PRIMARY CARE COMMISSIONING COMMITTEE 3 rd August 2016, 3.30pm Conference Room, Toll Bar House, Ilkeston DE7 5FH Agenda Item No. Business Item Presenter Action Attachment 1 Apologies for absence: Prof Ian Shaw, Pam Watson 2 Declarations of Interest or Conflicts of Interest relating to the Agenda Andrew Booth Andrew Booth Assurance 3 Minutes of meeting held on 6 th July 2016 Andrew Booth Approval Item 3 4 Matters Arising/Action Sheet from meeting held on 6 th July 2016 Andrew Booth Approval Item 4 5 Derbyshire Clinical Waste Extension to Contract David Knight Approval Item 5 6 GP Patient Survey Heidi Scott- Smith Assurance/ Discussion Item 6 7 Forward Planner 16/17 Heidi Scott- Smith Assurance Item 7 8 Any Other Business Andrew Booth 9 Date of next meeting 7 th September 2016 at 3.30pm in the Conference Room, Toll Bar House, Ilkeston Chair: Dr Avi Bhatia Chief Officer: Mr Rakesh Marwaha
EXECUTIVE SUMMARY SHEET PRIMARY CARE COMMISSIONING COMMITTEE MEETING 3 rd August 2016 REPORT TITLE Derbyshire Clinical Waste Extension to Contract ITEM NO. 5 IS THIS PAPER FOR DECISION ASSURANCE DISCUSSION Action and recommendation Seek formal CCG approval for a 2 year extension to this contract to March 2019; and seek CCG support for a further piece of work to develop the longer term strategy for this contract from April 2019. Executive Summary and Purpose of Paper Matters for Consideration The contract for collection of clinical waste from GP practices could potentially end in 2017, the group Nottinghamshire Healthcare Trust (NHT) formerly Derwent Shared Services (DSS) who operate the contract are keen to exercise the contract extension of 2 years and are hopeful that can be further extended. 1. It is recommended that the clinical waste element of the contract is extended until March 2019. 2. It is recommended that the longer term strategy for the contract beyond March 2019 is explored during 2016/17 to identify a preferred strategy and procurement route. 3. It is recommended that CCGs identify leadership of this longer term strategy with the other Derwent Members. Cost implications Potential cost associated with early termination of contract Expected completion Governance and CCG Assurance Framework considerations Better Health To support effectiveness in primary care Better Care Sustainability Leadership Clinical Priority Areas (please tick ) Mental Health Dementia Quality and compliance issues identified Identification of risks and cross reference to risk register N/A N/A Learning Disabilities Cancer Diabetes Maternity Page 1
Any conflicts of interested identified/action taken? Has a Privacy Impact Assessment been considered for this project or piece of work? N/A N/A Equality Analysis and Due Regard completed Outcome of Equality Analysis and Due Regard Not applicable It is judged that it is not proportionate on the basis that the report does not directly impact any single group. This completes the due regard required. Author Jonathon Rycroft Director Heidi Scott-Smith Date July 2016 Page 2
CCG Primary Care Commissioning Committee Date of meeting: Title: 5/7/16 Agenda Item: Derbyshire Clinical Waste Procurement Paper Presented by: Written by: Joe Lunn / Dave Knight Jonathan Rycroft Purpose of paper: Nottinghamshire Healthcare Trust (NHT) provides a logistics and storage service in Derbyshire on behalf of a number of parties including NHS England, CCGs, FTs and local authorities (known as the Derwent Members). This shared service arrangement is reflected in a 3 year contract between the Derwent Members and NHT which is due to expire March 2017. The contract includes an option to extend for a further two years until March 2019. It is important to note that the contract includes potentially significant liabilities (e.g. redundancies, committed costs) for the Derwent Members on contract expiry or termination. The Derwent Members met with NHT on 16 March 2017 to discuss the future of the contract including a reduction in the NHS England component due to the transition of primary care support services to PCS-England (Capita). In advance Derbyshire CCGs had indicated support to explore a 2 year extension and this was shared at the meeting. All the other members confirmed support for a two year extension at the meeting. Members were also supportive of a further piece of work to explore the longer term options and strategy in relation to this contract. The purpose of this paper is to: 1. Seek formal CCG approval for a 2 year extension to this contract to March 2019. 2. Seek CCG support for a further piece of work to develop the longer term strategy for this contract from April 2019. Key Issues and Recommendations: Background This logistics and storage service was originally developed as a shared service for NHS bodies in Derbyshire and was known as Derwent Shared Services. For a period this service was operated by Berkshire before NHT took responsibility for the service. Our understanding is that the contractual arrangements follow on from those in place under predecessor PCTs. In terms of primary care NHT provide the following service to NHS England: Page 3
GP courier services/blue bags Secure/non secure stationary Management of Death Records Clinical waste service for GPs The total contract value for all members is approximately 1,500k per annum. The annual contract value is 621k for primary care. The first three services listed above are provided as part of the NHS England Primary Care Support (PCS) Services. As part of the transition of PCS services to Capita these services will no longer be required. They account for about 10% of the contract value. At the 16 March meeting Derwent Members agreed to a contract variation to reflect this reduction, provided that NHS England accepts the reasonable liabilities for this change. NHS England and NHT have since agreed how this will be treated and a contract variation is being drawn up. Under co-commissioning the Derbyshire CCGs are responsible for commissioning the clinical waste service for GPs. Usually GP practices make their own arrangements for clinical waste and this is reimbursed by NHS England (on behalf of fully delegated CCGs) as part of the contract payments. In Derbyshire most GP practice clinical waste arrangements are through the NHT shared service, with NHT being paid directly by NHS England. The annual contract value for the clinical waste service is 443k which is about 28% of the total NHT contract. The service is provided for 148 GP surgeries (main and branch sites). This would indicate an average annual cost of 2.9k per site, although clearly costs will vary between sites based on the frequency and volume of clinical waste collections. Quality and Value We understand that the Derwent Members examined costs and value for money in detail at the time NHT took responsibility for the service from Berkshire. At the meeting on 16 March the Derwent Members confirmed that they remained assured that the contract demonstrated value for money. We are not aware of any issues with the service provided by NHT and there has been positive feedback from practices. In Nottinghamshire practices are reimbursed for clinical waste services directly. The Primary Care Hub finance tem have analysed the costs for this service in Nottinghamshire against those in Derbyshire. This has indicated a comparable cost per patient of 0.47 per patient in Derbyshire and 0.52 per patient in Nottinghamshire. Potential liabilities The contract includes potentially significant liabilities to the Derwent Members on contract expiry or termination. Assuming a new provider would be procured to provide the shared services then some of these liabilities could potentially be mitigated e.g. redundancies could be minimised through TUPE arrangements. The worst case scenario is that all liabilities associated with not extending the clinical waste element of the contract for 2 years would fall to the CCGs in March 2017. NHT have estimated that these termination costs could be 92k. The loss of economies of scale could also increase the cost to the remaining services by 35k to the other members and under Page 4
the contract the CCGs may need to consider these. Proposal At the meeting on 16 March the Derwent Members were all supportive of a two year extension to the contract. The clinical waste service provided by NHT is performing well and the members are assured it demonstrates good value for money. There are also significant potential liabilities at the point of contract expiry or termination. It is therefore proposed that CCGs support the 2 year extension of the contract to March 2019. The members were also supportive of a further piece of work to explore the longer term strategy in relation to this contract. A number of the members were keen to explore opportunities to extend the contract for a further period (e.g. 5 + 2 years) beyond March 2019. It is therefore proposed that a more detailed piece of work is undertaken during 2016/17 to identify a preferred strategy and procurement route for this shared service. This piece of work will need to involve all the Derwent Members. It may be an advantage for this to be led by one of the members (e.g. one of the Derbyshire CCGs). It will need to consider contract performance, value for money and potential liabilities to the members should the contract terminate. It is recommended that specialist procurement support is engaged in this process. The Primary Care Hub will support CCGs consider the clinical waste element of this. Please also note that any proposal to directly award the clinical waste element of the contract is likely to require central NHS England approval through a business case in line with the Standing Financial Instructions. Recommendation 1. It is recommended that the clinical waste element of the contract is extended until March 2019. 2. It is recommended that the longer term strategy for the contract beyond March 2019 is explored during 2016/17 to identify a preferred strategy and procurement route. 3. It is recommended that CCGs identify leadership of this longer term strategy with the other Derwent Members. Action required by CCGs: Consider and approve the first two recommendations in this paper. Provide written confirmation to the Primary Care Hub for the recommendations. Confirm which Derwent Member will lead the development of the longer term strategy for this shared service contract. Page 5
EXECUTIVE SUMMARY SHEET PRIMARY CARE COMMISSIONING COMMITTEE MEETING DATE: 03 August 2016 REPORT TITLE GP Patient Survey ITEM NO. 6 IS THIS PAPER FOR DECISION ASSURANCE DISCUSSION Action and recommendation The Committee is requested to: Note the survey and discuss those practices that are consistently performing below the national and local average Executive Summary and Purpose of Paper Matters for Consideration The GP Patient Survey (GPPS) is an England wide survey, providing practice level data about patients experiences of their GP practices. This is administered by Ipsos MORI. The data in this slide pack are based on the July 2016 GPPS publication. This combines two waves of fieldwork, from July to September 2105 and January to March 2016, providing practice level data. The response rate for Erewash CCG was 45%. The GP Patient survey measures patients experiences across a range of topics, including: Making appointments, waiting times, perceptions of care at appointments, practice opening hours and out of hours services. Overall practice performance against the indicators, paying attention to those that are consistently performing below the national and local average Cost implications N/A Expected completion N/A Better Health Better Care Sustainability Leadership Mental Health Governance and CCG Assurance Framework considerations Dementia Quality and compliance issues identified Identification of risks and cross reference to risk register Any conflicts of interested Improving the overall patient experience in primary care and ensuring they have access to services at the right time in the right. Improving the overall patient experience in primary care and ensuring they have access to services at the right time in the right. Improving the overall patient experience in primary care and ensuring they have access to services at the right time in the right. Improving the overall patient experience in primary care and ensuring they have access to services at the right time in the right. Clinical Priority Areas (please tick ) Learning Disabilities Cancer Diabetes Maternity There are practices consistently reported within this survey as being below local & national average Links to quality within primary care N/A Page 1
identified/action taken? Has a Privacy Impact Assessment been considered for this project or piece of work? NO (delete as appropriate) Equality Analysis and Due Regard completed Outcome of Equality Analysis and Due Regard Not applicable It is judged that it is not proportionate on the basis that the report does not directly impact any single group. This completes the due regard required Author Director Heidi Scott-Smith Date July 2016 Page 2
NHS EREWASH CCG Latest survey results July 2016 publication Version 1 Public 1
Contents This slide pack provides results for the following topic areas: Background, introduction and guidance.... Slide 3 Overall experience of GP surgeries...... Slide 8 Access to GP services...... Slide 13 Making an appointment. Slide 20 Waiting times at the GP surgery..... Slide 28 Perceptions of care at patients last GP appointment.. Slide 31 Perceptions of care at patients last nurse appointment. Slide 35 Satisfaction with the practice s opening hours.. Slide 39 Out-of-hours services....... Slide 42 Statistical reliability... Slide 46 Want to know more?.. Slide 48 2
Background, introduction and guidance 3
Background information about the survey The GP Patient Survey (GPPS) is an England-wide survey, providing practice-level data about patients experiences of their GP practices. Ipsos MORI administers the survey on behalf of NHS England. For more information about the survey please refer to the end of this slide pack or visit https://gp-patient.co.uk/. This slide pack presents some of the key results for NHS EREWASH CCG. The data in this slide pack are based on the July 2016 GPPS publication. This combines two waves of fieldwork, from July to September 2015 and January to March 2016, providing practice-level data. In NHS EREWASH CCG, 3,101 questionnaires were sent out, and 1,380 were returned completed. This represents a response rate of 45%. Prior to 2015 these slide packs presented Area Team averages for each CCG. These are no longer included following the integration of Area Teams into the four existing Regional Teams. However, CCGs can still see how their results compare to those of other local CCGs. The questionnaire can be found here: https://gp-patient.co.uk/surveys-and-reports. Note the numbering may change each publication due to the addition or removal of questions. 4
Introduction The GP Patient Survey measures patients experiences across a range of topics, including: - Making appointments - Waiting times - Perceptions of care at appointments - Practice opening hours - Out-of-hours services The GP Patient Survey provides data at practice level using a consistent methodology, which means it is comparable across organisations and over time. The survey has limitations: - Sample sizes at practice level are relatively small. - The survey does not include qualitative data which limits the detail provided by the results. However, given the consistency of the survey across organisations and over time, GPPS can be used as one element of evidence. It can be triangulated with other sources of feedback, such as feedback from Patient Participation Groups, local surveys and the Friends and Family Test, to develop a fuller picture of patient journeys. This slide pack is intended to assist this triangulation of data. It aims to highlight where there may be a need for further exploration. Practices and CCGs can then discuss the findings further and triangulate them with other data in order to identify potential improvements and highlight best practice. The following slide suggests ideas for how the data can be used to improve services. - The data are provided twice a year rather than in real time. 5
Guidance on how to use the data The following suggest ideas for how the data in this slide pack can be used and interpreted to improve GP services: Comparison of a CCG s results against the national average: this allows benchmarking of the results to identify whether the CCG is performing well, poorly, or in line with others. The CCG may wish to focus on areas where it compares less favourably. Analysing trends in a CCG s results over time: this provides a sense of the direction of the CCG s performance over time. The CCG may wish to focus on areas that have seen declines over time. Considering questions where there is a larger range in responses among practices or CCGs: this highlights areas in which greater improvements may be possible, as some CCGs or practices are performing significantly better than others nearby. The CCG may wish to focus on areas with a larger range in the results. Comparison of practices results within a CCG: this can identify practices within a CCG that seem to be over-performing or under-performing compared with others. The CCG may wish to work with individual practices: those that are performing particularly well may be able to highlight best practice, while those performing less well may be able to improve their performance. 6
Interpreting the results The number of respondents answering (the base size) is stated for each question. The total number of responses is shown at the bottom of each chart. All comparisons are indicative only. Differences may not be statistically significant particularly when comparing practices due to low numbers of responses. For guidance on statistical reliability, or for details of where you can get more information about the survey, please refer to the end of this slide pack. Maps: - CCG and practice-level results are also displayed on maps, with results split across 5 bands (or quintiles ) in order to have a fairly even distribution at the national level of CCGs/practices across each band. Trends: - Latest / July 2016: refers to the July 2016 publication (fieldwork July to September 2015 and January to March 2016). - July 2015: refers to the July 2015 publication (fieldwork July to September 2014 and January to March 2015). - July 2014: refers to the July 2014 publication (fieldwork July to September 2013 and January to March 2014). - June 2013: Refers to the June 2013 publication (fieldwork July to September 2012 and January to March 2013). For further information on using the data please refer to the end of this slide pack. * More than 0% but less than 0.5% When fewer than 10 patients respond In cases where fewer than 10 people have answered a question, the data have been suppressed and results will not appear within the charts. This is to prevent individuals and their responses being identifiable in the data. 100% Where results do not sum to 100%, or where individual responses (e.g. fairly good; very good) do not sum to combined responses (e.g. very/fairly good) this is due to rounding. 7
Overall experience of GP surgeries 8
Overall experience of GP surgery Q28. Overall, how would you describe your experience of your GP surgery? CCG s results over time CCG s results National results Latest Good Poor July 2015 Good Poor 86% 4% 85% 5% 10% 3% Very good Fairly good 40% Neither good nor poor 85% Good July 2014 Good Poor June 2013 84% 5% 46% Fairly poor Very poor 5% Poor Good Poor 81% 8% Practice range in CCG % Good Local CCG range % Good Lowest Highest 68% 96% Lowest Highest 82% 91% Base: All those completing a questionnaire: National (819,140); CCG 2016 (1,346); CCG 2015 (1,289); CCG 2014 (1,414); CCG 2013 (1,542); Practice bases range from 100 to 124; CCG bases range from 1,346 to 6,122 %Good = %Very good + %Fairly good %Poor = %Very poor + %Fairly poor 9
Overall experience: how the CCG s results compare to other local CCGs Q28. Overall, how would you describe your experience of your GP surgery? Percentage of patients saying good Results range from 82% to 91% Comparisons are indicative only: differences may not be statistically significant Base: All those completing a questionnaire: CCG bases range from 1,346 to 6,122 %Good = %Very good + %Fairly good 10
Overall experience: how the CCG s practices compare Q28. Overall, how would you describe your experience of your GP surgery? Percentage of patients saying good Results range from 68% to 96% Comparisons are indicative only: differences may not be statistically significant Base: All those completing a questionnaire: Practice bases range from 100 to 124 %Good = %Very good + %Fairly good 11
Overall experience: how the CCG s practices compare Q28. Overall, how would you describe your experience of your GP surgery? Percentage of patients saying good Practices CCG National average 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% COLLEGE STREET MEDICAL PRACTICE THE MOIR MEDICAL CENTRE LITTLEWICK MEDICAL CENTRE ADAM HOUSE MEDICAL CENTRE CCG PARK VIEW MEDICAL CENTRE GLADSTONE HOUSE SURGERY DR WEBB AND PARTNERS OLD STATION SURGERY EDEN SURGERY THE AITUNE MEDICAL PRACTICE THE GOLDEN BROOK PRACTICE ILKESTON HEALTH CENTRE Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to low numbers of responses Base: All those completing a questionnaire: National (819,140); CCG (1,346); Practice bases range from 100 to 124 %Good = %Very good + %Fairly good 12
Access to GP services 13
Ease of getting through to GP surgery on the phone Q3. Generally, how easy is it to get through to someone at your GP surgery on the phone? CCG s results over time CCG s results National results Latest Easy Not easy July 2015 Easy Not easy July 2014 Easy Not easy June 2013 68% 28% 72% 24% 75% 22% 18% 10% 4% Very easy 22% Fairly easy Not very easy Not at all easy Haven't tried 47% 70% Easy 26% Not easy Easy Not easy 75% 22% Practice range in CCG - % Easy Local CCG range - % Easy Lowest Highest 45% 93% Lowest Highest 62% 84% Base: All those completing a questionnaire: National (832,192); CCG 2016 (1,372); CCG 2015 (1,303); CCG 2014 (1,442); CCG 2013 (1,570); Practice bases range from 98 to 126; CCG bases range from 1,372 to 6,223 %Easy = %Very easy + %Fairly easy %Not easy = %Not very easy + %Not at all easy 14
Ease of getting through to GP surgery on the phone: how the CCG s practices compare Q3. Generally, how easy is it to get through to someone at your GP surgery on the phone? Practices CCG National average Percentage of patients saying it is easy to get through to someone on the phone 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% THE MOIR MEDICAL CENTRE LITTLEWICK MEDICAL CENTRE OLD STATION SURGERY CCG COLLEGE STREET MEDICAL PRACTICE THE AITUNE MEDICAL PRACTICE DR WEBB AND PARTNERS GLADSTONE HOUSE SURGERY THE GOLDEN BROOK PRACTICE PARK VIEW MEDICAL CENTRE ADAM HOUSE MEDICAL CENTRE ILKESTON HEALTH CENTRE EDEN SURGERY Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to low numbers of responses Base: All those completing a questionnaire: National (832,192); CCG (1,372); Practice bases range from 98 to 126 %Easy = %Very easy + %Fairly easy 15
Helpfulness of receptionists at GP surgery Q4. How helpful do you find the receptionists at your GP surgery? Latest CCG s results over time Helpful Not helpful July 2015 Helpful Not helpful July 2014 Helpful Not helpful June 2013 Helpful Not helpful 87% 10% 86% 12% 86% 11% 85% 13% CCG s results 6% 3% 4% Very helpful Fairly helpful 43% Not very helpful Not at all helpful 44% Don't know National results 87% Helpful 11% Not helpful Practice range in CCG - % Helpful Local CCG range - % Helpful Lowest Highest 78% 96% Lowest Highest 82% 93% Base: All those completing a questionnaire: National (831,620); CCG 2016 (1,368); CCG 2015 (1,301); CCG 2014 (1,442); CCG 2013 (1,573); Practice bases range from 100 to 126; CCG bases range from 1,368 to 6,223 %Helpful = %Very helpful + %Fairly helpful %Not helpful = %Not very helpful + %Not at all helpful 16
Helpfulness of receptionists at GP surgery: how the CCG s practices compare Q4. How helpful do you find the receptionists at your GP surgery? Percentage of patients saying receptionists at the GP surgery are helpful 100% Practices CCG National average 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% THE MOIR MEDICAL CENTRE COLLEGE STREET MEDICAL PRACTICE LITTLEWICK MEDICAL CENTRE OLD STATION SURGERY CCG GLADSTONE HOUSE SURGERY THE GOLDEN BROOK PRACTICE DR WEBB AND PARTNERS ILKESTON HEALTH CENTRE ADAM HOUSE MEDICAL CENTRE PARK VIEW MEDICAL CENTRE THE AITUNE MEDICAL PRACTICE EDEN SURGERY Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to low numbers of responses Base: All those completing a questionnaire: National (831,620); CCG (1,368); Practice bases range from 100 to 126 %Helpful = %Very helpful + %Fairly helpful 17
Awareness of online services Q6. As far as you know, which of the following online services does your GP surgery offer? Percentage aware of online services offered by GP surgery 100 90 80 70 60 50 40 30 20 10 0 22% Booking appointments online 31% 31% 31% Ordering repeat prescriptions online 3% 5% Accessing my medical records online 8% 9% None of these 55% 50% Don't know Practice range within CCG CCG National Base: All those completing a questionnaire: National (808,746); CCG (1,333); Practice bases range from 96 to 122 Comparisons are indicative only: differences may not be statistically significant 18
Online service use Q7. And in the past 6 months, which of the following online services have you used at your GP surgery? Percentage used online services in past 6 months 100 90 80 70 60 50 40 30 20 10 0 4% 8% Booking appointments online 10% 11% Ordering repeat prescriptions online *% 1% Accessing my medical records online 88% 85% None of these Practice range within CCG CCG National Base: All those completing a questionnaire: National (810,322); CCG (1,340); Practice bases range from 97 to 122 Comparisons are indicative only: differences may not be statistically significant 19
Making an appointment 20
Success in getting an appointment Q12. Last time you wanted to see or speak to a GP or nurse from your GP surgery, were you able to get an appointment to see or speak to someone? Latest CCG's results over time Yes No July 2015 Yes No July 2014 Yes No June 2013 Yes No 87% 10% 87% 10% 86% 11% 85% 10% 17% 10% CCG s results 4% Yes 70% Yes, but I had to call back closer to or on the day No Can't remember National results 85% Yes 11% No Practice range in CCG - % Yes Local CCG range - % Yes Lowest Highest 75% 98% Lowest Highest 80% 92% Base: All those completing a questionnaire: National (798,498); CCG 2016 (1,324); CCG 2015 (1,267); CCG 2014 (1,380); CCG 2013 (1,524); Practice bases range from 96 to 124; CCG bases range from 1,324 to 6,035 %Yes = %Yes + %Yes, but I had to call back closer to or on the day 21
Success in getting an appointment: how the CCG s practices compare Q12. Last time you wanted to see or speak to a GP or nurse from your GP surgery, were you able to get an appointment to see or speak to someone? Percentage of patients who said they were able to get an appointment last time they tried to see or speak to a GP or nurse 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% LITTLEWICK MEDICAL CENTRE THE MOIR MEDICAL CENTRE COLLEGE STREET MEDICAL PRACTICE CCG ADAM HOUSE MEDICAL CENTRE THE AITUNE MEDICAL PRACTICE THE GOLDEN BROOK PRACTICE OLD STATION SURGERY GLADSTONE HOUSE SURGERY ILKESTON HEALTH CENTRE PARK VIEW MEDICAL CENTRE EDEN SURGERY DR WEBB AND PARTNERS Practices CCG National average Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to low numbers of responses Base: All those completing a questionnaire: National (798,498); CCG (1,324); Practice bases range from 96 to 124 %Yes = %Yes + %Yes, but I had to call back closer to or on the day 22
Convenience of appointment Q15. How convenient was the appointment you were able to get? CCG's results over time CCG s results National results Latest Convenient Not convenient July 2015 Convenient Not convenient July 2014 Convenient Not convenient June 2013 Convenient Not convenient 90% 10% 92% 8% 91% 9% 92% 8% 45% 9% Very convenient Fairly convenient 45% Not very convenient Not at all convenient 92% Convenient 8% Not convenient Practice range in CCG - % Convenient Local CCG range - % Convenient Lowest Highest 86% 96% Lowest Highest 90% 96% Base: All those able to get an appointment: National (685,063); CCG 2016 (1,170); CCG 2015 (1,129); CCG 2014 (1,213); CCG 2013 (1,361); Practice bases range from 87 to 114; CCG bases range from 1,170 to 5,192 %Convenient = %Very convenient + %Fairly convenient %Not convenient = %Not very convenient + Not at all convenient 23
Convenience of appointment: how the CCG s practices compare Q15. How convenient was the appointment you were able to get? Percentage of patients saying their appointment was convenient Practices CCG National average 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% COLLEGE STREET MEDICAL PRACTICE THE MOIR MEDICAL CENTRE OLD STATION SURGERY THE AITUNE MEDICAL PRACTICE CCG LITTLEWICK MEDICAL CENTRE THE GOLDEN BROOK PRACTICE EDEN SURGERY DR WEBB AND PARTNERS PARK VIEW MEDICAL CENTRE ADAM HOUSE MEDICAL CENTRE GLADSTONE HOUSE SURGERY ILKESTON HEALTH CENTRE Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to low numbers of responses Base: All those able to get an appointment: National (685,063); CCG (1,170); Practice bases range from 87 to 114 %Convenient = %Very convenient + %Fairly convenient 24
What patients do when they are unable to get appointment / are offered an inconvenient appointment Q17. What did you do on that occasion? Percentage who went on to do something else when unable to get appointment/ offered inconvenient appointment 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 54% 37% Went to the appointment I was offered 18% 22% Got an appointment for a different day 4% Had a consultation over the phone 6% 4% 1% 3% 3% 5% *% Went to A&E Saw a pharmacist Used another NHS service 10% Decided to contact my surgery another time 13% 14% 13% Didn t see or speak to anyone CCG National Base: All those who were not able to get an appointment or were offered an inconvenient appointment: National (113,406); CCG (168) Comparisons are indicative only: differences may not be statistically significant 25
Overall experience of making an appointment Q18. Overall, how would you describe your experience of making an appointment? CCG's results over time CCG s results National results Latest July 2015 July 2014 Good Poor Good Poor Good Poor June 2013 Good Poor 70% 13% 70% 14% 73% 12% 72% 14% 17% 10% 3% Very good 29% Fairly good Neither good nor poor Fairly poor Very poor 41% 73% Good 12% Poor Practice range in CCG - % Good Local CCG range - % Good Lowest Highest 56% 86% Lowest Highest 69% 83% Base: All those completing a questionnaire: National (795,484); CCG 2016 (1,319); CCG 2015 (1,249); CCG 2014 (1,372); CCG 2013 (1,509); Practice bases range from 97 to 121; CCG bases range from 1,319 to 5,998 %Good = %Very good + %Fairly good %Poor = %Fairly poor + %Very poor 26
Overall experience of making an appointment: how the CCG s practices compare Q18. Overall, how would you describe your experience of making an appointment? Percentage of patients saying they had a good experience of making an appointment 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% THE MOIR MEDICAL CENTRE LITTLEWICK MEDICAL CENTRE COLLEGE STREET MEDICAL PRACTICE OLD STATION SURGERY CCG DR WEBB AND PARTNERS THE AITUNE MEDICAL PRACTICE THE GOLDEN BROOK PRACTICE GLADSTONE HOUSE SURGERY EDEN SURGERY ADAM HOUSE MEDICAL CENTRE PARK VIEW MEDICAL CENTRE ILKESTON HEALTH CENTRE Practices CCG National average Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to low numbers of responses Base: All those completing a questionnaire: National (795,484); CCG (1,319); Practice bases range from 97 to 121 %Good = %Very good + %Fairly good 27
Waiting times at the GP surgery 28
Waiting times at the GP surgery Q20. How do you feel about how long you normally have to wait to be seen? CCG's results over time CCG s results National results Latest Don't wait too long Wait too long July 2015 Don't wait too long Wait too long July 2014 Don't wait too long Wait too long June 2013 Don't wait too long Wait too long 59% 32% 57% 36% 57% 34% 58% 36% 23% 10% 9% I don't normally have to wait too long I have to wait a bit too long 59% I have to wait far too long No opinion/doesn't apply 58% Don t wait too long 34% Wait too long Practice range in CCG % Don t wait too long Local CCG range % Don t wait too long Lowest Highest 36% 81% Lowest Highest 55% 64% Base: All those completing a questionnaire: National (799,241); CCG 2016 (1,330); CCG 2015 (1,256); CCG 2014 (1,378); CCG 2013 (1,515); Practice bases range from 97 to 123; CCG bases range from 1,330 to 6,038 %Wait too long= %Wait a bit too long + %Wait far too long 29
Waiting times at the GP surgery: how the CCG s practices compare Q20. How do you feel about how long you normally have to wait to be seen? Practices CCG National average Percentage of patients saying they don t normally have to wait too long 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% COLLEGE STREET MEDICAL PRACTICE DR WEBB AND PARTNERS LITTLEWICK MEDICAL CENTRE GLADSTONE HOUSE SURGERY OLD STATION SURGERY CCG ADAM HOUSE MEDICAL CENTRE THE MOIR MEDICAL CENTRE PARK VIEW MEDICAL CENTRE EDEN SURGERY THE GOLDEN BROOK PRACTICE ILKESTON HEALTH CENTRE THE AITUNE MEDICAL PRACTICE Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to low numbers of responses Base: All those completing a questionnaire: National (799,241); CCG (1,330); Practice bases range from 97 to 123 30
Perceptions of care at patients last GP appointment 31
Perceptions of care at last GP appointment Q21. Last time you saw or spoke to a GP from your GP surgery, how good was that GP at each of the following?* CCG s results National results % Poor CCG results % Poor *Those who say Doesn t apply have been excluded from these results. Very poor Poor Neither good nor poor Good Very good 4% 4% 3% 4% 4% 4% 4% 3% 4% 4% 3% 3% 3% 3% 11% 7% 11% 14% 12% Very poor 41% 39% 39% 40% 40% 44% 50% 47% 42% 44% Very good Giving you enough time Listening to you Explaining tests and treatments Involving you in decisions about your care Treating you with care and concern Base: All those completing a questionnaire excluding 'doesn't apply': CCG (1,298; 1,296; 1,260; 1,199; 1,282); National (794,990; 793,029; 763,302; 733,291; 780,925) %Poor = %Very poor + %Poor 32
Confidence and trust in the GP Q22. Did you have confidence and trust in the GP you saw or spoke to?* Latest July 2015 July 2014 June 2013 CCG's results over time Yes No Yes No Yes No 95% 5% 95% 5% 95% 5% 32% 5% CCG s results *Those who say Don t know/can t say have been excluded from these results. Yes, definitely Yes, to some extent 64% No, not at all National results 95% Yes 5% No Yes No 94% 6% Practice range in CCG - % Yes Local CCG range - % Yes Lowest Highest 85% 100% Lowest Highest 94% 98% Base: All those completing a questionnaire excluding 'don't know/ can't say': National (781,398); CCG 2016 (1,290); CCG 2015 (1,232); CCG 2014 (1,347); CCG 2013 (1,494); Practice bases range from 90 to 122; CCG bases range from 1,290 to 5,891 %Yes = %Yes, definitely + %Yes, to some extent 33
Confidence and trust in the GP: how the CCG s practices compare Q22. Did you have confidence and trust in the GP you saw or spoke to?* *Those who say Don t know/ can t say have been excluded from these results. Percentage of patients saying they have trust and confidence in their GP Practices CCG National average 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% COLLEGE STREET MEDICAL PRACTICE ADAM HOUSE MEDICAL CENTRE CCG LITTLEWICK MEDICAL CENTRE OLD STATION SURGERY DR WEBB AND PARTNERS ILKESTON HEALTH CENTRE THE MOIR MEDICAL CENTRE THE AITUNE MEDICAL PRACTICE THE GOLDEN BROOK PRACTICE GLADSTONE HOUSE SURGERY PARK VIEW MEDICAL CENTRE EDEN SURGERY Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to low numbers of responses Base: All those completing a questionnaire excluding 'don't know/ can't say': National (781,398); CCG (1,290); Practice bases range from 90 to 122 %Yes = %Yes, definitely + %Yes, to some extent 34
Perceptions of care at patients last nurse appointment 35
Perceptions of care at last nurse appointment Q23. Last time you saw or spoke to a nurse from your GP surgery, how good was that nurse at each of the following?* CCG s results National results % Poor CCG results % Poor 5% 6% 9% *Those who say Doesn t apply have been excluded from these results. Very poor Poor Neither good nor poor Good Very good 2% 2% 2% 2% 2% 3% 3% 2% 3% 3% 13% 8% Very poor 36% 37% 36% 38% 36% 56% 54% 53% 46% 53% Very good Giving you enough time Listening to you Explaining tests and treatments Involving you in decisions about your care Treating you with care and concern Base: All those completing a questionnaire excluding 'doesn't apply': CCG (1,231; 1,217; 1,190; 1,071; 1,192); National (712,463; 705,297; 686,913; 625,477; 695,184) %Poor = %Very poor + %Poor 36
Confidence and trust in the nurse Q24. Did you have confidence and trust in the nurse you saw or spoke to?* CCG's results over time CCG s results *Those who say Don t know/can t say have been excluded from these results. National results Latest July 2015 July 2014 June 2013 Yes No Yes No Yes No 97% 3% 96% 4% 97% 3% 24% 3% 73% Yes, definitely Yes, to some extent No, not at all 97% Yes 3% No Yes No 98% 2% Practice range in CCG - % Yes Local CCG range - % Yes Lowest Highest 94% 100% Lowest Highest 97% 98% Base: All those completing a questionnaire excluding 'don't know/ can't say': National (703,184); CCG 2016 (1,210); CCG 2015 (1,191); CCG 2014 (1,274); CCG 2013 (1,429); Practice bases range from 81 to 112; CCG bases range from 1,209 to 5,413 %Yes = %Yes, definitely + %Yes, to some extent 37
Confidence and trust in the nurse: how the CCG s practices compare Q24. Did you have confidence and trust in the nurse you saw or spoke to?* *Those who say Don t know/ can t say have been excluded from these results. Percentage of patients saying they have trust and confidence in their nurse Practices CCG National average 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% THE MOIR MEDICAL CENTRE THE AITUNE MEDICAL PRACTICE LITTLEWICK MEDICAL CENTRE EDEN SURGERY CCG ADAM HOUSE MEDICAL CENTRE THE GOLDEN BROOK PRACTICE ILKESTON HEALTH CENTRE COLLEGE STREET MEDICAL PRACTICE GLADSTONE HOUSE SURGERY PARK VIEW MEDICAL CENTRE OLD STATION SURGERY DR WEBB AND PARTNERS Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to low numbers of responses Base: All those completing a questionnaire excluding 'don't know/ can't say': National (703,184); CCG (1,210); Practice bases range from 81 to 112 %Yes = %Yes, definitely + % Yes, to some extent 38
Satisfaction with the practice s opening hours 39
Satisfaction with opening hours Q25. How satisfied are you with the hours that your GP surgery is open? CCG's results over time Latest Satisfied 75% Dissatisfied 9% July 2015 Satisfied 75% Dissatisfied 10% July 2014 Satisfied 76% Dissatisfied 10% June 2013 Satisfied 76% Dissatisfied 10% 11% 6% 3% 6% 43% CCG s results 32% Very satisfied Fairly satisfied Neither satisfied nor dissatisfied Fairly dissatisfied Very dissatisfied I'm not sure when my GP surgery is open National results 76% Satisfied 9% Dissatisfied Practice range in CCG - % Satisfied Local CCG range - % Satisfied Lowest Highest 62% 86% Lowest Highest 73% 82% Base: All those completing a questionnaire: National (820,097); CCG 2016 (1,349); CCG 2015 (1,287); CCG 2014 (1,421); CCG 2013 (1,541); Practice bases range from 100 to 124; CCG bases range from 1,349 to 6,123 %Satisfied = %Very satisfied + %Fairly satisfied %Dissatisfied = %Very dissatisfied + %Fairly dissatisfied 40
Satisfaction with opening hours: how the CCG s practices compare Q25. How satisfied are you with the hours that your GP surgery is open? Percentage of patients saying they are satisfied with the hours their GP surgery is open 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% THE MOIR MEDICAL CENTRE COLLEGE STREET MEDICAL PRACTICE DR WEBB AND PARTNERS PARK VIEW MEDICAL CENTRE LITTLEWICK MEDICAL CENTRE CCG OLD STATION SURGERY GLADSTONE HOUSE SURGERY THE GOLDEN BROOK PRACTICE ADAM HOUSE MEDICAL CENTRE ILKESTON HEALTH CENTRE THE AITUNE MEDICAL PRACTICE EDEN SURGERY Practices CCG National average Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to low numbers of responses Base: All those completing a questionnaire: National (820,097); CCG (1,349); Practice bases range from 100 to 124 %Satisfied = %Very satisfied + %Fairly satisfied 41
Out-of-hours services 42
Use of out-of-hours services Q41. Considering all of the services you contacted, which of the following happened on that occasion? I contacted an NHS service by telephone 63% 61% CCG National A health professional called me back 19% 26% A health professional visited me at home 7% 6% I went to A&E 31% 33% I saw a pharmacist 6% 9% I went to another NHS service 15% 23% Can't remember 8% 4% Base: All those who tried to contact an NHS service when GP surgery closed in past 6 months: National (130,950); CCG (196) 43
Use of out-of-hours services* Q42. How do you feel about how quickly you received care or advice on that occasion? Base: All those who tried to contact an NHS service when GP surgery closed in past 6 months: National (131,188); CCG (196) 25% 6% 69% It was about right It took too long Don't know/doesn't apply 62% 31% About right Took too long Q43. Considering all of the people you saw or spoke to on that occasion, did you have confidence and trust in them? Base: All those who tried to contact an NHS service when GP surgery closed in past 6 months: 33% 10% 4% Yes, definitely 53% Yes, to some extent No, not at all Don't know/can't say National results National National results 86% 9% (131,325); CCG Yes No (198) *The out-of-hours questions were redesigned for July-September 2015 fieldwork to reflect changes to service provision. As such, trends will not be shown for these questions until the July 2017 publication. %Yes = %Yes, definitely + % Yes, to some extent 44
Overall experience of out-of-hours services* Q44. Overall, how would you describe your last experience of NHS services when you wanted to see a GP but your GP surgery was closed? CCG s results National results 15% 5% Very good 3% Fairly good 40% Neither good nor poor Fairly poor Very poor Don't know/can't say 35% 67% Good 15% Poor Practice range in CCG - % Good Local CCG range - % Good Lowest Highest 56% 89% Lowest Highest 62% 80% *The out-of-hours questions were redesigned for July-September 2015 fieldwork to reflect changes to service provision. As such, trends will not be shown for these questions until the July 2017 publication. Base: All answering who have tried to call an out-of-hours GP service in the past 6 months: National (131,456); CCG 2016 (198); Practice bases range from 14 to 20; CCG bases range from 175 to 985 45 %Good = %Very good + %Fairly good %Poor = %Fairly poor + %Very poor
Statistical reliability 46
Statistical reliability Participants in a survey such as GPPS represent only a sample of the total population of interest this means we cannot be certain that the results of a question are exactly the same as if everybody within that population had taken part ( true values ). However, we can predict the variation between the results of a question and the true value by using the size of the sample on which results are based and the number of times a particular answer is given. The confidence with which we make this prediction is usually chosen to be 95% that is, the chances are 95 in 100 that the true value will fall within a specified range (the 95% confidence interval ). The table below gives examples of what the confidence intervals look like for an average practice and CCG, as well as the confidence intervals at the national level. An example of confidence intervals (at national, CCG and practice-level) based on the average number of responses to the question Overall, how would you describe your experience of your GP surgery? Average sample size on which results are based Approximate confidence intervals for percentages at or near these levels Level 1: 10% or 90% Level 2: 30% or 70% Level 3: 50% +/- +/- +/- National 836,312 0.09 0.13 0.14 CCG 4,000 1.18 1.86 2.07 Practice 100 5.05 9.41 11.3 For example, taking a CCG where 4,000 people responded and where 30% give a particular answer, there is a 95% likelihood that the true value (which would have been obtained if the whole population had been interviewed) will fall within the range of +/-1.86 percentage points from that question s result (i.e. between 28.14% and 31.86%). When results are compared between separate groups within a sample, the difference may be real or it may occur by chance (because not everyone in the population has been interviewed). Confidence intervals will be wider when comparing groups, especially where there are small numbers e.g. practices where 100 patients or fewer responded to a question. These findings should be regarded as indicative rather than robust. 47
Want to know more? 48
Further background information about the survey Across both waves of the research the survey was sent to c.2.1 million adult patients registered with a GP practice. Participants are sent a postal questionnaire, also with the option of completing the survey online or via telephone. Results are available every six months for every practice in the UK and date back to 2007, allowing meaningful comparisons of patients experiences. For more information about the survey please visit https://gp-patient.co.uk/. The overall response rate to the survey is 39%, based on 836,312 completed surveys. Weights have been applied to adjust the data to account for potential age and gender differences between the profile of all eligible patients in a practice and the patients who actually complete a questionnaire. Since the first wave of the 2011-2012 survey the weighting also takes into account neighbourhood statistics, such as levels of deprivation, in order to further improve the reliability of the findings. Further information on the survey including: questionnaire design, sampling, communication with patients and practices, data collection, data analysis, response rates and reporting can be found in the technical annex for each survey year, available here: https://gp-patient.co.uk/surveys-and-reports 2.1m Surveys to adults registered with an English GP practice 836,312 Completed surveys in the July 2016 publication 39% National response rate 49
Where to go to do further analysis For reports which show the National results broken down by CCG and Practice, go to https://gp-patient.co.uk/surveys-and-reports - you can also see previous years results here. To analyse the survey data for a specific participant group (e.g. by age), go to http://results.gp-patient.co.uk/report/1/rt1_profiles.aspx To break down the survey results by survey question as well as by participant demographics, go to http://results.gp-patient.co.uk/report/6/rt3_result.aspx To look at trends in responses and study the survey data by different participant groups, go to http://results.gppatient.co.uk/report/12/rt1_profiles.aspx For general FAQs about the GP Patient Survey, go to https://gp-patient.co.uk/faq 50
For further information about the GP Patient Survey, please get in touch with the GPPS team at Ipsos MORI at GPPatientSurvey_Enquiry@ipsos.com We would be interested to hear any feedback you have on this slide pack, so we can make improvements for the next publication. 51
Erewash CCG Primary Care Commissioning Committee Forward Work Programme 2016-2017 Item Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar Director Action Frequency Primary Care Commissioning Committee Theme & Trend Report of Practice Annually Visits Co-Commissioning Audit Review Terms of Reference HSS Annually Healthwatch GP comments HSS Quarterly Position Statement NHSE complaints Data HSS Quarterly Risk Register HSS Quarterly Self Certification