appointments and where and how to access the most appropriate service. Audit of GP capacity mapping availability within a 48 hours period and sufficient annual appointments. The surgery published minor injury guidance; advertise this in the surgery, on the website and GP discussed this with patients at point or presentation to Findings: ensure they were aware of the options that were available, not just seeing a GP. Full The published practice also national worked data with is only the CCG available in support to of 2008, the Pharmacy however by First mapping scheme, the enabling trend in patients GP appoints to access is was selected possible treatments to forecast and anticipated medications demand free for of GP charge appointments at local pharmacies. for future years. From 2003 to 2008 there has been an average increase in demand for GP appointments of 3%. Assuming this was to continue this would produce an average consultation rate of 3.9 appts in 2013 and 4.1 in 2014. On review of 2013 vs 2014 urgent attendance data, 2013 showed 2697 urgent GP appointments booked. 2014 shows 2498 appointments booked a fall of 7% Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Ave all Our consultations aim to continue this 4.71 communication 4.96 5.14 on an 5.22 ongoing 5.37 basis. 5.45 N/a N/a N/a N/a N/a N/a Ave GP consultations 3.1 3.2 3.25 3.3 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.1 Action 3 3% 3% 3% 3% 3% 3% Offer patients choice of alternative access based on disdcussion with patient at point of GP contact, to include telephone and email. Based on our practice list size in 2013 of 11,288 this means a requirement of 44,000 appointments. We recognised that the age demographics also impact The surgery on consultation increased its rates. capacity The average for telephone over 65 consultation population in percentage light of the in above the UK action is approx to 7600 17.5%. dedicated Our practice phone demographic slots. These saw is 29%. a utilisation We could rate of therefore 88.1% (6703 assume patient that contacts). our 3200 patients over 65 would consult more with a GP, well above the average consultation rate in the UK. Taking a crude calculation of the % difference in the UK average and Shanklin Medical Centre of 65% increase in consultation rate, this would mean the over 65s would consult Action 4 with a GP on average 6.43 time per year. Re casting the anticipated demand this would now mean 8,088 patients consulting 3.9 time per year and Continue the over to publise 65s (3200) new consulting Vision Online at a Services, rate of 6.43 enabling times. patients An estimated to access total GP requirement appointments. of 52, 119 GP appointments. We have actively publicised both booking GP appointments and order repeat prescriptions. Online prescription requests have topped 9000 in 11 months and online appointments booked have increased to 700. it is clear that requiesting prescritions online is a popular service, however, the demand for booking GP appointments is minimal. We will continue to promote and provide both these services. 10
Action 5 Work with and contribute to the IOW Clinical Commissioning Group and GP Locality to support fir for purpose urgent access. Shanklin Medical Centre has liaised with various stakeholders, including the CCG, patients and reflected on feedback from external agencies. We are pleased to say that our model of urgent access has been highly regarded and it has been noted that our patient use of A&E and the Walk in centre has been low. We have not been advised to make any changes to our systems. Action 6 Action Engage with and contribute to the IOW CCG ensuring appropriate Pharmacy development for minor injuries/ailments. The surgery published minor injury guidance; advertise this in the surgery, on the website and GP discussed this with patients at point or presentation to ensure they were aware of the options that were available, not just seeing a GP. The practice also worked with the CCG in support of the Pharmacy First scheme, enabling patients to access selected treatments and medications free of charge at local pharmacies. Action 7 Review the viability of enhanced Nurse roles, to include Advanced Nurse Practioners In line with business planning activities, the Partnership along with the Lead Nurse and Practice Manager reviewed to viability of ANP roles within Shanklin Medical Centre. Guidance and support was taken from the CCG regarding training requirements and relevant funding opportunities. Key Benefits: o GP vs ANP costs o ANP 40pts per day. o Change to OCD /Urgent patient demand o Course module costs funded 11
Action 7 Review the viability of enhanced Nurse roles, to include Advanced Nurse Practitioners Key Costs: o Course Days (Portsmouth/Southampton) Principles of History Taking & Physical Assessment (8 full days 3 half days Sept 14) Diagnostic Assessment & Decision Making (9 days Jan 15) Research Methods & Evidence Based Practice (4 days Autumn 15) Independent & Supplementary Prescribing (4 half days Jan/Mar 16) Pharmacology & Applied Clinical Science (8 days, 1 Exam day Jan /Mar 16) NMC require additional 10 study days Transition to Advanced Practice (6 days Nov 16 to June 17) Total 53 days plus travel & support over 3 years Job creation at end of qualification / changes to working practices for 3 years Options o Support Development over 3 years o Decline at this stage Consider role of ANP for future Recruit existing ANP if needed Expression of interest was received from an existing member of staff. After discussion, the relevant staff member was unable to commit to the requirements of the course at this stage. The Partnership considered if there was an immediate need for this role and if so should there be specific recruitment. Factors included, access, space availability, impact on patients and impact on existing staff. On balance, there was no clear need for such a role at this stage; however the Partnership would happily support the development of this role in the future based on changes in resources and the wishes of existing staff development. 4. 12
4 PPG Sign Off Report signed off by PPG: YES reports circulated to vprg group Date of sign off: 10 March 2015 Comments from members of the Group: Thank you - Very informative On the whole it was a very good Report, very informative Many thanks for today's mailing and the attached summary. From a patient's perspective it is very comforting to note that the medical centre is operating within capacity and that must reflect successful forward planning over the years. It is so good to know that many people feel positive, like me about the excellent Communication and Healthcare you provide at Shanklin Medical Centre. How has the practice engaged with the PPG: How has the practice made efforts to engage with seldom heard groups in the practice population? Membership of the vprg is part of the registration process, allowing all patients to easily become members, ensuring a broad and inclusive demographic reach. Has the practice received patient and carer feedback from a variety of sources? Yes. FFT, Suggestions box, direct comments and emails, MORI survey. 13
Was the PPG involved in the agreement of priority areas and the resulting action plan? Yes How has the service offered to patients and carers improved as a result of the implementation of the action plan? Yes (see notes in priority areas above) Do you have any other comments about the PPG or practice in relation to this area of work? No 14