PPG Meeting Notes | Hillfoot Surgery

Notes and Actions from Patient Participation Group Meeting 10/03/14
Notes of Second Patient Particiption Group Meeting 27/11/2012

The second meeting of our Patient Participation Group took place on Tuesday 27th November 2012. This was attended by 6 patient representatives, the Practice Manager and Assistant Practice Manager.

Notes of Latest Patient Participation Group Meeting

Please Click Here to Download the Hillfoot Surgery PPG Notes 12th April 2017

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Please Click Here to Download the Hillfoot Surgery PPG Notes 17th March 2015

Notes and Actions from Patient Participation Group Meeting 10/03/14

the Patient Participation Group Meeting on 10/03/14 was attended by eight patient representatives, the Practice Manager and Assistant Practice Manager.

1) Welcome and introductions

Sophie welcomed two new members, and everyone introduced themselves.

2) Update on key developments at the surgery since the last PPG meeting

Staff development – we have increased capacity of the nursing team by training two members of receptions staff as healthcare assistants. They can now undertake phlebotomy (blood tests), blood pressure checks, new patient checks and are in the process of training to do health checks for patients aged 40-75s. Hopefully this has made it far easier for patients to get an appointment with the nursing team without too long to wait.
We are currently undertaking work to increase detection of diabetic patients and pre-diabetic patients (those at risk of developing diabetes unless they make dietary and physical activity lifestyle changes). We are hoping to attract additional resources to continue this active screening and also call in all pre-diabetic patients for an annual lifestyle review and blood test to check they’ve not become diabetic, and if they have, to ensure we start early intervention. By detecting and treating this condition earlier we can vastly reduce the risk of long term complications. Since starting our active screening in May 2013 we have identified an additional 46 diabetic patients and an additional 44 pre-diabetic patients.
In April the surgery are starting a new initiative, along with 15 other surgeries in North West Leeds, called the Productive General Practice Programme. This involves reviewing and scrutinising every aspect of how we work with a view to making improvements. We are employing a new receptionist on a one year contract to free existing staff to participate. Sophie and Dr Steward will take a lead for Hillfoot.

3) Results of most recent Patient Survey

The doctors and staff are disappointed with the most recent survey results. Although many patients are extremely satisfied, there were a number of negative comments in relation to reception staff attitude and our appointment system so we will focus on these areas for our development plan next year.
There is a feeling that expectations are rising and this is reflected in the results. Examples discussed include despite no changes to opening hours, patient are now less satisfied, and despite replacing all chairs in waiting room area with brand new ones, we still scored lower in this area than when we had tatty old ones!
There were 20 comments about reception staff being rude in the survey results and one group member described that he had witnessed this, although it doesn’t apply to all reception staff as many go over and above at all times. Several present stressed the value of empathy and re-assurance from all staff and the huge impact this would have on patient experience of our surgery. Sophie and Sue to monitor telephone calls and conversations they overhear at desk and make notes to inform individual feedback and future team development and training.
The surgery will prioritise customer service and telephone skills training for staff and ensure all receptionists participate in a training programme covering these areas.
The GP appointments system, which changed in November 2012, was discussed in detail. Sophie explained the rationale behind all same day appointment requests being assessed by a GP on the telephone first. The workload of primary care continues to increase however resources remain the same so we need to work smarter. As a practice we need a system that is safe i.e. the GPs have capacity to assess everyone who feels they require a doctor on the same day, and prioritise those with urgent clinical needs, rather than those who telephone first getting priority for face to faceResearch shows this type of appointment system where the GPs increase clinical capacity for more urgent cases by assessing all patients on the telephone first, is associated with lower A+E attendances. Our attendance rate is in the lowest 20% of Practices. GPs can deal with the majority of problems with telephone advice and only need to invite one in 4 or 5 patients down to surgery for a face to face consultation.
Some patients don’t like telephone appointments whereas others value them, however group members really appreciated the explanation and felt it would help if the practice make a concerted effort to share this more widely with all patients. If they understand the rationale they are more likely to be accepting and supportive of the system.
The surgery will create a display in reception, a leaflet available on reception (and ask clinicians to give out in consultations) and a crib sheet for staff to help them explain how our GP appointments system work.
The surgery are currently exploring whether we can reduce requests for appointments to discuss test results (and thus free up appointments for other things) by training one or two staff members to send a reassuring letter with a more detailed explanation of test results which are OK, so people don’t feel the need to speak to the GP for reassurance.

4) Care Quality Commission Inspections

At some stage in the next two years the surgery will have an inspection by the Care Quality Commission to assess the quality of our service.
Feedback from other surgeries who have gone through the process indicates the inspectors really like to meet PPG Members for their feedback where possible.
A few group members kindly indicated they would be willing to give feedback.
The surgery will only get 2 days notice for the inspection visit, so as and when they get the call Sue will contact group members to see if anyone is available.

5) Review of waiting times in surgery to see clinicians

a)Sophie tabled waiting times sitting in surgery for each GP. There is significant variation. Sophie to feed back to GPs and review whether we should add additional breaks to the clinics of those GPs who consistently over run.
b)Some group members acknowledged the GPs who over run do so as they are excellent listeners and give individual patients as long as they need, so they were worth the wait.

6) Issues raised by PPG Members not already covered elsewhere in agenda

The booking-in touch screen is now (in the main) working again though the surgery have turned off the facility to show if a GP is running late as it’s currently inaccurate thus misleading for patients. As soon as the computer company have rectified this problem we will switch it back on again.
Only GP face to face consultations can be booked on-line at this moment in time, though the surgery hope the computer company will improve the functionality of this product so we can open it up to wider appointment types in the future.
On-line access to medical records will become a reality by March 2015, starting with testDr Maddy is currently giving feedback on the development of this functionality nationally.
A couple of members thanked the surgery for doing a fabulous job.
Members felt it would be helpful if a GP was present at the PPG forum. Sophie has raised this with the GPs since the meeting and they are in agreement that it is a good idea, and will attend future PPG meetings in rotation.

7) Summing up and closing remarks

Sophie thanked everyone for attending and for sharing their valuable feedback.
In the next few months, along with other surgeries in the Clinical Commissioning Group Area, we will be installing an IPAD in our waiting area for patients to complete a questionnaire and give feedback in relation to any visit. This will provide this group and the surgery with some very valuable information to review and discuss at future meetings.
Our next meeting is due to take place in September. Details to follow nearer to the time.

8) Summary of Action Agreed for 2014/2015

Practice Manager and Assistant Practice Manager to monitor telephone calls and conversations overheard on reception desk to help inform future team development and training, with a particular emphasis on the importance of empathy and reassurance.
The surgery will prioritise customer service and telephone skills training for staff and ensure all receptionists participate in a training programme covering these areas.
The surgery will create a display in reception, a leaflet available on reception (and ask clinicians to give out in consultations) and a crib sheet for staff to help them explain how our GP appointments system works and why it is set up the way it is.
GPs to attend future PPG meetings in rotation.

Notes and Actions from Patient Particiption Group Meeting 26/03/13

The Patient Participation Group on Tuesday 26th March 2013 was attended by 8 patient representatives, the Practice Manager and Assistant Practice Manager.

1) Welcome and introductions

Sophie welcomed everyone to the meeting and introduced our new member. A brief overview was given on the purpose and history of the group.

2) Update on areas identified for action at last PPG meeting

Appointments system – alterations to the appointments system in November 2012 to provide a quicker response to requests for same day appointments has received mixed feedback from patients in our survey. Group members fed back their own personal experiences of receiving a ring back from the GP who may deal with their problem on the phone or invite them down to surgery. On the whole experiences were very positive and they felt it was working well, gave them a quick response and made better use of scarce GP time. The issue of how suitable this system is for patients who don’t speak English as a first language was raised. Sophie and Sue to discuss this with the GPs to see if there is a way we can make it easier for this particular group to access a GP in an appropriate way. Some patients are still confused with how the new appointments system works, perhaps caused by different staff explaining it in different ways, so the surgery will develop a standard script for staff so they all explain it in the same way.
Making our front of house more welcoming. Since the last meeting we have taken simple steps to make our front of house more welcoming. Staff now introduce themselves by name when answering the telephone and we are in the process of getting new name badges. This has received very positive feedback from patients.
New clinical computer system – on the 29^th April the surgery will be switching to a new clinical computer system, EMIS web, to house all of our patient medical records and appointments system. This is a major change and will potentially cause some disruption to our service as we switch over. Plans have been put in place to minimise pressure during this time including increasing GP and nurse capacity in the week beforehand, and issuing 2 months of medication for those patients on regular repeat medication for whom it is safe to do so, so they don’t need to contact the surgery during this time. Patients currently signed up to our on-line appointments and prescriptions services (39%) will need a new password and login for the new system. The surgery are currently working out the best way to manage this change to minimise inconvenience toOnce we are up and running with the new system it should provide additional functionality which will benefit patient care.
Lighting on paths approaching to surgery was raised as a priority area last time. Since this meeting we have sought a quote for low level lighting on bollards along the paths approaching the surgery however due to the major ground work required to install the outside cabling this is expensive so may not be feasible. We are exploring whether ther are more economical viable options to improve the lighting on the side of the building that will not produce a glare for patients as they approach. At the same time due to a number of recent incidents we are currently exploring ways to improve security at the surgery.
Access to nursing appointments – further to the last meeting when some group members fed back they struggled to get a timely nurse or healthcare assistant appointment Sophie reported that from the start of July we are planning some minor adjustments to our nursing skill mix which should enable us to generate an additional 3 hours of clinical time per week within the nursing team. Hopefully this will improve access for patients.

3) Review of Results of Latest Patient Survey (February 2013) and identification of action required

Our overall score for the patient survey in 2013 is 71%. This is in line with the national average (1% below), but slightly lower than our scores in 2 previous years. The results are a little disappointing given the efforts made to address poorer areas from previous years, however the national average score has dropped this year, indicating patient expectations are rising and services are becoming more stretched. Many group members were surprised by the results as they personally felt there had been many improvements.

Areas where our current score is 5% or more different from the national average are:

Ability to see GP within 48 hours – we score 7% below the national average indicating this in as area to review. The reasons for this were discussed and it was felt it may reflect poor understanding of how our new appointments system works. It was agreed it would be helpful for all staff to have a common explanation of the new appointments system so patients understand all options available.
Ability to speak to GP on phone – we score 8% above the national average in thisIn recent years we have vastly increased the number of telephone appointments to make it easier for patients to access a GP and to save a trip to surgery for simple queries where a face-to-face appointment is not necessary.
Ability to see practitioner of choice – we score 10% below the national average and 12% below out best score for this area in 2008 which was achieved through making our appointments system moreThis is an area to review and it may also be improved by a better understanding of how our appointments system works.
Time for visit – we score 5% above the national average for this area indicating GPs give individual patients the time they require in consultations rather than rushing. This may though adversely affect the waiting time in surgery.

The areas with highest number of ‘poor’ ticked in the survey, suggestion particular frustration, are:

Seeing GP of choice – 17
Telephone access – 12
Seeing GP within 48 hours – 17
Waiting time – 12

The telephone access was discussed in detail as we scored lower than last year despite doubling the phone lines into surgery from 2 to 4. Since increasing our incoming lines, 31% more incoming calls are being answered (these were previously getting an engaged tone), the call attempts into surgery have dropped by 50%, and 774 extra calls are answered each month, all of which suggest phone access has in fact improved. Given these facts the group discussed possible causes of phone frustration. The surgery will review the waiting time until calls are answered as patients may find it reassuring if the message letting them know someone will be with them as soon as possible, starts a little sooner than at present.

Waiting time and ability to see the GP is still the area where patients are most dissatisfied both at Hillfoot and nationally. The group agreed it is helpful that patients are now informed of overrunning clinics via our patient information screens (a suggestion from this group in Feb 2012). A few years ago we introduced catch-up breaks in clinics to reduce the likelihood of patients being kept waiting by appointments overrunning, and made our appointments system more flexible to help patients book a consultation with their GP of choice. We will re-audit these areas to see if improvements can be made, and feed back findings to the PPG in autumn.

A few years ago we scored below the national average for patients under the age of 25. We now score above the national average for this age group indicating our services now meet the requirements of a broader age range.

The group agreed the following as priority areas for action arising from the survey, and the surgery will report on at the next PPG meeting due in October 2013:

Review waiting times in surgery to see GP – surgery to undertake an audit of current waiting times by GP and if any particular patterns that could be addressed by regular ‘catch up’ breaks.
Keep monitoring telephone activity closely and reduce the time it takes for a reassuring message to be played if staff are unable to answer a call straight away.
Continue to promote making our front of house more welcoming. The new personal greeting sounds great.
Train reception staff to give a standard simple explanation of the appointments system and always explain all options to patients – as well as making our surgery more welcoming this may help patients to see their GP of choice and improve satisfaction with the appointments system. When all options are currently carefully explained it’s excellent, so it would be great if it happened across the board.

4) Issues raised by PPG Members not already covered elsewhere in agenda

Sophie and Sue asked for any other feedback on the surgery or issues group members would like to raise.

One member had experienced coming in and nobody being on reception and they waited for a few minutes. Sometimes staff on the phones are unable to come to reception immediately however it would be nice if they can politely acknowledge they know someone is waiting. Sophie and Sue to take this simple and effective suggestion back to staff.
The surgery to check whether ‘pick up in person’ is an option patients can tick when ordering prescriptions on-line and if not, to add this.
Several group members kindly fed back what a great surgery they feel Hillfoot is compared to stories they hear from friends registered elsewhere.
Group members enquired whether the number of missed appointments each month is improving. Sadly it remains at around 100 per month despite a system to identify and write to patients who regularly miss appointments. The new clinical computer system will include the functionality to text patients to remind them of their appointment and this may help to address the problem.
An update was given on the new NHS 111 service. This has replaced NHS Direct and West Yorkshire Urgent Care Services. Patients with an urgent healthcare need can now call 111 at any time of day and night to receive advice.
Excellent childhood immunisations uptake rates were discussed and the group congratulated the surgery on this achievement.
The group agreed it would be helpful to encourage as many patients as possible to feed back their comments to this group. Sophie and Sue to make a notice for the reception desk encouraging them to feed these back via our comments box.
Group members to share one another’s contact details

5) Summing up and closing remarks

Sophie and Sue thanked members for attending and sharing their valuable views and feedback. The next Patient Participation Group meeting is due to take place in October 2013. Further details will be shared nearer the time.

Notes of Second Patient Particiption Group Meeting 27/11/2012

The second meeting of our Patient Participation Group took place on Tuesday 27th November 2012. This was attended by 6 patient representatives, the Practice Manager and Assistant Practice Manager.

1) Welcome and introductions

Sophie welcomed everyone to the meeting and thanked them for attending.

2) Update on areas identified for action at inaugural PPG meeting

A new telephone system was installed in September. This has doubled the number of phone lines (now 4 incoming lines and 4 outgoing lines) so hopefully it will now be easier for patients to get through on the telephones. Group members fed back their thanks.
The surgery haven’t as yet addressed the problem of how we inform patients of test results after it was reported that this can take time and be very unclear. When we get a new computer system in April/May we may be able to text results to patients at the point the GP views these, and whether or not further action is required. This should make results far quicker and clearer for patients with a mobile phone, though we still need to improve the current system for those without a mobile.
Dr Maddy and Sophie have now developed a surgery website and are grateful to members of the PPG for their constructive feedback. As well as providing useful information about the surgery patients are able to book appointments and repeat medication online via the site. The group discussed whether those using online facilities were at a slight advantage over patients booking appointments by telephone. If they log on before 8am in the morning technically they are because they can book appointments that have become available at midnight that other patients can only access when the surgery opens at 8am.
Yesterday the surgery introduced a new way of managing requests to see a GP on the same day. This has taken a lot of planning and has been implemented in response to feedback from PPG members at our last meeting in relation to poor response times for requests for urgent ring backs, increased GP workload, and a recognition by doctors that when demand for appointments is particularly high the current system can be dangerous as the on call GPs simply don’t have the capacity to deal with all requests in a timely manner. 2/3rds of GP appointments remain pre-bookable, however all patients requesting a same day appointment receive a telephone ring back from the GP. All GPs help with these early in the morning so they are able to deal with simple things quickly on the telephone, and prioritise and give enough time to patients with more complex needs who require a face to face appointment. On a Monday there is approximately 6 hours worth of GP ring-back time in the morning (spread over 4 GPs) and 3 hours on other days.

Yesterday was the first day of the new system and it went relatively well. We plan to learn and tweak the system as we go along.

Members of the group reported how reassuring and convenient it is to be able to get a relatively quick ring back from the GP. One member also reported how much she had appreciated having all her options for an appointment explained by a staff member e.g. ring back today, face to face another day etc. Sue and Sophie to feed this back to staff.

The patient self-check-in screen has now been updated to keep patients informed of waiting times if GPs over-running. Some members also reported that it reprimands them if they arrive late! Sue and Sophie had been unaware of this.
Making our front of house more welcoming was identified as a priority last time and since then 2 team members have attended a customer care course. 4 team members attended a course earlier this month that was advertised as telephone handling techniques, however on the day it was a self defence course so the surgery were understandably cross at having been misled. Group members suggested some simple ways we could make our front of house more welcoming – staff to wear name badges, and to always start phone calls with a ‘good morning/afternoon Hillfoot Surgery, (name) speaking, how can I help?’. All agreed this was a good idea. The surgery will look to implement this in the new year.
Practice profile information is now included in new patient information packs.
Patient survey – Sophie reported that the surgery has decided to delay this until end of January/early February to give the new phone system and new appointments system to settle in so we can see if they have an impact on the satisfaction scores.

3) Update on Other Surgery Developments

Sophie reported all waiting room and consultation room chairs have been replaced as old ones were getting worn and did not meet new infection control requirements. A discussion about infection control took place including minimising magazines and only having wipeable/cleanable toys in the waiting area.
All internal lighting has been replaced to improve ergonomics and be more environmentally friendly.
We are changing our clinical computer system in April/May. This will be a major operation for the surgery which although painful at the time should bring long term benefits to how we can manage care for patients as the new system will have increasedThe surgery has narrowed it down to two potential new providers and is currently undertaking an option appraisal.
From September we started to take 4^th Year Medical Students five times a year. We have 4 at a time for 3 week blocks. While with us the students are learning about the management of patients with long term conditions and palliative care and spend time shadowing GPs and nurses, and visiting patients and their families. Two members kindly said they were willing to get involved with our students.

4) Issues raised by PPG Members

Poor lighting in the car park and paths approaching surgery were raised by group members. The surgery has invested heavily in other areas over the year including the phones and upgrading all internal lighting, though will ask an electrician to review outside lighting to see if we can find an affordable solution.
Two members raised they have struggled to get a timely appointment with the Healthcare Assistant (HCA) recently. Sophie explained some members of the nursing team may soon reduce their hours which means if we replace with a HCA, who can do 70% of what a nurse can do, we would be able to slightly increase overall capacity of the nursing team whilst keeping the cost the same.
One member asked if there were long term plans for patients to be able to access their medical records to see past results/procedures etc. Sophie reported this is currently being developed at a national level and is likely to be a reality within 5 year. Watch this space.
One member gave very positive feedback about the medication reviews undertaken by Boots Pharmacy on Galloway Lane.

5) Summing up and closing remarks

Sophie thanked group members for attending and once again sharing their valuable feedback. The main priority for the surgery to address between now and the next meeting will be to make our front of house more welcoming. The next meeting will be scheduled for the end of February/mid March when we have the next set of patient survey results.

Notes of Inaugural Patient Particiption Group Meeting 29/02/2012

The inaugural meeting of our Patient Participation Group took place on Tuesday 29th February 2012 and was attended by 8 patients, the Practice Manager and Assistant Practice Manager.

1) Welcome, introductions and ground rules

Sophie welcomed members of the group to the inaugural meeting of the Patient Participation Group (PPG) and thanked them for attending. The group agreed ground rules and members introduced themselves.

2) Remit of the group

Sophie (Practice Maaner) outlined the remit of the group which is to discuss the results of the annual practice survey and share personal experiences to identify what is important for patients at Hillfoot and to help develop a realistic action plan to improve our service.

3) Review of patient survey results and experiences of group members

Dr Sixsmith attended for part of this session and thanked members for giving their valuable time and input.

The group discussed the results of the patient survey which had been previously circulated, and added their own personal experiences.

a) We are in line with the national average for our survey results, which is a good starting point. Results of the most recent survey also show that younger people are more satisfied with the service than in previous years.

b) Difficulty getting through on the telephones, especially first thing in the morning, was discussed. Sophie explained that the surgery has a call analysis service and is aware of this problem. The surgery set up online services for booking appointments 2 years ago to try and reduce pressure on the telephone system. This does not appear to have reduced pressure but has nevertheless been welcomed by many patients. 30% are now signed up to the service and about 30 appointments a week are booked online. The surgery is currently reviewing the phone system. This was welcomed by the group but caution was expressed against long queues.

c) Some members had experienced difficulty getting to see their GP of choice within a reasonable timescale whereas others, who were able to be very flexible in when they attended, had not experienced this. Dr Sixsmith explained if patients require a GP urgently rather than being able to book a routine appointment in advance, they may need to see an alternative GP.

d) The group consensus was that the medical care received from the doctors at Hillfoot is very good. The survey highlighted time waiting in the waiting room to see a GP to be an area of frustration both at Hillfoot and nationally. The flip side to this is that patients say that GPs at Hillfoot give plenty of time when they do see them and patients value this. It was agreed it would be useful to keep patients informed if GPs are over-running, especially those with young children who tend to get easily bored and restless. Sophie to investigate the feasibility of alerting patients to over-running clinics on the patient call screen and the booking in screen when patients arrive.

e) The availability of appointments was discussed. In a typical week we have in the region of 500 GP appointments (a mixture of face to face and telephone). 2/3rds of these are bookable in advance and 1/3 are bookable on the day to accommodate patients who require urgent medical attention. If these have all been booked patients who require advice from a doctor on the same day are offered a ring back with the on call GP who triages these to ensure clinically urgent cases are seen.

One member shared an experience where the seriousness of her pain was not picked up by reception staff. She contacted the surgery after all appointments for that day had been booked by other patients and was told she would have to wait until 4pm for the on call GP to telephone. Her but her condition was too serious to wait that long and was escalated by another part of the healthcare system. This highlights the way we managed this call that day did not flag it’s urgency. The surgery will review this area.

Alternative options to manage high demand for appointments were discussed including sit-and-wait clinics and GPs triaging all calls requesting a same-day appointment, not just those that arrive after appointments already booked by other patients.

f) Members reported mixed experiences of reception staff. Some have always received friendly, helpful and compassionate care whereas one or two reported they had experienced an unhelpful attitude. The surgery to review how we can make our front of house more welcoming. Some group members fed back they had witnessed some patients being very rude and unpleasant to reception staff, and acknowledged this must be very difficult to deal with.

g) Examples were shared which highlighted the system for getting test results isn’t always clear or consistent.

In one case a message asking a patient to arrange to see the GP to discuss test results was left on an answering machine. As well as the risk of not picking up the message (as happened in this case) there is potential for a breach of confidentiality. Sophie confirmed staff should not leave messages. Instead if they cannot speak to the patient direct, a letter should be sent. To review this with staff.

Another member described recent difficulty getting test results for her child. There appears to be a lack of clarity on when to call for results/whose responsibility it is to call. Dr Sixsmith confirmed patients should call for their own test results, and we need to be clearer on letting them know realistic timescales in which to call. The surgery also need to ensure staff give a clearer message to patients who call before their result has been received and reviewed by the GP.

h) One member who is a relatively new patient found the practice profile circulated before the meeting very useful and suggested this could be given out to new patients. The group agreed this is a good idea.

i) The surgery website (currently in development) was discussed. This will aim to keep patients better informed about our services as well as being an access point to book appointments and order repeat prescriptions online. It is being created in-house so we have the skills to keep it up to date on a daily basis with important messages for patients. Group members with internet access kindly agreed to give feedback before we advertise it to the wider practice population.

4) Action plan

The following areas were identified for action:

a) Review of telephone system

b) Review of how patients are informed of test results

c) Development of website – group members with internet access to kindly give feedback on draft website Sophie and Dr Maddy are currently developing.

d) Review handling of urgent calls/requests for same day appointments.

e) Keeping patients informed of waiting times if GPs over-running

f) To review how we can make our front of house more welcoming.

g) Give practice profile information to new patients

h) Agreed to continue to use the existing patient survey as a useful tool to give honest year on year feedback on how we’re doing. Plan to re-survey in June/July.

5) Summing up and closing remarks

Group members were thanked for attending and giving their honest and valuable feedback.

The next PPG meeting will be scheduled for September. Group members agreed a Tuesday night at 6pm is a relatively good time. To increase the time to 1 ¼ hours.