WOKINGHAM PPG FORUM CO-ORDINATED SURVEY 2013
Background
The Wokingham PPG Forum brings together, on a roughly quarterly basis, representatives of the patient participation groups from the practices in the Wokingham area with representatives from the Wokingham Clinical Commissioning Group (CCG). Currently there are 12 Wokingham area practices that have PPGs.
Early in 2013, seven of these Wokingham area practices (Brookside, New Wokingham Road, Parkside, Swallowfield, Wargrave, Woodley Centre and Woosehill) agreed, through their PPGs, to cooperate in a survey of their patients/patient reference groups (PRGs). This was a first attempt at PPG cooperation of this sort. The Forum hopes to learn from this experience and to issue further questionnaires to an increased number of PRG respondents in the future.
The number of patients responding was as follows:
Surgery PPG Responses
Brookside 21
New Wokingham Road 10 Parkside 6
Swallowfield 63
Wargrave 284 Woodley Centre 525
Woosehill 41
Total Wokingham area 950
Woodley Centre carried out its survey using a facility provided by the “My Surgery” website. The other surgeries used the Survey Monkey questionnaire program provided by the CCG. The results were consolidated and analysed using spreadsheets. Burma Hills had 101 responses to a question about GP referrals to specialists in a different form to the other practices’ PPGs.
Page 1 of 14 Summary of Demographics
From the table below it can be seen that significantly more women than men completed the surveys
Gender (numbers)
l
Brookside Swallowfield Woosehil NewWok’m Parkside Wargrave Woodley Centre TOTAL Male 6 19 18 5 3 111 178 340 Female 15 42 20 5 3 163 308 556 Not stated 0 2 3 0 0 10 39 54
Total 21 63 41 10 6 284 525 950
Gender (percentages)
grave
Brookside Swallowfield Woosehill New Wok’m Parkside War Woodley Centre TOTAL Male (%) 29% 31% 47% 50% 50% 41% 37% 38% Female (%) 71% 69% 53% 50% 50% 59% 63% 62%
Age Range
Age Range (numbers)
m
ha
Brookside Swallowfield Woosehill NewWok Parkside Wargrave WoodleyCentre TOTAL Below 18 3 3 18 to 24 1 1 0 0 4 16 22 25 to 34 1 4 1 2 1 12 64 85 35 to 44 3 8 7 2 2 21 96 139 45 to 54 5 11 6 2 2 28 79 133 55 to 64 3 17 10 1 43 85 159 65 to 74 8 16 12 1 1 84 85 207 Over 75 0 6 3 2 83 71 165 Not Stated 0 0 2 0 9 26 37 Total 21 63 41 10 6 284 525 950
Page 2 of 14 This graph shows the overall percentage age distribution
Age Profile (all responses)
25.0%
20.0%
15.0%
Numbers 10.0%
5.0%
0.0% Below 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 Over 75 18 Age Ranges
Employment status
This table shows the proportions of those responding that were in work.
Employment Status (numbers)
dley Centre dley
Brookside Swallowfield Woosehill NewWok’m Parkside Wargrave Woo TOTAL Full time work ( >30hrs / wk) 7 27 12 4 50 191 291 Part time work (< 30 hrs /wk) 3 8 8 3 35 85 142 Retired 9 26 13 3 153 142 346 Not in work 2 1 6 0 25 76 110 Not Stated 0 1 2 0 10 31 44 Total 21 63 41 10 273 525 933
Note Parkside did not ask this question
In all areas and particularly Wargrave more of the respondents were retired than were in work.
Summary of questions asked
All PPGs asked the first question about GP referrals in exactly the same format. The other five questions were optional and were asked by some or all of the seven participating PPGs , sometimes in different formats.
Page 3 of 14
Question
Brookside Swallowfield Woosehill NewWokinghamRd Parkside Wargrave WoodleyCentre GP referral to specialists x x x x x x x Accessing Surgery Medical Records on line x x x x x Making an appointment without having to ring x x x x x or call again Acceptability of waiting times x x x x x Same sex practitioner x x x x Surgery website x x
Parkside asked a different set of additional questions.
GP referrals to specialists
The following table summarises the number of returned questionnaires by practices’ PPGs and the total number of referrals reported by patients.
Practice Total returns Total referrals Brookside 21 16 New Wokingham Road 10 5 Parkside 6 2 Swallowfield 63 47 Wargrave 284 208 Woodley Centre 525 234 Woosehill 41 26 TOTAL 950 538
Page 4 of 14 The next table shows the hospitals and clinics that people were referred to:
Royal Berkshire, Reading 326 Wexham Park, Slough 6 Frimley Park, Surrey 6 John Radcliffe, Oxford 10 Wokingham Hospital 25 Townlands, Henley 13 Berkshire Independent, Reading as an 31 NHS patient Berkshire Independent, Reading as a 33 private patient Others 88 TOTAL 538
The main providers in “Others” are Spire / Dunedin (14) and Circle (11) and other local surgeries and physiotherapy facilities. Woodley did not record which hospitals were included in “Others”
We asked patients about their experiences of their referrals and to score them on a scale of one to six where 1 was very poor and 6 was excellent.
Six Practices Woodley Combined Communication / 5.0 4.6 4.8 Setting up an appointment Reception / Waiting 4.6 4.5 4.6 time Quality of Medical 5.3 4.8 5.1 treatment Access / Car 3.9 3.9 3.9 Parking Follow up 4.5 4.2 4.4 communications
Page 5 of 14 We then looked at individual hospitals on their own to ascertain whether known problems at the RBH were depressing the figures.
RBH Berks Ind as NHS Berks Ind as private Number of reports 320 30 33 Communication / 4.7 5.0 4.6 Setting up an appointment Reception / Waiting 4.4 4.8 5.1 time Quality of Medical 4.9 5.3 5.3 treatment Access / Car 3.4 5.0 4.6 Parking Follow up 4.5 4.5 5.2 communications
It would seem that the evidence here probably indicates that the RBH car parking problems are foremost in patients’ perceptions. It is also notable that the scores for the private Berkshire Independent are not significantly better than the RBH for most of the other questions.
Comments and patient testimonies
There were 232 comments making some 275 points emanating from these 538 referrals. As these included 26 compliments and 2 suggestions, it follows that there were 247 issues raised that were critical.
Far and away the most frequently raised issue was car parking at the Royal Berkshire Hospital which constituted 78 (32%) of the 247 critical issues raised. It is evident from the various comments that problems with parking cause a great deal of anxiety for many vulnerable people. This will get much worse if Reading Council tightens up parking restrictions around the hospital.
The following table attempts to categorise the issues raised though this will always be subjective.
Page 6 of 14 Category of issues raised Number raised % Parking and parking charges 78 31.1% Waiting and delay 41 16.8% Poor late or non-existent follow up 27 11.1% Appointments system 18 7.4% Communications between patients GPs 21 8.6% and the hospitals and clinics Hospital administration 26 10.7% Surgery administration 9 3.7% Clinical issues 15 6.1% Patient records 1 Rudeness and dismissive behaviour 7 2.5% Signage 1 Pharmacy errors and delays 2 Confidentiality issues 1
Total number of issues raised 247 100.0%
Compliments 26 Suggestions 2
TOTAL 275
It is important to look in some detail at the detail of some of the issues raised by patients as this can in many cases identify emerging or hidden problems that ought to be dealt with.
Clinical Issues
Dealing first with the category of clinical issues five of the 15 issues raised are set out below :
The consultant did not turn up or confirm that he would not be turning up. The doctor I saw seemed a bit unsure and referred to another doctor. Neither doctor asked enough me questions to get to the heart of the matter/they did not seem to be able to access my medical details and took some information from a copy of a report I happened to have brought with me. They appeared to recommend a procedure without finding out from me what difficulties I had and, therefore, what the next step should be for me.
Fracture missed on initial visit. 'Urgent recall' sent by second class post!
Good care from doctors however pain management poor. Nurses failing to routinely ask for pain scores and slow to act on high pain scores. Denied pt opiates despite being prescribed and pain score 8+/10 because pt wouldn't be able to go home after po/Im/iv morphine.
Opportunity for specialist referral to the hospital earlier for fertility problems, when there is an underlying problem related to a longstanding medical condition.
Every time I visit my GP it is made clear that cutting costs are more important than people's health. I've been asked more than once whether I have insurance that could pay, even though I am a British citizen and entitled to free healthcare.
Page 7 of 14 Though these appear to be isolated reports , any of them could indicate more serious problems that are either hidden or emerging.
Rudeness and dismissive behaviour
Rudeness at the RBH amongst reception and medical staff was also raised
The receptionists have always been very rude and ignore you when you're at the desk waiting, and then whilst helping me they then assisted the next person behind me in the queue and made me wait. They're condescending and expect you to know all the answers, they do not make you feel welcome at all, especially when you're not well! On the otherhand, The medical treatment I've received from my doctor has been the best I've ever received!
Good initial consultation at the Royal Berkshire but after this my son waited for nearly 12 months until he had his operation. The main issue was poor communication and rudeness from the secretary.I was so upset by the incident I actually complained. Having worked in the NHS I understand the importance of good communication with patients.
I had reason to complain to PALS after my first visit as I found the consultant rude and unhelpful. The problems I raised were dealt with to my satisfaction.
Car Parking
The problems of parking at the RBH are long standing and, to be fair, the current administration has tried to deal with it without a great deal of success. They relocated an entire floor of staff parking to Queens Road and have recently installed automatic barriers. However the issue continues to provoke anxiety and concern particularly amongst frail and vulnerable patients. Clearly there is a link with waiting times and delays but also with clinic timings and locations. Anxious patients arrive at the crack of dawn to make sure of getting a parking slot thus exacerbating the problem. Patient flow at the RBH and the relocation of clinics needs to be reviewed yet again on a hospital wide basis.
The following testimonies illustrate the impact on patients.
I have to rely on my husband being able to take time off work to take me in to my hospital appointments as it is so difficult to park. If I have an early morning appointment I can find space in the multi storey carpark but am unable to walk the length of the link corridor to the outpatient clinic. The 'buggy' does not usually run at this time of morning. Either outpatient clinic needs to be closer to the carpark or a multi story carpark needs to be built on the existing staff carpark. I am not registered disabled but have noticed that the disabled spaces at the outpatient end of the hospital are usually full early in the morning.
We get very worried about inability to park as my husband has to be wheeled out in a chair after the block and this makes him very anxious. Also the machine broke down and carefully timed appointments not able to take place. No one knew when phoned when the machine might be repaired.
Finding a Car parking space at the RBH was more stressful than seeing the consultant.
EPR system and appointments
For the last 6 months there have been a number of reports of problems associated with the introduction of the new Electronic Patient Record system at the RBH and in particular about problems with appointments. The table above only indicates 18 issues being raised but this may be misleading.
Page 8 of 14
Clearly patients have been inconvenienced though we are told that this is one of the better implementations of the Cerner Millenium EPR system.
Typical experiences are set out below :
Completely failed to get hold of anyone at the hospital, and was unable to book appointment online or through NHS hotline. You need to have people available to take calls outside the hours of 10am and 12pm as it can be difficult for working people to call during these TWO hours. Ended up going private.
Arrived for follow up with paperwork and correct date and time to find there was no clinic that day. Calls to RBH entailed long telephone queue so no follow up carried out
Communication for follow up was messy, but I really do understand it was caused by EPR and NOT by staff, they sorted it out efficiently and politely.
One hospital appointment was changed four times and the consultant said to me I had taken a long time to come and see him again!!!
I had a really upsetting and horrible experience at the Royal Berks Hospital that left me totally gutted ! I ended up going privately to the Berkshire Independent as I was almost unable to see out of my right eye. I had been waiting for months to be seen & after my appointment was cancelled I turned up for the next appointment & was told that that had been cancelled too. How could this be! Apparently a computer error! I complained but heard nothing from Royal Berks at all.
Surgery appointments system
We asked whether, when seeking a surgery appointment in the last 12 months, respondents had usually asked for a specific nurse or doctor and whether it was possible to get an appointment without having to ring back. 4 surgeries, Woodley Total Brookside, Centre
Wargrave etc.
When seeking a surgery appointment in the last 12
months, have you asked for
SameDay day later A SameDay day later A SameDay day later A A specific GP 144 98 70 79 214 177 Any GP 138 31 219 65 357 96 A specific nurse 17 32 4 9 21 41 Any Nurse 42 114 6 12 48 126
Yes No Yes No Total Total Did you get what you asked for without 300 33 348 136 648 169 having to ring back ?
Page 9 of 14
Five practices participated in this question: Brookside, New Wokingham Road, Wargrave, Woodley Centre and Woosehill. Four of the practices, Brookside, Woosehill, New Wokingham Road and Wargrave would appear to provide what people ask for most of the time. However, the Woodley Centre responses show that in that practice 28% (136 ) of responding patients say that they have to ring back compared to just under 10% elsewhere.
Surgery waiting times
We asked patients about their experience of waiting at the surgery (from the due appointment time to actual time of consultation). The overall position on waiting times and their acceptability is shown in the tables below. Five practices participated in this question: Brookside, New Wokingham Road, Wargrave, Woodley Centre and Woosehill. The Woodley Centre figures are shown separately because their patients were asked the question of acceptability generally, not against the three time scales.
Waiting time to see a doctor. 0-10 mins 10-20 mins > 20 mins Total 4 Surgeries Peoples experiences of waiting times 161 137 25 323 Considered acceptable 156 110 4 270 Considered unacceptable 0 20 19 39 (12%) Not stated 5 7 2 14
Woodley Centre Peoples experiences of waiting times 163 242 78 483 Considered acceptable 301 Considered unacceptable 70 (14%)
The data behind this table had to be heavily edited in order to yield these results as many people had interpreted the question in a different manner to that intended and had inserted more than one response to the questions posed. Future questionnaires will need to be more rigorously tested to remove any ambiguity.
Though Woosehill has a small sample size, it should be noted that 21 out of 41 responses from that surgery deemed the waiting times experienced as being unacceptable.
Waiting time to see a nurse. 0-10 mins 10-20 mins > 20 mins Total 5 Surgeries Peoples experiences of waiting times 169 79 7 255 Considered acceptable 167 64 3 234 Considered unacceptable 1 13 3 17 (7%) Not stated 1 2 1 4
Page 10 of 14 Woodley Centre
Peoples experiences of waiting times 279 90 9 378 Considered acceptable 278 Considered unacceptable 15 (4%) Not stated 85
It seems reasonable to conclude that waiting time for doctor or nurse appointments is not a big issue for most patients.
Same sex practitioner
This question was only asked at 4 practices (Brookside, New Wokingham Road, Wargrave and Woosehill). The question posed was “When seeing a doctor or nurse, is it important to see someone of the same sex?”. The outcome is set out below:-
All respondents. 4 practices Doctor Nurse Always 12 4% 16 5%
Sometimes 177 51% 96 28%
Never 143 41% 182 53% Not stated 13 4% 51 15%
Total 345 345
Very few patients prefer “always” to see a same sex practitioner, but about half indicate that “sometimes” it is important for them to do so.
If the table is restricted to responses from females, the following results are obtained. This indicates a marginally greater preference amongst women for a same sex practitioner.
Women only. 4 practices Doctor Nurse
Always 5 3% 12 6% Sometimes 114 58% 76 39% Never 66 34% 72 37%
Not stated 10 5% 35 18% Total 195 195
Page 11 of 14 Patients medical records
The following questions were asked at 4 practices (Brookside, Swallowfield, Wargrave and Woosehill). We also asked for comments.
It is proposed that, where possible, patients should be entitled to view their own personal medical records online
a) Have you asked to see your surgery records in the past? b) Might you be interested in doing so in the future? c) Do you have any concerns about confidentiality at present? d) Would you be concerned if medical records were available online?
The results are set out below:- Personal medical records Yes No Not Stated TOTAL
Have you asked to see your 30 (7%) 370 (88%) 19 (4%) 419 medical records in the past Might you be interested in doing 298 (71%) 93 (22%) 28 (7%) 419 so in the future? Do you have any concerns about 44 (10%) 350 (84%) 25 (6%) 419 confidentiality at present? Would you be concerned if 203 (48%) 191 (46%) 25 (6%) 419 medical records were available online?
The responses reveal a substantial degree of interest hedged by concerns about the security of whatever system delivers the information. There is very little concern about the security of the current system of recording patients’ notes.
Typical comments made by patients about future security concerns include :-
I feel that everyone is entitled to view their own medical records without difficulty but would be worried about security issues if they were put online.
My concern is related to the security that will be applied to any on-line system and access to the records. Confidentiality is of paramount importance and I would want to see fairly detailed descriptions of the security arrangements to be assured that personal records are safe and could not be accessed or hacked into by unauthorised persons or organisations.
If "hackers" can break into the Pentagon computer, then the NHS has no chance of keeping records confidential.
Extremely concerned about patient confidentiality. Concerned that patients records could potentially be shared with pharmaceutical companies, insurance, government records. No storage of data of DNA
Page 12 of 14 Surgery Website
Only Wargrave and Woodley Centre asked patients whether they had accessed their surgery website.
Woodley asked three questions
Yes % No % Not stated Have you been to our website? 185 35% 307 58% 33 Have you ordered repeat prescriptions using the 93 18% 393 75% 39 website ? If yes, are you satisfied with this website? 126 24% 38 7% 361
Wargrave asked two
Yes % No % Not stated The website was upgraded in June 2012. Have you 57 20% 224 79% 3 accessed it since then? If yes, did you find it useful?" 48 91% 5 10% 4
The results do not indicate widespread use of the website at either location though clearly the repeat prescription facility will ensure repeat use of the site for those using this feature.
Page 13 of 14 CONCLUSIONS & RECOMMENDATIONS
Size of response The Wokingham PPG Forum considers that a response from nearly 1000 patients in the area is significant and that coordinated surveys of this sort should be developed over time as a useful means of testing patients’ concerns and guiding the CCG’s commissioning priorities. The CCG should encourage the development of Patient Reference Groups across all practices.
Distribution of responses The bulk of the returns from this patient survey came from Woodley and Wargrave reflecting the well-established PPGs at these practices and their progress in setting up patient reference groups (PRGs). The Wokingham PPG Forum has accepted as a high priority the objective of recruiting a significant number of patients to each practice’s PRG.
GP referrals to specialists Patients’ experience of referral by GPs to specialists is broadly satisfactory particularly in terms of the quality of medical treatment. Access/Car parking is however perceived as a problem, which is especially bad at the Royal Berks Hospital. This needs to be addressed by the relevant authorities.
Surgery appointment systems In general, at the practices surveyed, patients appear satisfied with the way appointment systems work. Some patients still have to call back a second time to get an appointment and the aspiration of practices is and should be to prevent this.
Waiting times In the main patients appear content with waiting times for GPs and nurses at their surgeries. But, where there were some contrary responses, future surveys might need to ask the question again.
Same sex practitioners Practices should be aware that about half of patients indicate that sometimes it is important for them to see a practitioner of the same sex.
Patient medical records Any plans to compel GP surgeries to provide on-line access to patients personal medical records should take into account the level of concern about confidentiality that has been identified by this survey. It might be prudent to allow individual patients to be able to block access to any of their personal medical records as has been done with the Summary Care Record.
Surgery websites Surgery websites are potentially a good source of information for patients, but awareness is relatively low. The main service provided by the websites covered by this survey is the ordering of repeat prescriptions and Woodley’s results indicate that a significant number of people (93) are using this facility.
Patient Testimonies In this coordinated survey of patients in the Wokingham area, respondents were given the opportunity to comment and make suggestions. These testimonies –always anonymous - will all be passed on to the appropriate professionals. This report has selected a limited number of comments to illustrate the nature of the patient experiences that lie behind some of the statistics in the tables.
Page 14 of 14