Wrafton House Surgery

Directed Enhanced Service

Final REPORT

2012 – 2013

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

Index

1.	DES Outline							Page 3
 
2.	Recruitment to the PRG					Page 4

3.	Two Year Analysis of Questionnaire Results		Page 5/6

4.	Profile of the Patient Reference Group            		Page 7/8

5.	Practice Discussions						Page 9

6.	Practice Action Plan	2012 –2013       			Page 10

7.	Implementation of the Action Plan				Page 11

8.	Surgery Opening Times						Page 12

9.	Appointment Explanation					Page 13

10.	Appendix 1 Invitation to the AGM	2013			Page 14

11.	Appendix 2  Diabetes Questionnaire				Page 15/16

                                               Wrafton House

Patient  Participation Group  (PRG) DES Outline
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 still anticipate that in the future that the PRG member  will become more involved with the PPG. Dr Eric Sherrard has analysed the GPAQ survey each year since it began in 2003.
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 it was agreed to use the GPAQ Questionnaire Version 3 again this year.  By using the same questionnaire it is much easier to compare the results.
Once again we chose CMI Publishing to analyse the results and produce the reports for both Wrafton House and our Branch Surgery in Northdwn Road.
The questionnaires were handed to all patients who had doctors appointments booked during a two week period in November 2012.  These appointments were both routine and advanced access appointments. 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  319  which far  exceeded the required number of 250.

RECXRUITMENT TO THE PATIENT REFERENCE GROUP (PRG)

All  patients who were given a GPAQ questionnaire were also handed a slip asking if they would like to be a member of the Patient Reference Group (PRG) and if they would like to be notified by e mail. There was a separate box for the slip to go into to ensure of the anonymity of the GQPQ questionnaire.

All patients registered with Wrafton House are automatically a member of our Patient Participation Group (PPG) and it was hoped that a virtual group would extend our membership.

TWO YEAR ANALYSIS OF SURVEY RESULTS BY  CMI PUBLISHING

The following table shows the survey results for the two years, blue 2013 results.

Ethnicity
GPAQ V2 
National benchmarks	GPAQ V2 
	2012
GPAQ V3
Our practice results	2013
GPAQ V3
Our practice results	PRG Profile	
%white	92.2	81.2	86%	74%	
%Asian/Asian British	3.7	5.0	7%	7%	
%Black/Black British	1.8	5.3	3%	8%	
% Mixed	1.1	1.3	1%		
% Chinese	0.3	0.8	0%		
% Other Ethnic Group	0.9	1.3	3%	10%	

PATIENT SURVEY STATISTICS
Gender
GPAQ V2 
National benchmarks	GPAQ V2 
	2012
GPAQ V3
Our practice results	2013
GPAQ V3
Our practice results	PRG Profile	
% female	64.7%	73%	65%	66%	
% male	35.3%	27%	35%	39%	

Long standing Health Condition
GPAQ V2 
National benchmarks	2012
GPAQ V2 
	2012
GPAQ V3
Our practice results	2013
GPAQ V3
Our practice results	
% long standing health condition	49%	60.3%	43%	

Employment

GPAQ V2 
National benchmarks	2012
GPAQ V2 
	2012
GPAQ V3
Our practice results	2013
GPAQ V3
Our practice results	
% employed	48.4	38.1	45%	
% unemployed	2.5	6.3	5%	
% in full time education	3.4	0.0	5%	
% unable to work/long term sickness	7.2	12.7	10%	
% unable to work/long term sickness	7.2	12.7	10%	
% looking after home/family	9.6	17.5	5%	
% retired	27.5	20.6	29%	
% other	1.6	1.6	2%

Short  Summary of results combining both surgeries (blue 2013)

97%   97%  of our patients found our receptionists helpful or fairly helpful

68%   77%  found it easy or fairly easy to get through on the phone

70%   73%  said if they needed they could get an appointment on the same day

78%   82%  say the practice is open at convenient times

98%   95% had total confidence in their GP

93%   91%  say their experience of our surgeries is good, very good or excellent.

94%   93% would recommend us to someone who had just moved into the area

PROFILE OF THE PATIENT REFERENCE GROUP.

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 THE PATIENT PARTICIPATION 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			

PRACTICE DISCUSSIONS WITH THE PATIENT PARTICIPATION GROUP

As in previous years, on receipt of the reports, Dr Eric Sherrard, a member of the Patient Participation Group,  reported and compared the results to previous years and then presented the findings to our in house TARGET session in November  2012.  

This session comprised of the partners and all of our staff.  Once again he gave a very positive  response and thanked the doctors and staff for their dedication to all of the patients in both practices. One area that causes concern annually is the waiting time to see the doctor.  The waiting time often arises when a patient has telephoned on the day  requesting to be seen urgently.  These appointments are 5 minutes only to deal with a problem that has arisen that day and needs to be seen quickly. The patient then often presents with a list of problems which they have had for several months.  The doctor then has to make the difficult decision to keep to the 5 minute rule of one problem only and ask the patient to make a routine appointment for their other concerns, which do not need immediate attention. However, on occasions, the other problem is far more serious and needs immediate attention.    Although the doctor would have made the best possible clinical decision it often results in for waiting patients.

Survey Results discussed at the PPG Committee Meeting in November 2012

Extract from the minutes of the Patient Participation Group  Meeting held at Wrafton House on Tuesday 27th November 2012:-

“Eric very kindly attended the practice today to report on the analysis of the patient survey to all our doctors and staff.  He felt the practice continues to offer all our patients an excellent service.  The areas which we need to look at are at how long the patients are kept waiting to see the doctor and the number who wish to make appointments on line.  It is still a relative small number but it is increasing.  There is a Department of Health directive which states that all practices must offer this by 2015, so we will be looking at this in detail in the next 12 months.  As we have a large demographic population of patients who are not computer literate, this may not benefit the majority of our patients.  Northdown results were slightly better as it is a much smaller surgery.  Patients appear to be kept waiting longer on the 5 minute extra same day appointments. This is usually because they have more than one problem to be dealt with.”

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

This year they will be holding their Annual General Meeting on 6th June 2013.  We will again be inviting all members of the  Patient Participation Group  and the  members of Patent Reference Group  to attend this event

PRACTICE ACTION PLAN  2012/2013

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

2.	To recruit an additional half time partner to increase the availability of appointments.

3.	To look at using a programme for booking appointments and taking prescription requests on line.

4.	To seek the views of patients with long term conditions such as Diabetes (see appendix 7).

5.	Refurbishment of our branch surgery at Northdown Road

6.	Refurbishment of Wrafton House

7.	New Telephone system to improve telephone access to the surgery.

8.	Customer Service Training for staff.

IMPLEMENTATION OF THE PRACTICE ACTION PLAN

1.	The monitoring of routine appointments continues to be calculated each morning prior to the surgery opening  and we have increased in excess of 50 per week compared to the same time last year.  The partners monitor the availability of routine appointments at the weekly partners meeting.

2.	A new half time partner, Dr Attia Noor, was recruited and started in December 2012 which has resulted in the additional appointments.

3.	After discussion, the practice felt that at this moment in time, due to our elderly and socio economic demographics, on line booking would be disadvantageous to them.  
However, we will begin to offer this to our patients over the coming 12 months.

4.	A Diabetes Mellitis specific questionnaire has been produced and will be given to our patients with this long term condition. (Appendix  1 )

5.	Northdown Road Surgery has had a complete refurbishment, new carpets, repainting, new boiler and the nurses treatment room layout was reconfigured to better suit both the nurses and patients needs.

6.	Wrafton House has been repainted and  had new carpets in the waiting area and corridor.  

7.	Financial restraints, due to the refurbishment of our premises, have put the new telephone system on hold until the next financial year.

8.	Staff training in all areas of customer service has been ongoing.

In addition to the above after discussion between the doctors, practice manager and the Committee Members of our Patient Participation Group it was agreed that all of our patients would   benefit from the regular monitoring of their health and this has resulted in the PPG agreeing to fund the rental of a “Health Pod” machine for use in the waiting room for a two year period.  This health pod takes, weight, height, BMI and Blood Pressure readings.  The printout from the machine can be used to update our patient’s records as well as allowing our patients to keep track of their health. 

CONFIRMATION OF OPENING TIMES:

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.

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 pre-bookable 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 1 
Invitation to the Patient Participation Group Annual General Meeting 2013

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 19th Annual General Meeting of
‘The Friends of Wrafton House’
will be held on Thursday the 6th June 2013,
in the waiting room of the surgery, at 7pm
AGENDA
1.	Apologies for Absence.
2.	Minutes of the 17th 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, 
Dr Hari Pathmanathan 
Chairman of the Clinical Commissioning Group

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 6th June at 7.00p.m.

Full Name ……………………………………    Address …………………………… 

APPENDIX  2

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