REPORT ON LOCAL PATIENTS PARTICIPATION FOR THE COURTLAND SURGERY ILFORD February 2012
Local Participation Report 1 Background Patients Reference Group Following the guidance by Primary Medical Services (Directed Enhanced Services) (England) Directions 2011 (the DES Directions), general practices are required to set up a Patients Reference Group (PRG) to satisfy the following aims: - to ensure patients are involved in decisions about the range and quality of services provided - to reward & encourage practices for routinely asking for and acting on the views of their patients - to publish the outcome of the engagement and the views of the patients on the Internet. As a first step, a PRG was set up, a survey questionnaire put together and patients asked about their views. This version of the report details the responses to the questions. As a next step the survey results will be discussed with the PRG and an action plan agreed before publishing the Local Patients Participation Report on the website. This is expected to be completed by March 2012. 2 Methodology for the Survey carried out 2011/2012 Sample Size: During December 2011, 75 survey forms were requested of which 58 survey forms were completed. Although 58 completed forms is a relatively small group out of a total population of 2,700 patients at the Courtland Surgery, it nevertheless allows making statistically valid statements about the wishes of the patients population with a high degree of confidence. The results for each of the questions were analysed using the statistical significance calculator and all results reported in this report. Nature of the Sample: The questionnaires were left at reception and patients were encouraged to complete these whilst they were waiting for their appointments during January 2012. This does provide a good cross section of patients of the Courtland Surgery although no demographic or ethnic details were recorded. This might have prevented a number of patients participating in the survey. The group of patients having completed the questionnaires will have either attended the surgery recently or will have received the questionnaires by mail. Although this might reflect on more recent visits and experiences with the surgery, it can nevertheless be assumed that those views are representative of the total patients population of the surgery over the past year. In addition, a number of patients as well as completing the survey forms also made some free-form comments about the surgery which are also recorded in this survey. 2 Courtland Surgery Local Participation Report
3 Processing Steps Establishing the PRG In order to establish the PRG for only registered patients, the practice manager contacted in early December 2011 a cross-section of the practice either by telephone or by letter from the following special groups: - Nursing Homes - Learning disability community None of these special groups agreed to participate. Furthermore, 10 patients of varying ages and ethnicity were written to, asking them to participate in the PRG. Out of 10, there were 9 no-responses and 1 indicated that he was not interested. As a next step, notices (leaflets We want to know what you think issued by the PCT) were left in reception during December 2011 and January 2012. Care was taken to issue the leaflets to a cross section of the patient group of the Courtland Surgery to ensure representation by both sexes, as much as possible all age and ethnic groups. Although names were provided on the returned leaflets (and in most cases email addresses and/or telephone numbers) no demographic data (age, sex, home address) or ethnic data was recorded. In our view that has helped to recruit members of the PRG and might explain why no participants from special interest groups could be found. This action conducted in December 2011 resulted in 15 patients indicating willingness to participate in the PRG. This is viewed as a reasonably sized virtual PRG which will be contacted by email or by telephone. Because the members of the PRG are all registered patients that have attended the clinic recently, it was decided that this is reasonably representative of the patient population of the clinic. Developing a Survey Questionnaire Also in December 2011, a draft patients survey was set up. The basis for the questions on the survey was those asked in patient surveys in previous years as part of QOF. The NAPP website was also consulted to ensure that best practices were adopted. The 15 patients which previously indicated interest in participating in the PRG were contacted either by letter or email and issued with a copy of the patients survey. The letter requested their comments and feedback on the proposed survey. The draft survey was also sent to the Patients Participation Group (PPG). The general response was that the survey questionnaire did ask the basic questions about the practice and its operation. Nobody suggested any additional questions or any amendments. 3 Courtland Surgery Local Participation Report
Conduct of Survey The survey forms were then left at reception for patients to complete during December 2011 and January 2012 and 58 patient forms were completed. This draft report was then completed in late January 2012 and issued to the PPG for comments. Calculation of Results The completed survey forms were analysed using the same methodology and techniques which are used in conducting Mori Research Surveys and carried out by a qualified statistician. Presentation and Discussion of Results by PPG The completed survey and draft report was then presented to the PPG and issued to the PRG for comments. In a meeting in February 2012 the report and comments were discussed and an action plan formulated which is included in the final report. Publication of the Location Participation Report The final version of the Local Participation Report has been published on the MyHealth website. Copies of the report have been distributed to PPG/PRG, the Staff at the surgery, the PCT and further copies will be left in reception. 4 Survey Results Introduction The general view of the patients about the surgery is very positive and many patients have made positive Further Comments about the doctor, the confidence of patients in his diagnosis and the general satisfaction with the service. The surgery is also particularly highly rated in respect to cleanliness and tidiness. However, patients have the least satisfaction with the length of time they see the doctor at 10 minutes and to see the doctor at the appointed time. To get an appointment on the day and to pre-book appointments is also a somewhat lesser concern. These overall results are also borne out by the comments patients made on the form. The results are summarised below: 4 Courtland Surgery Local Participation Report
Note: The Yes and Mostly answers have been added together in this chart for clarity. In the following sections, each individual question will be dealt with in greater detail. This will be followed by a detailed evaluation of the positive and critical comments by patients. Appointments It is perhaps not surprising that patients are least satisfied with the length of appointments of 10 minutes and whether they see the doctor at the appointed time. The number of patients being dissatisfied this is 40% and 45% respectively. Whilst 60% and 55% are either satisfied or mostly satisfied. The detailed responses are given in the charts below: Q: Do you usually see the doctor at the appointed time? 5 Courtland Surgery Local Participation Report
Q: Are 10 minutes per patient enough? Q: Can you get an on-the-day appointment if required? Q: Can you pre-book an appointment if required? 6 Courtland Surgery Local Participation Report
Confidence in the Doctor and his Diagnosis By and large, the patients are very satisfied with the service they are receiving at the Courtland Surgery. Specifically, the confidence in the doctor s diagnosis (97% are confident) and the interest the doctor takes in patients problems (95%) is very high. Even considering the relatively small sample size, it can be said that at a 95% statistical confidence level the whole of the Courtland Surgery patient population of about 2,700 patients, between 92 and 100% of all patients are satisfied with the diagnosis given by the doctor. Between 91 and 99% of the total patient population consider the doctor taking sufficient interest in their problems, again at 95% confidence level. Equally telling, 91% of the sample is generally satisfied with the level of care that they receive and consider that their long-term conditions are managed well. This is equivalent to between 87% and 95% of the total patient population of the Courtland Surgery being satisfied with the general level of care they receive and how their longterm problems are being managed (again at 95% statistical confidence level). The results for the individual questions are given in detail below: Q: Do you have confidence in the diagnosis of the doctor? Q: Does the Doctor take interest in your problems? 7 Courtland Surgery Local Participation Report
Q: Are you generally satisfied with your care? Q: Do you think your long-term conditions are managed well? Reception Area and HCA The general level of satisfaction with the Reception area is very high, with 88% of the respondents either being totally satisfied (77%) or mostly satisfied (11%) and only 12% not being satisfied at all. Nevertheless, this is clearly an area that needs addressing and some of the comments made by patients give an indication to what actions might have to be taken. Q: Do you find the reception helpful? 8 Courtland Surgery Local Participation Report
The surgery introduced a Healthcare Assistant (HCA) in 2011 which is taking on some of the roles the doctor or the nurse previously has conducted, including taking blood samples, dressings, remove stitches, regulatory and NHS health check. The patients reacted very well to this with 91% finding the HCA helpful. In this context is it interesting to note that as a result, a very large portion of the patients prefers the blood tests to be taken at the surgery rather than at a hospital with 83% preferring the surgery. Q: Do you find the HCA helpful? Q: Do you prefer blood samples to be taken at the surgery or at a hospital? General Upkeep of the Surgery Patients are generally very happy with the cleanliness and tidiness at the surgery with 90% being satisfied or mostly satisfied whilst only 10% are not. Q: Are you satisfied with the tidiness and cleanliness of the surgery? 9 Courtland Surgery Local Participation Report
5 Individual Comments Made by the Respondents 50 of the 58 respondents also left comments about the surgery with the overwhelming majority of comments being positive, specifically, there are a large number of complimentary comments about the doctor and the staff at the surgery. However, there are also a number of critical comments which will be addressed in the action programme to be developed with the PRG. All comments made by patients are given in the tables below: What do you like most about the surgery? What do you like least about the surgery? General comments I want an appointment quickly Doctor is very understanding Sometimes the doctor is very rushed Surgery is clean The medical care given the doctor The doctor and the staff Great Doctor Its tidy and clean The staff & doctor The doctor takes time to listen Not sure Staff most helpful Its local Its well managed and its clean Polite Reception, doctor is very helpful and caring Good treatment and friendly staff Friendly staff It is properly heated Helpful, clean and tidy The process of booking an appointment waiting there is no privacy when talking at reception Telephone conversations with receptionist The wait Reception area is not private Not enough doctors Appointment process Not enough appointments The pigeons Comment on 18th Doctor is really understanding he speaks Urdu and Hindu Person on the reception needs to be more tolerant Excellent Practice Manager who has turned around surgery The Doctor Good Totally satisfied 10 Courtland Surgery Local Participation Report
What do you like most about the surgery? The doctor when you can see him Pleasant and helpful What do you like least about the surgery? Lack of parking, telephone not answered, unavailability of appointments when required General comments Overall, personally, I find the practice to be very satisfactory once you have an appointment. The doctor and staff are very helpful. Positive staff responses This is a very good practice and I have been a patient for many years and would not consider moving. Doctors treatment The doctor Bright and clean and warm in winter. Most of the time I have to wait for an appointment Waiting time, it needs a TV It s near to where I live. I am generally satisfied with my care. The doctor's attitude and professionalism and friendly and welcoming attitude of staff The staff The staff Booking appointments can be very tedious. Very difficult ringing at 9am as you can t get through. Then appointments are fully booked. Another telephone would be helpful. Would be better if there was more than one doctor. Doctor's ability Uncomfortable seating Sometimes children are allowed to run riot. Not good for sick people Good service No complaints Overall environment and staff is friendly Doctor and reception service You never get seen on time. Quite often the receptionist think they are the boss There is no female doctor Booking an appointment is a bit difficult. It should be made easy and quick. It would be more convenient to have a lady doctor. No privacy at reception. We have been registered with Dr Babbar for only several months but have been extremely satisfied with his attitude helpfulness promptness and also professional advice. We would recommend his clinic to others. Receptionists are also very polite and accommodate our needs regarding appointments. Doctor knows what he is talking about when diagnosing. Waiting over 30 minutes when one has an appointment Dr Babbar is the best doctor and saved me from having my leg amputated after I have been diagnosed by 5 doctors including one at the hospital. I even went to emergency and was told there was nothing wrong. Doctors with skill and experience are essential when it comes to health and that is exactly what Dr Babbar is - skilled friendly and professional. 11 Courtland Surgery Local Participation Report
What do you like most about the surgery? What do you like least about the surgery? General comments Professional and caring Near to home The confidence, I am satisfied Long waiting and not easy to get on phone in the morning. Doctor The waiting time It s fairly comfortable Needs to be more aerated Helpful staff and caring GP Clean and tidy The Doctor I like my doctor Reception Customer Service not very good It is uninviting, could benches, uncomfortable when having to wait a long time Receptionist needs to stop chewing gum. Today, heating switched off. The Medical attention It is very minimalistic. The HCA is caring The receptionists & the doctor Very caring and confident practitioner. All staff is extremely courteous and polite. Delighted to be a patient of Dr Babbar's surgery. Difficult to comment because the doctor is always too busy when I do see him. He always gives the impression he has too many patients to see in one session. Overall very positive. Dr Babbar is a very good doctor, prompt and efficient. When a patient comes to the surgery the first person he sees is the reception desk. Some of the Staff could do with some 'customer care skills' which I believe can help the patient of the problem. There is no courtesy, politeness just basic skill like listening to your patients. The 6 times I have been to the surgery, I have found the floors are always dirty, walls in waiting room are appalling, especially the side adjacent to the receptionist office. If you are a new patient the receptionist doesn't explain procedures to patients and the receptionist herself looks 'over worked' thus her attitude to patients is bad. When in the consulting room the patients chair s almost 5 meters away from the doctor's and you have to shout your problem with the door open. There is no privacy. The doctor's position just seems so aloof. 12 Courtland Surgery Local Participation Report
6 Action Plan The survey has identified a number of areas where improvement is possible. These areas were in the main: - Telephones not been answered quickly enough, - the doctor not seeing patients on time and - the 10 minutes that the doctor is seeing the patients is not long enough. The following action programme has been agreed by the PPG/PRG and will be implemented as soon as is feasible: To improve the time that telephones are answered, receptionists will not ask patients about their complaint any longer but only verify name and date of birth. Certain telephone calls, i.e. prescriptions or messages for the doctor, are handed over to the HCA to deal with. The surgery has set the target to make as many on-the-day appointments for patients as is possible apart from the ability to pre-book a number of appointments. To improve the time the doctor actually sees and treats patients, another consulting room has been opened and the doctor will see patients in alternating consulting rooms, effectively seeing 2 at a time thus increasing the time for individuals that need it. Furthermore, a locum has been recruited. It should be noted however that the 10 minutes consultation time limit is an NHS Directive. The PPG/PRG felt that the more basic survey will bring the real issues in the practice to light rather than the more intricate Mori survey which is conducted without any direct patients participation. This effort will be maintained to continuously improve the service to the patients. 13 Courtland Surgery Local Participation Report