Guildhall Surgery

UPDATE MARCH 2012

Guildhall Surgery Patient Forum Group Report

This report summarises development and outcomes from the Guildhall Surgery Patient Forum Group (PFG) in 2011/12.

It contains:

Profile of the practice population
The process used to recruit to our Patient Forum Group
The Priorities for the survey and how they were agreed
The method and results of the Patient Survey
The Action Plan that was agreed and how it was agreed
The progress made with the action plan so far

1. Profile of the practice

The Guildhall Surgery is situated in the small rural town of Clare. It is a single site practice consisting of approximately 5,100 patients. The practice offers an average of 2,300+ appointments per month across the 3GP partners, 3 Nurses, Health Care Assistant and salaried GPs. The practice population is broken down into the following age group percentages as follows:-

Ø 0-16 16%

Ø 17-35 15%

Ø 35-54 27%

Ø 55-74 33%

Ø Over 75’s 9%

On average 50.5% of the population is female, 49.5% is male. A high majority of the practice population record their ethnicity as British White.

PFG Profile

The Patient Forum Group consists of 12 members recruited from all local areas and age ranges around Clare. The Forum Group age range is representative of the practice population age range as follows:

35-54 25%, 55-74 66%, 75’s and over 1%.

The practice continues to encourage membership of the under-34 years age group by offering access to the Forum Group via email and postal attendance. However, at this time we have not been able to encourage ongoing involvement. Previous members of the Forum Group who were in this age range have felt unable to remain as members due to their work commuting and family/life commitments. The practice continues to promote and encourage membership from this age group.

Members of the Forum Group who are parents to children from 0-17 years act as representatives for this age group.

Members of the Forum Group are representative of the ethnicity, parental, gender and disability status of the practice population.

Forum meetings are held at regular intervals across the year during March, June and November.

Patient Forum members receive minutes, information updates via post or email or local publications.

As agreed at the March 2012 meeting in order to expand feedback to the PFG from members of the patient population, a notice will be displayed in the reception area inviting patients to write in to the forum group via the Practice Manager with their comments. This will then be circulated to the PFG ready for the next meeting and feedback will be forwarded to those patients following the meeting.

The Forum Members have not given their permission for their personal details to be published.

2. The process used to recruit to our PFG

In order to recruit to our PFG the surgery provides the following information:

Posters in Practice – Posters are displayed throughout the practice inviting patients to apply in writing to join the PFG.
Information is also available on the practice website and in the practice leaflet
Word of mouth - patients are encouraged to apply following discussions with the Partners or Practice Manager

3. The Priorities for the survey and how they were agreed.

The Practice discussed the survey at Patient Forum Groups. Concerns were raised at each Forum Group meeting from as early as 2007 regarding the high incidents of DNA’s or Did not Attend appointments lost across all clinicians throughout the practice. Comments were also regularly noted from patients attending the surgery who observed the monthly DNA figures displayed around the practice.

As DNA is an area that occurs daily across all clinicians throughout the surgery and has a large impact on patient access it was agreed with the PFG in July 2011 that this would be an ideal access topic to survey. By focusing on all DNA offenders, it was felt that a message might get through to the persistent offenders thus alleviating pressure on the appointment system. A questionnaire was compiled and agreed with the PFG. This was sent out to patients who DNA’d appointments over a set period. The results of the survey were then compiled into a report and forwarded to all PFG members for the next meeting.

4. The method and results of the Patient Survey

Once we had established the priorities we developed the survey using the following:-

Letters written to each patient who DNA’d
Included with the letter a survey and SAE which investigated the circumstances behind the DNA

We carried out the survey between 13 July and 21 September 2011.

Survey Results

· 64 appointments were identified as DNA appointments

· 54 different DNA patients between these dates were identified and sent a questionnaire:

2 of these patients each DNA’d 4 appointments over the period

Others had DNA’d a treble or double appointment, or 2 single appointments

‘Within family’ patterns occurred twice, one family having learning disabilities

· Of the 54 different patients who were sent a questionnaire

22 (41%) did not respond

32 (59%) did respond

· Of the 32 patients who did respond:

7 replied by telephone and these all occurred over the first 2-3 weeks (reason unknown)

2 or 3 of these responses were either strident or abusive towards our practice Staff

1 patient telephoned to dismiss 1 of 4 appointments made and missed by a family member

1 telephone respondent reported a loss of a family member (identifying a danger of broad postal surveys)

· Of the other 25 patients who returned the questionnaire (this list not being additive):

16 patients reported that they simply forgot (15 patients)

5 patients made (potential) patient errors

7 patients suffered (potential) receptionist errors

1 patient could not get through by telephone to cancel

1 patient cited their motor accident

1 patient cited becoming acutely unwell at home (and so forgot to cancel)

1 patient was in hospital

1 patient tried to attend and was so late that he/she gave up

These DNA Patient Survey results where then circulated to all members of the Patient Forum Group for discussion.

5. The Action Plan that was agreed and how it was agreed

In order to develop the action plan the PFG met on 2^nd November 2011 and the following actions were agreed with the group.

The 4 main actions agreed:

1. Improve recording; a spreadsheet will be formatted to record what type of appointment was DNA’d (OTD - on the day or long term), the frequency of the patients DNA’s and any other relevant information pertaining to each appointment.

2. Rather than publicising the DNA’s, the frequency of total appointments available will in future be displayed in the surgery.

3. The practice will undertake a publicity campaign push and target local parish magazines.

4. A letter will be sent to any patient acquiring 2 DNA’s within one month period. Prior to these being sent the Manager forwarded a draft copy of the first DNA letter to be used to all the forum group members for discussion and feedback.

Following a Partnership meeting it was agreed to extend the period of criteria for 2 DNA’s from one month to one year as one month, as one month would be very restrictive and will not include very many DNA patients. The PFG members were notified of this change in writing on 14^th December 2011.

The format of the first letter to be sent from 1^st January 2012 and the amendment to the threshold period was agreed with the forum members via post.

The areas where we could not achieve what the PFG wanted were:

Not all patients who DNA’d twice within one year were appropriate for the letter (family deaths, admission to hospital). It was therefore agreed with the PFG on 1^st March 2012 at the spring meeting that these criteria’s should in future be approved by each GP.

The areas where there were significant changes to our services were:

From 1^st January 2012 DNA’s are recorded on a daily basis on a spreadsheet, details of the type of appointment DNA’d are discussed regularly with the Practice Manager. The names of those patients who fit the criteria for a 1^st letter are forwarded to the GP and on approval the 1^st letter is sent out. The practice will display in reception areas the monthly total number of appointments available. The practice will target local publications detailing the loss of appointments through DNAs and the appointment availability at the surgery, requesting patients advise the surgery in good time if they are unable to attend their appointment where possible.

6. The progress made with the action plan

In summary, the progress made will only be defined after a period of time by comparing monthly numbers of DNA appointments from January to December 2011 to January to December 2012 (ongoing).

Any progress made with the action plan can then be evidenced.

The PFG is due to meet again Tuesday 3^rd July 2012 where any progress achieved so far will be reviewed. The practice intends to continue with these actions, to continue to review with the PFG the outcomes and will publish a report in 2013 to evidence improvement performance over the previous year.