Addington Road Health Centre, West Wickham

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ADDINGTON ROAD SURGERY

We now have a Patient Participation Group which has 33 members. Details of our group and our first project are detailed below. If you would like to join us please leave your email address at reception.

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Due to popular demand by our Patient Participation Group a patient survey was undertaken on our appointment system.

The following questionnaire was completed by over 100 of our patients.

These are the results:

PATIENT QUESTIONNAIRE AND EVALUATION

1. How long do you think is reasonable to wait for a routine appointment to see ANY doctor?

1-7 days	87
7-14 days	17
14-21 days	2
21-28 days	1

2. How long would you be prepared to see a doctor of your choice?

2 hours	1
2 days	3
3 days	2
4 days	4
1-10 days	7
1 week	26
1-2 weeks	30
2-4 weeks	3

3. The last time you wanted to see a doctor quickly and were not able to be seen within the next 2 week days why was that?

There weren’t any appointments	48
Times offered didn’t suit	10
Appointment offered was with a doctor I didn’t want to see	17
Another reason	0
Can’t remember	13

4. Are you aware that if you have an urgent problem you can speak to a doctor on the same day?

Yes	82
No	24

5. How satisfied are you with our current appointment system?

Very	21
Fairly	49
Neither satisfied or dissatisfied	22
Quite dissatisfied	8
Very dissatisfied	9

6. Taking into account that there are no additional financial or manpower resources available, what do you think we could improve on with our current appointment system, if anything and how?

Positive Comments

1. Seems to work ok for my requirements

2. It is very good as it is!

3. Present system seems to work well

4. Very satisfied

5. Receptionists are kind and helpful

Negative Comments

1. Answerphone Message to let you know where you are in the queue.

2. 8am-9am to ring for Urgent appointments only

3. Appointments to be able to book on line

4. Review the doctors we have

5. To be able to SEE a doctor always in an emergency

6. Difficult to get through on the phone, assess degree of urgency

7. More late/early appoints and less middays

8. Too many appointments with trainee doctors

9. Open Saturday morning

10. To see preferred doctor within 1-7 days

11. Non urgent appointment slots to be kept available or walk in sessions

12. Phone consultations to be promoted

13. Why take on more patients than we can deal with

14. Reduce GP admin

15. More after 5pm appointments less during the day

16. Open on Saturdays

17. Ring back or emails speed up making appointments

18. Would like ‘walk in’ appointments

19. More doctors

20. More appointments for working people

21. There should be a nucleus of full time doctors (ie. The partners)

22. Greater consistency – less short stay doctors

23. Speed things up

24. Streamline procedures, have measures and backup plans in place, if staff call in sick, explore phone system providers, best value for money – best solution for high call volumes. On line booking of appointments.

25. Have longer surgery hours and Saturday working.

26. Without further manpower little improvement possible

27. Telephone system takes too long to answer for direct contact.

28. No suggestion as you imply it is impossible

29. Surgery doctors to work on emergency out of hours home visits, not locums.

30. It appears that the surgery has a number of doctors who only work part time at this surgery so the chance of seeing the same one when you want an appointment is doubtful.

Are you male or female?

Male	27
Female	60

How old are you?

Under 18	1
18-24	3
25-34	7
35-44	10
45-54	9
55-64	15
65-74	18
75-84	23
85 and over	12

If you work and you needed to see a doctor at the surgery during your typical working hours. Can you take time away from your work to do this?

Yes	15
No	17

The suggestions by our patients for Question 6 have been divided into 2 categories:

1. SUGGESTED IMPROVEMENTS FOR CURRENT APPOINTMENT SYSTEM WITH NO ADDITIONAL FINANCIAL OR MANPOWER RESOURCES

2. 8am-9am ring for urgent appointments only
3. Appointments to be booked online	Emis
5. Always SEE a doctor in an emergency
6. Assess degree of urgency – difficult to get through on phone
11. Non urgent appointment slots kept free
12. Phone consultations promoted
14. Reduce GP admin time	Not possible with all the Government requirements
17. Emails to make appointments
11/18 Walk-in appointments	Has been tried before, but unsuccessful as appointments would run into lunchtime and beyond
21. There should be a nucleus of full time doctors (i.e. partners)
23. Speed things up	? Time spent with doctor ? phone calls
24. Back up procedures if GP calls in sick On-line booking system	? what’s needed with Emis

2. SUGGESTED IMPROVEMENTS FOR CURRENT APPOINTMENT SYSTEM WHICH WOULD NEED FINANCIAL AND/OR EXTRA MANPOWER RESOURCES

1. Answerphone message to let you know where you are in the queue.	Possible cost involved – would have to check with phone provider
4. Review doctors we have	Constantly under review but lacking resources
7. More late/early appointments less middays	Possible increase in doctors’ salaries as hours split
9/16. Open Saturdays	Cost involved salaries and building
15. More after 5pm appointments less during day	Extra cost
17. Ring back function applied	Not feasible
19. More doctors	Extra cost
20. More appointments for working people	Extra cost
24. Phone system providers – get best value for money – to help with high call volume	Possible higher cost involved – needs to be investigated
25. Longer surgery hours	Extra cost
27. Telephones take too long to be answered	More receptionists to answer calls = extra cost
29. Surgery doctors work on emergency out-of-hours home visits	This is a Government remit.

APPOINTMENT SYSTEM - REPORT

We have been aware for some time that there is dissatisfaction with the appointment system. The very fact that the majority of the Patient Participation Group chose this subject for our first survey is testament to this.

When the Government introduced targets for appointments some time ago, the whole appointment system was turned on its head as bookings suddenly had to include an element of availability 48 hours in advance and consequently spaces, which could have been booked in advance, had to be left free.

Since then, practices have wrestled not only with an increase in demand for appointments from the existing practice population, but also with an increase in patients joining the practice. All of this has to be achieved with no extra resources in either manpower or finances.

It is a proven fact that the demand for appointments will always outstrip those provided. However, in early 2005 we took on 1½ new Doctors and a whole time Nurse Practitioner. Later in the year Drs Robertson, Dilley and Sodipe reduced their clinical sessions and employed another whole time doctor which more than made up for the lost sessions. Despite this increase of 3½ clinicians, the demand still continued to grow and very quickly outstripped supply.

We have continued to try and improve the system with only limited success. The highest demand is for the two remaining partners, Dr Robertson and Dr Sodipe. Their appointments are now open 6 weeks in advance to save patients having to ring back several times. These slots are highly prized by patients who are able to wait. However, this also means that there is no availability in the short term unless there has been a cancellation.

ACTION PLAN

In an effort to address the increasing demand and improve access for our patients we are considering the possibility of introducing a completely different appointment system which has already been trialled by some other GP practices both in other parts of the country and in Bromley.

Under this new system, patients telephoning to arrange an appointment with a Doctor will be asked for their telephone contact details and a doctor will ring them back to discuss their problem with them, this is known as triaging.

This system would:

Allow issues that don’t require a face to face consultation to be addressed.
Allow for investigations to be requested prior to face to face consultation, thereby making a more effective use of the appointment.
Free appointments for people who need to be seen on the day.

We will shortly be visiting another practice where this system is currently operating to see how it could work at Addington Road.

Following this visit, we will let you know the outcome whether or not we will proceed with the triage system. If we think the system would benefit our patients we will undertake a pilot and patient satisfaction survey after 6 months.

PATIENT PARTICIPATION GROUP

a. The highest volume of our practice population consists of people aged 35-65 and with an ethnicity of ‘White’. Our Patient Participation Group reflects this profile.

The take up rate, however, was mostly from our female population.

b. We feel we offered the chance to all categories of our patients to participate in the group for the following reasons:

Our receptionists actively invited patients to join.

We had several posters around the building for all patients who came to the surgery to see.

A virtual group did not discriminate against disabled or housebound patients.

Next year we would seek to attract people who do not necessarily come to the surgery, and try to expand to include more male patients to try for a balanced view.

The virtual group did not discriminate against the working population.

c. We e-mailed out to everyone a list of subjects which could be considered by the Group and asked them for their vote on the first topic they felt we should tackle in this (financial) year. The result showed that the majority clearly favoured looking at the appointment system.

We then forwarded a list of questions that we felt could be included in a general patient survey and asked the Group to pick the 6 they felt asked the most suitable questions. The majority choices formed the basis of our survey.

d. The agreed survey was then given out to as many patients as possible. Those who came physically into the surgery were offered one, even if they only called in for a prescription. The local Pharmacist was asked to hand them out to our patients who called into the shop, and a local Care Home was asked to circulate the survey amongst their residents who were our patients.

e The results of the survey were analysed and the details sent to the Group. (see Website for analysis) We also prepared a Report/Action Plan and e-mailed this out, asking for comments.

f. Those patients who responded gave a positive response to the suggestions of investigating whether the introduction of a Triage appointment system would be suitable for our surgery and if it was thought to be so, then a trial of this system, with a review after 6 months could be implemented.

g. The Report/Action plan has been placed on the website and copies will be given out in the surgery. It was decided from the findings of the patient survey that since patients wanted to be seen by the GP in less than a week we should trial the triage system which has been introduced in some other parts of the country. Some suggestions arising from the survey had financial and manpower implications and therefore are not feasible at the present time.

h. Representatives of the practice plan to consult with local surgeries already implementing the Triage appointment system in order to assess its suitability for our practice.

If appropriate, this new appointment system will be set up in the practice.

i. Our opening hours are 0800 – 18.30 Monday to Friday. Our extended hours’ times are generally Tuesdays and Thursdays until 20.00 and Wednesdays until 20.15.

Please see the Action Plan and Report for further information.

Addington Road Surgery

Addington Road Health Centre

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