Wrafton House Surgery

Directed Enhanced Service

REPORT

2013 – 2014

Wrafton House Surgery
9-11 Wellfield Road
Hatfield
AL10 0BS
Report Completed by 
Sylvia Lane
Practice Manager

Index

1.	Introduction							Page 3 /4

2.	Patient Statistics							Page 5

3.	Summary of Results of both surgeries			Page 6

4.	Opening Times           						Page7

5.	Ann Willson Chair of Patient Participation Group	Page 6

6.	DES Components & Key Priorities				Page 9

7.	Patient Comments on Surveys   				Page 10   

8.	Recruitment							Page 13

9.	Demographics 							Page 14

10.	Appendix 1  Appointments					Page 15

11.	Appendix 2 AGM Invite					Page 16

12.	Appendix 3	Practice Action Plan				Page 17

13.	Appendix 4 Training Session					Page 18

14.	Appendix 5	Diabetes Questionnaire				page 19

Wrafton House
Introduction

Patient  Participation Group  (PRG) DES Report
This is year 3 and the  key objective of the DES is to ensure that patients are involved in decisions about the range and quality of services provided by the practice.
Access to General Practitioner services can have many dimensions.  However, the relevance and importance of these can and will vary between practices and their particular patient demographics.  Wrafton House operates an open list and is happy to accept new patients.

As reported last year at the start of this two year Direct Enhanced Service, (DES), Wrafton House has had a very active and supportive Patient Participation Group for nineteen  years now but we were very keen to actively encourage a Patient Reference Group which we hoped would  include a much wider variety of patients who might not have had as much time as some members of our PPG.  Although every patient registered at the practice is automatically a member of the Patient Participation Group, we have 10 committee members and 107 who contribute in other ways. We will continue to invite PRG members and send them newsletters with the hope that in time they may become more involved with the PPG. 

Dr Eric Sherrard who very kindly analysed the GPAQ survey for the practice each year since 2003 is now unable to continue with this task due to ill health.
The General Practice Assessment Questionnaire (GPAQ). GPAQ is a patient questionnaire which was developed at the National Primary Care Research and Development Centre at The University of Manchester for the 2003 GP contract. Building on several years of development and testing, GPAQ helps practices find out what patients think about their care. It specifically focuses on aspects of general practice that are not covered elsewhere in the Quality and Outcomes Framework - for example, access, inter-personal aspects of care and continuity of care. (www.gpaq.co.uk) 
After discussion with the partners in the practice  it was once again agreed  to use the GPAQ Questionnaire Version 3.  By using the same questionnaire it is much easier to compare the results to previous years and to present the findings to staff and doctors at an in house training session. As previously stated, Dr Eric Sherrard was not available to analyse the results this year.  We would like to take this opportunity to thank him for his hard work and dedication to Wrafton House since the PPG was formed in 1994.
CMI Publishing were chosen to analyse the results again for this year and produce the reports for both Wrafton House and our Branch Surgery in Northdwn Road. This ensures continuity.

The questionnaires were handed to all patients who had doctors appointments booked during a two week period in June 2013. We decided this year to change from November to June to see if this change of date would result in any different outcomes.
As you can see from the results no marked changes were apparent. 

These appointments were both routine and advanced access appointments (same day). Wrafton House and Northdown Road surgeries were both involved in the survey.  

As the questionnaires were given to all patients who attended for appointments we feel that it would be fair to presume that the breakdown in ethnicity and demographics would be a fair and accurate representation of our practice population. This is confirmed by the analysis below. The number of questionnaires completed was  368  which far  exceeded the required number of 250. It was also a greater number  than in previous years

PATIENT SURVEY STATISTICS

Ethnicity of Patients Filling in Questionnaires
GPAQ V2 
National benchmarks	GPAQ V2 
	GPAQ V3
Our practice results	PRG Profile	
%white	92.2	81.2	74%	
%Asian/Asian British	3.7	5.0	7%	
%Black/Black British	1.8	5.3	8%	
% Mixed	1.1	1.3		
% Chinese	0.3	0.8		
% Other Ethnic Group	0.9	1.3	10%	

Gender
GPAQ V2 
National benchmarks	GPAQ V2 
	GPAQ V3
Our practice results	PRG Profile	
% female	64.7%	73%	66%	
% male	35.3%	27%	39%	

Long standing Health Condition
GPAQ V2 
National benchmarks	GPAQ V2 
	GPAQ V3
Our practice results	
% long standing health condition	49%	60.3%	

Employment
GPAQ V2 
National benchmarks	GPAQ V2 
	GPAQ V3
Our practice results	
% employed	48.4	38.1	
% unemployed	2.5	6.3	
% in full time education	3.4	0.0	
% unable to work/long term sickness	7.2	12.7	
% looking after home/family	9.6	17.5	
% retired	27.5	20.6	
% other	1.6	1.6	

Short  Summary of results combining both surgeries

2103 (2012)
 98% (97%)  of our patients found our receptionists helpful or fairly helpful

67%  (77%)  found it easy or fairly easy to get through on the phone

69%  (73%)  said if they needed they could get an appointment on the same day

80% (82%)  say the practice is open at convenient times

96%  (95%) had total confidence in their GP

91%  (91%)  say their experience of our surgeries is good, very good or excellent.

95%  (93%) would recommend us to someone who had just moved into the area

Comparing the results above for (2012) and 2013:
	getting through on the telephone has gone down along with     
            being able to see a GP on the  same day.
 
The rest of the results are very similar over the two years. 

One of our priorities was to see how we could improve our patients’ experience of being able to get through on the telephone. As a result of this we now have three receptionists taking telephone calls and dealing with the front desk at the busiest period first thing in the morning.  We are also offering internet booking for routine appointments with a doctor, cancelling appointments and ordering repeat prescriptions.

Opening Times

Surgery opening times are as follows:

Wrafton House 
You can telephone the surgery  between  8.00 a.m.  – 6.30 p.m.
The surgery is open between 8.30 a.m. – 6.00 p.m.

Extended Hours  3rd  Saturday each month 8.30 a.m. -11.0 a.m.  and 
Monday evenings 6.30 p.m.  – 9.00 p.m. except for the Monday prior to the Saturday opening.

When closed Herts Urgent Care covers emergencies

Telephone  number 111

Northdown Road
The surgery is open Monday – Friday mornings 8.30 a.m. -12.30 p.m.
Monday, Wednesday and Friday evenings 3.30 p.m.  – 6.00 p.m.

When closed the telephones are answered by Wrafton House reception staff.

On receipt of the reports, this year, our Practice Manager analysed the results and these results were presented to all members of the staff and doctors by Dr Constable at our in house training session on 14th November 2013.

Sylvia Lane, our Practice Manager, presented the findings to our Patient Participation Group Committee at their meeting on Tuesday 25th March 2014.

Friends of Wrafton House
Patient Particiaption Group
Registered Charity No 1063522

2013 GP Patient Survey

The  committee of the Patient Participation Group discussed the 2013 Survey results at their meeting on 25th March 2014, after a presentation by Sylvia Lane, the Practice Manager.
 
The majority of patients were happy with the service that they had received  from the practice.  Receptionists try to get patients to see the requested doctor, whenever possible.

Overall, the patients appreciate the care taken by all staff to help them as much as possible. Staff do work to patient’s needs, not the clock, so unfortunately longer waits do happen and this can upset and worry some patients.  The Group is pleased that the staff ensure that the patients have the best available assistance to deal with their particular problem.

You will shortly receive the minutes of the committee’s meeting to confirm our appreciation of the Practice and its survey results.

Yours sincerely,
Ann Willson, Chair

The Survey Results were discussed at the PPG Committee Meeting 
on 25th March 2014 held at Wrafton House.

Extract from the minutes of the Patient Participation Group Committee Meeting held at Wrafton House on Tuesday 25th March 2014.

The committee members were very pleased with the results.

Patient Survey Analysis:  Sylvia, Practice Manager,  did a presentation to the committee on the 2013 Patient Survey results. There was also comparison with the two previous years’ reports. As a result of patients reporting having problems getting through on the telephone, the practice has added an extra receptionist and telephone line during the busy first hour each morning to improve the service to patients. The results appear to show that when patients complete the national survey, which they receive in the post, the results are less favourable than when handed to patients to complete after a consultation with a doctor. On a trial basis, the new appointments are now released on a Monday morning and Thursday morning. 

DES COMPONENTS

1.	The Patient Reference Group (PRG)  was established in 2012 but it  is disappointing that members do  not respond  to being asked to comment on the results of the patient surveys or to invites to the Annual General Meeting which is held in June each year.  Only one person replied sending their apologies. We will continue to invite the PRG members and would be delighted if any of them could attend.

2.	The Patient Participation Group have regular committee meetings which are attended by Dr Constable, the Practice Manager and the Reception Manager. Three members of the committee also attend our Management Team meetings quarterly and any issues which arise are discussed and if necessary acted upon. We will be e mailing our PRG regularly with newsletters and inviting them to join our PPG.  

KEY PRIORITIES

As a result of feedback, comments from our survey and discussions with the Patient Participation Group,  the following key priorities were implemented.

1.	Use of the internet for on line booking of appointments, cancelling of appointments and ordering repeat prescriptions. 

2.	 An extra receptionist is being used first thing each morning to help with the telephones and the desk. This enables more patients to get through on the telephone.

3.	Dr Attia Noor was appointed as a half time partner to make more appointments available.

4.	Refurbishment of both surgeries has been completed.

5.	Installation of new telephone system to improve access. This was installed in 2013.

6.	Customer Service training for staff.

We will continue to monitor our patient experience with the analysis of our annual GPAQ surveys. 

The Wrafton House Patient Participation Group are members of the National Association for Patient Participation and a Registered  Charity (Number 1063522/0)

They will be holding their Annual General Meeting in MayJune 2014.  We will be inviting all members of the  Patient Participation Group  and the  members of Paitent Reference Group  to attend this event.  This year we will be inviting someone from Age UK or Health Watch to address the group.

See Appendix 4
Patient GPAQ Survey 2013
Patient Comments

Dr Constable
The speaker system is not very clear.
I think this is the best GP practice in Hatfield. 
This is an excellent surgery I would recommend to anyone.
At W/E it would be reassuring for us older people to have some point of contact with the practice when things medically worrying but not sufficiently to warrant a 999 call.
Excellent as always.
This is only the first time I have been to the practice so found answering the questions  after one visit difficult.
Very hard to speak on phone line. 
Do not like being told by secretary you have only 5 minutes or you can only discuss one medical problem when of course several ailments may be caused by one problem. The more information a doctor receives helps him diagnose problem.
Okey (sic)

Dr Kelley
I’ve had to wait two weeks for this appointment it would be better if you didn’t have to wait so long.  My previous surgery allowed you to book on the day for any DR.
Receptionists, GP’s and Nurses all work very hard – it’s just getting an appointment with a doctor of my choice.
Receptionists rude and unhelpful at the best of times. They seem like they don’t want to be here and generally cold towards everyone even on the phone. When I’ve been waiting in reception, they just sit there and the phones ring.  The doctors usually very good here and the nurses good as well.
Please we need appointments when we are ill, not when we come out of our illness. Please arrange appointments when are needed not when you got booking dates.
Enable to make appointments with a doctor at the time of call.  Usually have to ring back again as the computer isn’t available to make dates in the near future. We are all busy people.  I personally don’t wish to see a doctor UNLESS I need to!!

Dr Jain
Too many appointments are made by reception for the same time hence a long waiting time.
Booking appointment through phone is difficult. It takes a long time to get connected.
The doctor and nurses I see I think are good/excellent – the system of making an appointment on the day (ringing non stop for 30 mins)  I think is “pants”
When you go to use telephone surgery virtually  impossible to get through. Sometime you have to wait nearly 45 mins 1 hour to see doctor

Dr Shah
Would like to see same doctor each time to ensure same continuity of care. My favourites keep leaving!  Would like out of hours care from this surgery not a stranger. More staff on reception at busy times
Appointment system is no different to when surgery was in Common Road or original surgery in St Albans Road. A period of many years.
I work until 16.30 Monday – Friday and find it ridiculous I have to wait 2 weeks for an appt from this time onwards. Then I have to wait over 30 mins before getting seen.
The receptionist I saw at 4.20 pm today (23.06.13) was quite rude. She kept talking to other nurses instead of attending to patients. They are usually also quite unfriendly and cold on the phone! If I had my way I will see another GP Only reason I still come is quite close to  my house. The doctors are excellent!!!
This GP practice is very good.  The only problem is getting an appointment. You have to wait half a day to get urgent appointment (especially for children) which affects those who go to work.  Bookable appointment is too long as well.  The time GP calls to the patient to assess the situation can be used to see 1 patient instead???
I work in London and as a result it is very difficult to get an appointment. I also don’t think it is appropriate to have to explain to the reception what I need to see a doctor or nurse for.
Like most they do the best they can – they are not always supported by the Trust. From my experience was better 8 years ago.
Service at desk always good. Follow up appointment arranged at desk.
When you are told to ring up between 4.- 4.30 sometimes the phone is always busy to get through.

Dr Dunseath
Would prefer for Saturday Sunday GP
All Dr’s are great

Dr Noor
Would like to see same doctor once seen on first visit, regarding following appointments. Never get to see senior doctor in practice any more in other words better chance to see the Queen than Dr Constable
Very efficient service under difficult situation and slightly limited resources
Waiting times
Absolutely brilliant service from Dr Noor very helpful
I would like to see my own doctor – Dr Constable more often

Northdown
Very good service
Northdown Road surgery is very good.  All staff are very polite and helpful.  WraftonHouse is the same but do tend to find reception staff at Wrafton can be rude and abrupt.
Having Northdown Road surgery on our doorstep is a god send.  If you have a poorly child who you don’t want to make a journey to Wrafton House but the larger surgery has a great variety of services/clinics which are helpful in non emergency case.
The practice is very clean and the service so helpful you can’t beat it.
Would be nice if you could see a more variety of doctors at Northdown Road. Instead same doctors also get to see doctors of your choice.
No Problems
I’ve been with other doctors and they have not been as good as this one. 
Very helpful receptionist at Northdown

RECRUITMENT OF THE PATIENT REFERENCE GROUP

A recruitment drive was held during our busy flu clinics in October / November and December  to try and recruit new members.  The committee members also sold raffle tickets to increase their funds. These funds will be used for the benefit of all patients of the practice, by purchasing or leasing equipment which the NHS is not required to supply.

Patient Reference Group 
Profile of Members

73 Female  			47   Male		=  120

White British	3	2.5%	
British Mixed	87	72.5%	
Other White	3	2.5%	
Refused/not stated	9	7.5%	
African	5	4.2%	
Asian Pakistani	1	.8%	
Other Black	3	2.5%	
Other Asian	1	.8%	
British Pakistani	1	.8%	
White Asian	1	.8%	
British Pakistani	1	.8%	
White Black African	1	.8%	
Not Known	1	.8%	
White Carribean	1	.8%	
Indian British	1	.8%	
Indian English	1	.8%	
			
Total	120		

Age Group of Patient Reference Group (PRG)

	Under 20	20-29	30-39	40-49	50+	Totals		
Male	2	2	5	9	29	47	39%	
Female	1	9	15	11	37	73	61%	
								
Totals	3	11	20	20	66	120		
%	2.5%	9.1%	16.7%	16.7%	55%			

Age Group of Practice Population

	Under 20	20-29	30-39	40-49	50+	Totals		
Male	1189	594	686	712	1423	4603	49%	
Female	1125	661	675	638	1578	4678	51%	
								
Totals	2314	1255	1361	1350	3001	9281		
%	24.9	13.5	14.7	14.5	32.4			

Appendix 1
Appointment Explanation
Wrafton House

Appointments

Routine Appointments - For the doctor of your choice: please book in advance. 
If booking by telephone, please ring between 11.00am-3.00pm when the telephone lines are quieter. Telephone number  01707 265454

Advanced Access (same-day) Appointments - to see a doctor: please telephone between  8.30-11.00 am for these morning appointments. If the demand is very high for these appointments the receptionist will take your telephone number so that a doctor can ring you back to discuss your problem.

Urgent Evening Appointments - With the duty doctor for urgent problems arising after lunchtime that cannot wait until the next morning: please telephone between 2.00-4.00pm. The duty doctor may ring you back to discuss your problem.  

Telephone Surgeries – These appointments are available every day for 30 minutes. The morning surgery is either 8.30 – 9.00 or 9.00 – 9.30 a.m. (please check at reception for morning times as they vary with different doctors) and every evening 4.00 – 4.30 p.m.  The telephone number for this service is 01707 278426. The call is directed straight to the duty doctor but we cannot guarantee everyone who tries will get through. At other times of the day this number is unavailable.

Telephone Consultations – there are a limited number of these appointments each day and they need to be booked in advance through reception.

Extended Hours
Wrafton House is open the third Saturday of each month and on Monday evenings apart from the Monday prior to Saturday opening. We are open for prebookable appointments between the following times:

Monday evenings 6.30 – 9.00 p.m.
Saturday Mornings 8.30 – 11.00 a.m.

There is always one doctor and one practice nurse available however these appointments do need to be booked in advance.

Please also remember to cancel appointments if for any reason you cannot attend so that the appointment can be offered to another patient.

I hope this information clarifies the appointment system at
Wrafton House and by working together we can manage the extremely heavy demand for appointments each day.
Appendix 2

Invitation to the Patient Participation Group Annual General Meeting

The Friends of Wrafton House
(Patients Participation Group)
Wrafton House Surgery
9/11 Wellfield Road, Hatfield, Herts. A10 0BS
(Registered Charity No 1063522/0)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 
Notice is hereby given that the 20th Annual General Meeting of
‘The Friends of Wrafton House’
will be held on Thursday the 5th June 2014 (subject to change)
in the waiting room of the surgery, at 7pm
AGENDA
1.	Apologies for Absence.
2.	Minutes of the 19th Annual General Meeting.
3.	Matters arising therefrom not covered elsewhere.
4.	Chairman’s Report.
5.	Treasurer’s Report.
6.	Secretary’s Report.
7.	Election of Chairman, Treasurer, Secretary, and Committee Members.
8.	Appointment of Auditor.
9.	Any other business (to include any motion of which due notice has been given).

If any patient wishes to raise a point about the group and its activities, please put it in writing to our Honorary Secretary, Gayna Wright at Wrafton House.

Following the formalities of the Annual General Meeting, 

A Representative from Age UK will give a presentation on their services

Ann Willson. Chair
RSVP
Please let us know if you will be coming to allow for refreshments and seating
………………………………………………………………………………………

I will be able to attend the AGM on Thursday 5th June 2014 at 7.00p.m.
(date subject to confirmation from Age UK)
Full Name ……………………………………    Address …………………………… 
Appendix 3
Practice Action Plan 2014/2015

1.	To continue to monitor as at present the number of routine appointments available each day in the practice.

2.	To ensure enough staff are available to answer the telephones during the busy early morning period.

3.	To complete the annual patient survey using the General Practice Assessment Questionnaire (GPAQ)

4.	To actively recruit new members of the Patient Participation Group (PPG) and the Patient Reference Group (PRG)

5.	After being declared compliant in the following outcomes during our CQC Inspection on 6th February 2014, 
 
Outcome 1 – Respecting and involving people who use services
Outcome 8 -  Cleanliness and infection control
Outcome 14 - 	Supporting workers
Outcome 16 – Assessing and monitoring the quality of service provision

Wrafton House will continue to keep up the high standards achieved by the  Primary Health Care Team.

Appendix 4
In House TARGET Training Session for Doctors and Staff

In House TARGET

     Tuesday 15th November 2013

        12.30 – 1.00 p.m.  	Lunch

1.00– 2.00 p.m.
Patient Survey Analysis – Dr  John Constable

 
Appendix 5

Sample of Questionnaire to be sent to all of our Diabetic patients 
Wrafton House

Diabetic Patient Survey 

Q1. Where do you go for your diabetes check-up, where your test results and treatment are reviewed? This check-up is sometimes known as an ‘annual review’ though some people have more or less than one every year. 
(Please tick one box only)

1. 􀂆 My doctor’s surgery 
2. 􀂆 The hospital clinic 
3. 􀂆 Somewhere else, please state _______________________________________
4. 􀂆 It varies 
5. 􀂆 I have never had a diabetes check-up 
6. 􀂆 I don’t know 

Q2. In the last 12 months how many times have you had a diabetes check-up 
(where your test results and treatment are reviewed)?
1. 􀂆 None
2. 􀂆 Once
3. 􀂆 Twice
4. 􀂆 Three or more times
5. 􀂆 I don’t know

Q3. Thinking about the last 12 months, for each statement please place a tick in the box that you most agree with most?

	Always	Most of the time	Some of the time	Rarely	Not at all	
I was able discuss my ideas about the best way to manage my diabetes.						
I was given the chance to discuss possible different medications.						
I was able to discuss my goals in caring for my diabetes.						
I was given personal advice about the kinds of food to eat.						
I was given personal advice about my levels of physical activity.						
We agreed when my next appointment would be.						
We agreed a plan to manage my diabetes over the next 12 months.						

Q4. In the last 12 months, have you had any of the following tests? 

	Yes	No	Don’t know	
A special blood test to look at your long-term or ‘average’ blood glucose level. This test is called HbA1c, and is taken by a doctor or nurse.				
Your blood pressure taken by a doctor or nurse.				
A cholesterol test by a doctor or nurse.				
An eye test where a photograph of the back of your eyes was taken.				
Your bare feet were examined.				
You have talked to a dietician.				
You have had your weight checked by a doctor or nurse.				

Q5. How much have you been involved as much as you wanted in decisions about the care and treatment you have received from your diabetes medical advisors?

1.  I have been very involved 
2.  I was involved as much as I wanted to be
3.  I wanted to be a bit more involved
4. 􀂆 I wanted to be a lot more involved
5.  Not very involved

Thank you for completing this questionnaire
Please return it to reception of the surgery you usually attend