Proud to be The Red & Green Practice Waterside (Hythe) & Blackfield Health Centres

Patient Participation in 2011/12

Practice Report

Red & Green Practice (J82056)

An open report to our patients and Hampshire PCT giving details of how Red & Green practice and Hythe and Blackfield Patient Groups have worked together to improve services for patients in 2011/12.

This report is also available online at the practice website (www.redandgreenpractice.co.uk) and at NHS Choices

Test Proud to be The Red & Green Practice Waterside (Hythe) & Blackfield Health Centres

31st March 2012

Patient Participation DES 2011/12 – Practice Report

This report follows a template for reporting on practice achievement of the Patient Participation Scheme DES 2011/13. In doing so, it provides evidence of key stages for the DES in 2011/12, but this only tells half a story and does little to highlight the fantastic engagement of the group with the practice over the past four years.

Formed in 2008 to enable greater patient engagement and interaction with practice decision making, the group provided the impetus to address variable standards of locality phlebotomy and lack of blood testing in the practice. With pressure from the group to improve, the practice worked on a commissioning proposal and the PCT agreed to continue and then further improve blood testing provision at Hythe and Lymington Hospitals. Hythe and Blackfield Patient Group have played a significant role in achieving a considerable improvement in the local blood testing service.

In 2009, the group were instrumental in making sure the local community was well informed about the intended merger of the Red and Green Practices. In addition to making sure the practices clearly communicated their intentions, the group arranged public meetings and contributed to newsletters to make sure the patients and public of Hythe and Blackfield were fully aware of changes, and that the practice and our intentions, came under proper public and patient scrutiny.

After receiving complaints about poor pharmacy customer service in Blackfield, the group carried out a patient satisfaction survey in 2010 of pharmacy provision in the entire locality. Prompted by complaints, and supported by the independent Patient Group survey results, the practice assessed viability of a pharmacy connected to the Blackfield surgery. A GP-led pharmacy at Blackfield looks unlikely in the near-term but heightened awareness of problems in the area seems to have improved locality provision. Due to open 2012, the practice has started work on a new pharmacy at the Waterside surgery. This new pharmacy will open 100-hours a week to provide a greatly improved service to all residents in the Waterside and East New Forest.

An historic practice problem with access, especially prebookable appointments, was the focus in 2011/12. Extensive consultation and survey work has resulted in significant changes to the appointment pathway and redesign of surgery access - with quite outstanding results. A new “same day” Minor Illness Clinic was piloted at Waterside surgery and a significant increase in patient satisfaction prompted the Patient Group to support the practice to implement a further pilot at Blackfield in November 2011. In March 2012, the practice agreed the distinctive “Same Day Service” will remain permanently, with the support of the Patient Group.

Arising from survey work around access, we noticed patients were starting to ask about continuity – put simply, once patients found it easier to see a GP, they started to ask if they could see the same doctor on subsequent visits. Continuity of care matters to patients, and all the more so to older patients and those with long term conditions. National survey results for 2010/11 show two thirds of our patients (66%) want ‘continuity of care’. Four GPs have retired in the past four years and the survey shows only 60% of patients of those who want continuity of care said they could see a doctor of choice “always” or “a lot of the time”, so there is room for improvement.

An aging population, 30% of whom have a long term condition, and a forecast doubling of diabetes in the next ten-years, the cohort of patients who will benefit most from improved continuity of care looks set to increase in the years ahead. Discussed several times since September 2011, a Patient Group meeting in March 2012 agreed this would be the priority focus for the year ahead in 2012/13.

The Patient Group advertise and promote their activities at both surgeries with substantive and highly visible notice boards in surgery waiting rooms, promotional material runs on the large patient waiting room screens (purchased with funds raised by the patient group) and on the Patient Group website (accessible as stand-alone website and via the practice website). In addition, the group have taken their message “on tour”, attending events such as Exbury fete and Hythe Action Day with display materials and a gazebo/stand bought and paid for by the patient group.

The Patient Group established itself to work with GPs to improve services to patients and we are pleased the group has engaged so readily with the practice – it has made a real difference to our decision making. Registered as a charity, it is not a fund-raising group but has raised sufficient funds to maintain its independence, activities and profile. The group has the confidence to challenge the practice at its regular monthly meetings (where managers, Practice Manager and GPs regularly attend) as well as providing positive support for improvement and change.

The Patient Group has helped the practice become far more patient-focused and we genuinely look forward to continue working with the group as national policy changes begin to impact on locality health provision in the years ahead.

Gary Young John Carr Practice Manager Hythe and Blackfield Joint Patient Group Chairman

Patient Participation DES 2011/12 – Practice Report

Step 1: Establishing a Patient Reference Group

1.1 Understanding the Practice profile

An aging population: Extracted from the clinical system, Appendix 1: Information checklist for local patient participation report shows 92% are British white with a 50/50 male/female split. A significant proportion (23%) of the practice list is beyond retirement age (65+) and over half of our patients are over 45 years (52%).

Of equal significance is that the practice population continues to age faster than the national average. Sometimes termed a “super-aging” population, Appendix 2: Red & Green practice population variation (2007-2012) illustrates the point while Appendix 3: Red & Green practice weighted population variation (2007-2012) illustrates impact on practice weighting, i.e. an ever increasing demand on practice resources.

A recent demographic study (Attached Document 1: Waterside, South East New Forest and Totton Demographic Profile: age of population 2011-2016:) shows that, by 2034, 23% of the English national population is forecast to be aged over 65 years; the Red and Green practice population has achieved the national average of 23% of over 65’s per 1,000 population some 22-23 years ahead of the national picture, making our rapidly aging population a significant consideration.

Deprivation: The Practice operates from two surgeries at Waterside (Hythe) and Blackfield Health Centres, both of which have pockets of significant deprivation not immediately apparent when looking at indices for Hampshire as a whole; Appendix 4: Hampshire PCT Practice Index of Multiple Deprivation (2010).

The top ten local Wards by Indices of Deprivation are:-

1. Netley Marsh 2. Blackfield and Langley 3. Hythe South 4. Milton 5. Pennington 6. Fawley and Holbury 7. Ringwood South 8. Forest North 9. Becton 10. Bashley

Resource Use: A product of super-aging population, chronic conditions experienced by middle aged and elderly patients account for more appointments and visits than in younger populations and this places increasing demand on surgery resources, including doctor and nursing appointments, prescribing and referrals. Minority Groups: Clinical system information shows 0.61% of the total registered patient population have learning difficulties, are in residential care or wheelchair users. Although a small proportion (153 patients) of a total 25,000 list, the Practice and the Patient Group remain very mindful of their greatly increased needs.

Opening Hours: As supporters of extended opening, we provide a full reception service for 114 hours/week between the two surgeries on an “open doors” basis with full telephone access and two receptionists at each surgery to allow patients to drop off and collect prescriptions, obtain normal test results, make general enquiries and book or rearrange GP or nurse appointments etc.

In July 2011, we gave assurance to our patients and the PCT to retain our extended opening and even increase clinical provision by a further six hours/week, to provide a total 19.5 hours of GP and nurse time every week between 6:30pm and 8:00 pm.

We have consistently carried out surveys and proactively engaged with patients to shape and deliver services best suited to meet differing needs of the populations served by each of our two Health Centres. This is an ongoing process resulting in incremental year on year improvements in patient satisfaction. Patients indicate they are happier with all aspects of service now than in 2007/08 - this is especially true of opening hours as both surgeries are achieving 97%- 99% positive (Good/Excellent) responses in surveys carried out throughout 2011.

Hythe and Blackfield: There are differences between our two local communities. The 2011 demographic study highlights that Hythe residents have an older average age than in Blackfield, while an earlier practice survey (measuring reaction to real-time Saturday opening), concluded Hythe residents tend to commute more with a greater need for access to the surgery outside of core hours. The same study also found that late night opening meets the needs of patients at both health centres better than fewer hours on a Saturday morning and so, to meet patient needs, our late night opening provides more hours than the Extended Hours LES specification requires.

1) Only 7 appointments (of 12,111 offered in the period) needed a Saturday appointment and the remainder indicated “late evening” appointments would equally meet their needs.

2) There was a statistically significant higher demand for appointments outside of core hours at Waterside (Hythe) than Blackfield surgery (79%/21%).

As participants in the Extended Hours DES, practice opening/surgery hours shown below are profiled to meet the needs of our local populations:

Waterside Health Centre Blackfield Health Centre

Monday 08:00 – 20:00 Monday 08:00 – 18:30 Tuesday 08:00 – 20:00 Tuesday 08:00 – 20:00 Wednesday 08:00 – 20:00 Wednesday 08:00 – 18:30 Thursday 08:00 – 20:00 Thursday 08:00 – 20:00 Friday 08:00 – 18:30 Friday 08:00 – 18:30 Saturday Closed Saturday Closed Sunday Closed Sunday Closed

1.2 Invitation to join the PRG

Established by Martin Cox and chaired to date by John Carr, the Patient Group was established in April 2008 and members have been recruited over time, including by invitation in practice newsletters (sent to all registered patient households), word of mouth, patient screens in the waiting rooms (Appendix 5: Patient Group Waiting Room Screen), leaflets and, in 2011 by way of a stall at Exbury Fete and Hythe Activity Day. The group, and that new volunteers are welcome, is well publicised and, more recently, in an attempt to grow an additional virtual group, the waiting room leaflet Appendix 6: Patient Group Recruitment Leaflet.

With a formal constitution (available http://blackfieldpatientgroup.co.uk/?page_id=19) and active National Association of Patient Participation (NAPP) members, the group meet monthly and all registered patients are invited to attend with minutes published on dedicated Patient Group notice boards in the waiting rooms at both surgeries (Appendix 7: Waterside Patient Group Notice Board) and on the group websites: (www.hythepatientgroup.co.uk) and (www.blackfieldpatientgroup.co.uk).

The Patient Groups have earned a reputation for high level engagement with the practice and their interest in the local health economy, and a very positive report on the group was prepared by Di Gouldie of HampshireLINk in January 2012 for West Hampshire CCG. Appendix 8: Report on Red and Green PRG by HampshireLINk.

Despite all of the above, the Patient Group and the practice have found it difficult to recruit new members as evidenced in minutes of regular meetings. Together, the practice and the group have concluded it is easier to recruit new volunteers when there is a “problem” rather than when “all is going well”. With this in mind, the Patient Group are mindful of taking advantage of opportunities as they come along.

A recent upsurge in parking problems with the neighbouring school in Blackfield provided such an opportunity in February 2012. The Practice Manager patrolled the car park gate for 2-weeks, handing out leaflets to all those wishing to park (Appendix 9: Patient Group Parking Leaflet) and invited patients to sign a petition supporting the group’s action with signatories advised they could receive minutes of Patient Group meetings. This was then followed up with one-to-one invitations to join either the face-to-face or virtual group. Again, patient screens were used to support the recruitment campaign (Appendix 10: Patient Group Screens - Car Park Recruitment Campaign), and the group will look for similar opportunities as they come along.

1.3 Size and Profile of the PRG

Patient Group: Meeting monthly with the Practice Manager, staff, GPs and nurses, the group have been termed “Patient Forum”, “Patient Participation Group” and more recently with the advent of this DES, “Patient Reference Group”. Regardless of title, the Patient Group has always been directly involved in practice decision making on issues affecting patients. The group has also actively sought and contributed to discussion on the implications of changes in the local and national health economy.

The group make up is profiled in Appendix 1. Given that consultation rates increase considerably with age, it is not surprising the group is a little older in profile than the whole practice list, although the age ranges from the 25-34 group into the over 85’s group, ensuring a fair spread of views. Slightly biased toward female participation, this reflects typical appointment attendance profiles (source: Final Report to the Department of Health: Trends in Consultation Rates in General Practice 1995/1996 to 2008/09: Analysis of the QResearch database. NHS Information Centre).

Given our understanding of practice profile and locality demographics, added to the size and regularity with which we survey patient needs, we believe the practice understands and responds well to the needs of the practice population as a whole, ensuring views and actions of the Patient Group are representative of the population we serve. Furthermore, we are able to anticipate and take positive action to respond ahead of the changing needs of our patients in the future.

That said, it is hoped that growing the group (see virtual group below) will help to increase representation of patients in the 17-24 age group, although we may have to accept that lower attendance rates and disengagement from democratic institutions and politics in general (Henn and Foard, 2011), mean this is a slow process.

Clinical system information re: ethnicity, learning disabilities, etc is given in brackets but should not be relied on as accurate as the practice has only recently started recording ethnicity, and an accurate learning disability register has been difficult at a regional level. Although the group does not have members with registered learning disabilities (0.18% of list), resident in nursing or care homes (0.28% of list) or wheelchair users (0.15% of list), one group member is registered disabled (5.55%).

Virtual Group: As highlighted in 1.2 above, recruiting for a virtual group has been difficult and, at the time of drafting this report, those agreeing to join a ‘virtual group’ stands at 24, plus 18 face to face group members, making 42 in total.

The Patient Group meeting 19th March 2012 agreed to focus on increasing group size in the year ahead. With a practice list of 25,000, it is likely the resulting group will become too large to meet in monthly meetings. So, to avoid dissolving the value for both practice and the patients gained from the monthly meetings, it has been suggested that a larger group could be set up as a “virtual” group.

Action 2. We will continue to develop a much larger group whose opinions and views can be sought via e-mail and at meetings. The development of this ‘virtual’ group will be an area of focus for 2012/13. The group agreed to proceed with this action.

Step 2: Agree Priority Areas

2.1 Local Survey – areas to be considered

The Patient Group had many areas to consider this year: Blackfield surgery parking (agreed little improvement could be made, Appendix 11: Patient Group Meeting 5th April 2011); a patient information centre needed more detail; and no further action looked likely in follow up to the prescription survey undertaken by the group in 2010/11 (Appendix 12: Patient Group Chairman’s Report 5th April 2011). Phlebotomy satisfaction surveys had been carried out in previous years and the group agreed to continue informally monitoring patient feedback while discussions with the PCT were ongoing (Appendix 13: Patient Group Meeting 6th June 2011). With access a persistent and historic problem, improvement has been on the Patient Group agenda since inception, especially in the early part of 2011 as “how an improved service could work” started to emerge in meetings with the Patient Group.

2.2 Identifying Priority Areas - rationale

Despite improvements in recent years, access to routine pre-bookable appointments has remained problematic, evidenced by feedback from suggestions cards and in- practice surveys, supported by national survey results. Ongoing dialogue between the practice and Patient Group set out to find ways to improve access to routine pre- bookable appointments. Red and Green historic national survey results showed:

Satisfaction with 2007/08 2008/09 2009/10 2010/11 Opening 76% 75% 85% 92% Phone Access 88% 90% 86% 75% PE7 90% 87% 98% 84% PE8 32% 43% 50% 58% Overall Care 92% 95% 96% Overall Admin 92% 91% 93% Overall Score 72% 80% 84% 83%

For all changes to same/next day and routine appointment mix had achieved improved satisfaction with access to prebookable appointments, the practice agreed with the Patient Group to pilot a “same day service” Minor Illness Clinic at Waterside commencing April 2011. The agreed area of priority was to measure satisfaction with the pilot compared to “no change” at Blackfield, in context of historic national survey results. In essence, make sure the pilot was liked and understood by patients and measure if it made a difference. If it did make a positive difference, the next priority would be to replicate the service at Blackfield Health Centre.

2.3 Agreeing Priority Areas – method

Choosing and agreeing access to appointments as a priority area was a result of ongoing discussion of patient satisfaction survey results and feedback at face to face meetings between the practice and the Patient Group.

2.4 Dates of Discussions

Discussions of access as a priority area was minuted at meetings in April and June 2011 and initial survey results reported to patients in the Patient Group Newsletter in July 2011 (Appendix 14: Hythe and Blackfield Patient Groups Newsletter July 2011).

Step 3: Collate Views

3.1 Survey Method

Survey forms (Appendix 15: Patient Survey Form) were given to patients attending both surgeries in regular opening times, including extended hours to 8pm, and handed in/collected at reception in April/May 2011. In follow up to the initial pilot survey results (April/May 2011), reported by the group at the June 2011 meeting and publicised in the July 2011 Patient Group newsletter, the survey was then extended without break (as first suggested by the Patient Group in April 2011), to measure and compare patient satisfaction across seven indicators at both Health Centres.

3.2 Credible Survey

The questions replicated previous national survey questions to give a long term comparison against historic responses to seven key indicators of patient satisfaction with the practice as a whole (longitudinal study). The pilot scheme and survey were supported by a “patient information leaflet” for display on waiting room screens (Appendix 16: Minor Illness Clinic Information), discussed and agreed in April 2011.

Per 3.1 above, we effectively operated two surveys; one at each surgery with the pilot at Waterside, and Blackfield as the control, so survey results could be compared between surgeries, and to historic trends in the national survey.

The initial survey was distributed to 500 patients in April/May 2011, and achieved 371 responses. Department of Health determination of Red and Green patient satisfaction with advance booking was based on just 59 national survey responses in 2010/11; giving a 12.74% margin of error. In appeal, we cited Department of Health guidelines indicating survey responses should be sufficient to fall within 7% margin of error (confidence interval). For a survey to be considered robust for our list size 195 patient responses will give a result within the allowed 7% margin of error; for 5%, 379 patients need to have responded. Our survey (April-May 2011) achieved 371 responses (5.05%) and is therefore credible and statistically robust. The longer term survey (April-September 2011), achieved a total of 1,623 responses (reducing the confidence interval, or margin of error to just 2.35%).

3.3 Survey Analysis

Results of the first survey, and emergent themes, were discussed by the Patient Group on 6th June 2011 and illustrate Patient Group engagement in identifying and determining importance of an innovative “Same Day Service” designed to improve urgent/acute access with the intention of freeing pressure on routine appointments.

The results discussed and recorded in the June 2011 minutes:

Waterside Results Satisfaction with 2007/08 2008/09 2009/10 2010/11 Apr/May Survey WS Opening 76% 75% 85% 92% 99% WS Phone Access 88% 90% 86% 75% 80% WS PE7 90% 87% 98% 84% 84% WS PE8 32% 43% 50% 58% 76% WS Overall Care 92% 95% 96% 98% WS Overall Admin 92% 91% 93% 99% WS Overall Score 72% 80% 84% 83% 89%

Blackfield Results Satisfaction with 2007/08 2008/09 2009/10 2010/11 Apr/May Survey BF Opening 76% 75% 85% 92% 97% BF Phone Access 88% 90% 86% 75% 78% BF PE7 90% 87% 98% 84% 73% BF PE8 32% 43% 50% 58% 62% BF Overall Care 92% 95% 96% 94% BF Overall Admin 92% 91% 93% 91% BF Overall Score 72% 80% 84% 83% 85%

Results show improvement in satisfaction with advance booking, and this correlated with an overall improvement in patient satisfaction with care, administration, and the practice as a whole. The emergent theme is that the “same day” pilot at Waterside appears to have been successful in improving access to advance appointments.

A comprehensive analysis of the longitudinal study then took place at a meeting with the Patient Group on 19th March 2012 focusing on improvement and highlighting an observable difference in consistency of satisfaction between Waterside Health Centre running the “same day service” and Blackfield Health Centre still running the “old” duty/triage system. The results and slides below presented and discussed with the Patient Group (Appendix 17: Patient Group Meeting 19th March 2012).

Waterside Results Satisfaction with 2007/08 2008/09 2009/10 2010/11 Apr/May Apr/Sep Survey Survey WS Opening 76% 75% 85% 92% 99% 99% WS Phone Access 88% 90% 86% 75% 80% 83% WS PE7 90% 87% 98% 84% 84% 83% WS PE8 32% 43% 50% 58% 76% 80% WS Overall Care 92% 95% 96% 98% 98% WS Overall Admin 92% 91% 93% 99% 98% WS Overall Score 72% 80% 84% 83% 89% 90%

Blackfield Results Satisfaction with 2007/08 2008/09 2009/10 2010/11 Apr/May Apr/Sep Survey Survey BF Opening 76% 75% 85% 92% 97% 97% BF Phone Access 88% 90% 86% 75% 78% 83% BF PE7 90% 87% 98% 84% 73% 80% BF PE8 32% 43% 50% 58% 62% 62% BF Overall Care 92% 95% 96% 94% 94% BF Overall Admin 92% 91% 93% 92% 92% BF Overall Score 72% 80% 84% 83% 85% 85%

In the survey results extended from April to September 2011, we see improvement with access to advance bookings continues to improve at Waterside, with all other measures either remain at the improved level observed during the initial survey, or improve further as patients adapt to the new system. At Blackfield, results remain largely consistent with no overall improvement.

When weekly results were compared, it also became apparent that consistency of satisfaction improved, especially with access to advance appointments, booking and administration, and with the practice as a whole, as the slides below illustrate.

The group felt the final slide was especially informative, summing all survey results to produce a single measure of overall satisfaction, which clearly illustrates the impact improving same day access and reducing routine appointment waiting times has had on the whole “sense of satisfaction” that patients felt at Waterside surgery. Satisfaction with Access to Advance Appointments

WS PE8 BF PE8

100%

90%

80%

70%

60%

50%

40%

30%

0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 /09 1 /1 1 1 1 1 1 1 1 1 1 1 /1 1 1 6/07 9/ 5 5/ 6/ 6/ 7/ 7/ 8/ 8 9/ 0 08 0 /0 /05/ /0 /06/1/06/ /0 /0 /07/1/07/ /0 /0 /08/ /0 /0 /09/ /0 0 8 5 20 2007/0820 20 06 13/05/1120 27 03 1 17 24 01 0 15 22 29/07/10 12 19 26/08/1102 09

Overall Satisfaction with Administration/Reception

WS Overall Admin BF Overall Admin

105%

100%

95%

90%

85%

80%

75%

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 /07 /08 /09 /10 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 05/ 05/ 05/ 05/ 06/ 06/ 06/ 06/ 07/ 07/ 07/ 07/ 07/ 08/ 08/ 08/ 08/ 09/ 09/ 006 007 008 0096/ 3/ 0/ 7/ 3/ 0/ 7/ 4/ 1/ 8/ 5/ 2/ 9/ 5/ 2/ 9/ 6/ 2/ 9/ 2 2 2 2 0 1 2 2 0 1 1 2 0 0 1 2 2 0 1 1 2 0 0

Overall Satisfaction Score

WS Overall Score BF Overall Score

100%

95%

90%

85%

80%

75%

70%

08 10 11 11 11 11 11 11 11 11 11 11 7/ 9/ 5/ 5/ 6/ 6/ 7/ 9/ 0 0 0 0 0 07/11 08/11 /08/11 /09/110 2006/07200 2008/0920006/05/1113/ 20/05/1127/ 03/06/1110/ 17/06/1124/ 01/07/1108/ 15/07/22/ 29/07/05/ 12/08/19 26/08/02 09/

Step 4: Discuss Survey with PRG

4.1 Discussion Method

Face to face meetings including 6th June 2011 and 19th March 2012 (see 3.3 above)

4.2 Rationale

After initial success with the Waterside pilot, it was agreed at the June meeting to extend the Minor Illness Clinic to Blackfield; the rationale being that the trial was liked by patients and significantly reduced pre-bookable appointment waiting times.

4.3 Agree Changes

At June 2011 meeting, it was agreed to maintain the Waterside Minor Illness Clinic and start a pilot at Blackfield. At the March 2012 meeting, it was agreed to maintain the Minor Illness Clinic at Waterside and Blackfield for the foreseeable future.

4.4 Contractual Impact

None apparent Step 5: Agree Action Plan

5.1 Actions Agreed

The plan agreed was to continue the Minor Illness Clinic “same day service” at Waterside Health Centre and commence a pilot at Blackfield. We agreed to continue monitoring patient satisfaction and report results, trends and conclusions.

5.2 Priorities

It was agreed at the Patient Group meeting on 19th March 2012 that satisfaction as a whole had improved significantly as a result of the change to appointments and it was mutually agreed to retain the Minor Illness Clinic at both surgeries.

5.2 Timeframe

See 5.2 above, ongoing/already implemented.

Step 6: Publicise

This report is available on the practice website, NHS Choices, at reception in both surgeries, with a copy supplied to NHS Hampshire.

Appendix 1: Information checklist for local patient participation report In order to support the assessment of the DES, practices' final report should address all of the elements below Stage one - validate that the patient group is representative

Show how the practice demonstrates that the PRG is representative by providing information on the practice profile:

Practice population profile PRG profile Difference

Age % 17 - 24 10% % 17 - 24 0% -10% % 25 - 34 11% % 25 - 34 6% -5% % 35 - 44 12% % 35 - 44 6% -6% % 45 - 54 15% % 45 - 54 6% -9% % 55 - 64 14% % 55 - 64 11% -3% % 65 - 74 12% % 65 - 74 28% 16% % 75 - 85 8% % 75 - 85 28% 20%

% Over 85 3% % Over 85 16% 13% Ethnicity White 22951 91.96% 100% 0.00% % British Group 258 1.03% 0.00% -1.03% % Irish 2 0.01% 0.00% -0.01% Mixed 527 2.11% 0.00% -2.11% % White & Black Caribbean 0 0.00% 0.00% 0.00% % White & Black African 0 0.00% 0.00% 0.00% % White & Asian 0 0.00% 0.00% 0.00% Asian or Asian British 86 0.34% 0.00% -0.34% % Indian 32 0.13% 0.00% -0.13% % Pakistani 4 0.02% 0.00% -0.02% % Nepalese 0 0.00% 0.00% 0.00% % Bangladeshi 0 0.00% 0.00% 0.00% Black or Black British 0 0.00% 0.00% 0.00% % Caribbean 4 0.02% 0.00% -0.02% % African 33 0.13% 0.00% -0.13% Chinese or other ethnic group 0 0.00% 0.00% 0.00% % Chinese 19 0.08% 0.00% 0.08% % Any Other 1041 4.17% 0.00% -4.17% TOTAL 24957 Gender % Male 12513 50.14% 33.34% -16.80%

% Female 12444 49.86% 66.66% 16.80% Practice Specific Care groups learning disability group 46 0.18% Resident in Care/Nursing Home 69 0.28% Wheelchair user 38 0.15%

Appendix 2: Red & Green practice population variation (2007-2012)

Source: Non-Elective admissions, case mix and demography for the Red and Green Practice (J82056), Waterside; part of West Hampshire CCG (10.02.12)

Appendix 3: Red & Green practice weighted population variation (2007-2012)

Source: Non-Elective admissions, case mix and demography for the Red and Green Practice (J82056), Waterside; part of West Hampshire CCG (10.02.12)

Appendix 4: Hampshire PCT Practice Index of Multiple Deprivation (2010)

Source: Non-Elective admissions, case mix and demography for the Red and Green Practice (J82056), Waterside; part of West Hampshire CCG (10.02.12)

Appendix 5: Patient Group Waiting Room Screen

The Hythe and Blackfield Patient Groups support the work of the Red and Green Practice to improve service and provide patients with a way of communicating with GP’s, Practice Manager and staff.

All patients are automatically members of the groups and are welcome to attend our monthly meetings, the Annual General Meeting, become committee members or volunteer to help.

To find out more about your Patient Group look us up on the internet:

www.hythepatientgroup.co.uk www.blackfieldpatientgroup.co.uk

Appendix 6: Patient Group Recruitment Leaflet

Appendix 7: Waterside Patient Group Notice Board

Appendix 8: Report on Red and Green PRG by HampshireLINk

From: Dianne Gouldie To: "[email protected]" Sent: Wednesday, 1 February 2012, 11:24 Subject: PPG Meeting

Dear John,

Apologies for the delay in writing to you. I would like to thank you for inviting me to your PPG Meeting at The Waterside Health Centre on Monday 9th January, 2012.

It was an excellent meeting and met all the criteria that I am looking for as a first class model for Patient Participation Groups. I was impressed by the groups enthusiasm, independence, and looking into all aspects of health and social care which not only affects your practice but in the local community. It was admirably chaired with lots of discussion and independent points of view.

The presence of your Practice Manager Gary Young who was very supportive, informative and encouraging made for excellent relationships and positive outcomes. You obviously had a good working relationship with him and the GP's, but were given an independent voice which was listened to.

As a group you were also a voice in your local community on Health and Social Care Issues with many contacts and a strong commitment and involvement. Patients were well informed of changes, given a voice and views taken into account. It was good that my presence in no way hindered you and a good open and honest meeting ensued.

I was particularly impressed by your invitation to a local Debt Advisory Group to explain their role in the community. This is very prevalent and a source of many health and social care issues. Your support was obviously very much appreciated.

I will be compiling a full report which will be of enormous help to other PPG's, and please pass on my congratulations to all the members of your group.

Kind regards

Di Gouldie HampshireLINk Management Board Member

Appendix 9: Patient Group Parking Leaflet

Appendix 10: Patient Group Screens - Car Park Recruitment Campaign

School Time Parking at Blackfield Doctor’s Surgery

Since Blackfield School changed its parking, parents have started to use the Doctors surgery car park to drop off and collect children from school.

School Time Parking at Blackfield Doctor’s Surgery

This has become so bad that doctor and nurse appointments can run up to 30-40 minutes late, disabled patients cannot park in the disabled bays and, recently, an emergency ambulance had difficulty getting in the surgery.

School Time Parking at Blackfield Doctor’s Surgery

Blackfield Patient Group are contacting school governors, local councillors, the Highways Agency, the local Community Support Officer and local Police, all in an effort to find a solution to the school time parking problem at Blackfield Health Centre.

School Time Parking at Blackfield Doctor’s Surgery

You can help by signing our petition at the reception desk.

If you add your email address, we’ll keep you up to date with progress with minutes of our monthly meetings by email.

Help us to make your voice heard and STOP your Doctors car park being used as a drop-off and pick-up point for the daily school run

T THANK YOU FOR YOUR SUPPORT

Appendix 11: Patient Group Meeting 5th April 2011

WATERSIDE AND BLACKFIELD JOINT HEALTH CENTRES PPG

ANNUAL GENERAL MEETING

Tuesday 5th April 2011

Attendees: Audrey Howe, George Howe, Isabel Smedley, Jackie Kemish, John Carr (Chair), John Moore, Karen Newman, Margaret McNaught, Sara Taylor, Stuart Harding, Sue Harding. GP Dr A Steadman was welcomed to the meeting.

1. Apologies Adam Smith-Connor, Elizabeth Moore, Gary Young, Muriel Abbott, Ron Last.

2. Minutes of Previous Annual General Meeting These were approved and signed.

3. Matters Arising There were no matters arising not covered by the Agenda.

4. Chairman’s report Attached on a separate sheet.

5. Election of Officers and Committee members

The Chair assumed that all listed members would continue. Mr & Mrs Farrow asked to be removed from the group. It had been agreed that published notes of the meeting would be available but not the full minutes to ensure confidentiality. The Treasurer (JK) and Secretary (SH) were formally proposed by John Moore and seconded by Stuart Harding and elected.

The Chair had expressed a wish to step down but remain in the group but no replacement available so he will continue on a temporary basis. Decision to meet as a joint group confirmed - facilitated ease of decision making. GH confirmed that the group were grateful for the leadership of the Chair.

7. Any Other Business

GH re Age Concern/Age UK. Age Concern had their official opening on the lst April 2011, Age UK had not been taken over by Age Concern. Age Concern now his its own franchise. More publicity required for Age Concern and this could be included in the website.

The Chair advised that the White Paper had now been changed although some PCTs were moving towards change and Practice Based Commissioning groups had undertaken a great deal of work. It is hoped that Dr Gregory would be able to update the meeting at some stage.

AH - National Patient Forum newsletter is interesting. Annual conference will be June 11th at Basingstoke. A representative of this group should attend and report back. The Chair advised that funding for attendance would be available and this was agreed.

StH - still problems with parking at Blackfield. The Chair felt there was nothing more that could be done but will draft a letter to the school on behalf of the group.

JC confirmed the triage system for appointments was working well and perhaps a survey could be undertaken in July. Discussed survey and it was noted that new leaflets in the surgery were helpful. Dr Steadman agreed these were useful for minor injuries.

The next AGM will be in April 2012 with date to be advised.

The next general meeting will be held on the 9th May 2011.

Appendix 12: Patient Group Chairman’s Report 5th April 2011

WATERSIDE AND BLACKFIELD PATIENT PARTICIPATION GROUP ANNUAL GENERAL MEETING Tuesday 5th April 2011 CHAIRMANS REPORT

Prescription Survey Just after our last AGM we decided to conduct a prescription Survey in response to comments made to members of the committee regarding the prescription services available to patients. The questions were about waiting times, arrangements for repeat prescriptions, medicine stocks and home delivery services. The completed forms covered responses from customers of all Pharmacies in the area. Additional comments made by the respondents produced useful additional information. Although the small number of surveys completed made it difficult to draw conclusions some clear patterns could be seen from the data.

Application to HMRC for recognition as a charity. In June, having finally managed to set up a bank account with no charges, we were in a position to send to the HMRC the additional information they requested This was sent at the beginning of July. Eventually they replied informing us that in the period between our initial submission and their receipt of the additional information the criteria had changed and we would have to re-submit on line. In addition they stated that they would not accept our main objective as an objective being wholly charitable in law. As a result of this we needed to hold an Extraordinary General meeting to change this in our constitution. This meeting was held in November and our application re-submitted in December. In January of this year we were informed that our application had been successful. This now means that we can apply for grants and donations that were not previously available to us. We can also register for gift aid registration.

PPG Website Earlier this year we started to discuss the possibility of a PPG website linked to the main practice website. Having decided how we wanted to organise it and what it should include Adam took on the task of setting it up in consultation with Gary Young. At our March meeting Adam was able to give us a demonstration of what the website could look like based on his work to date. The committee asked Adam to complete the task. Adam suggested that if we wished to contact younger patients we should also have a Facebook account. This was agreed unanimously. Our thanks to Adam for his work on this project.

PPG Information booklet We were about to revise and update our booklet when we decided to develop the website. Further work was put on hold so that we could ensure a close link between the website and the booklet. The website and booklet will improve our communication with the patients and hopefully enable us to get more people involved not necessarily as committee members but as helpers.

Information Centre We have discussed the setting up of an Information Centre here at Waterside for use by all patients and staffed by volunteers. This development is on hold at the moment until the proposed refurbishment has been completed. At this point we should be in a position to submit the project for approval by the partners. Jackie Kemish and I have recently visited the Testvale Surgery to look at their centre which has been in operation for a number of years. The lady who organises the centre has offered to come and talk to us about their experience and give us some advice.

Screens At last year’s AGM Gary Young announced that we had been given £10,000 by ESSO to finance the Surgery Information Screens. These have worked well although as you would expect have attracted a full range of comments from “waste of money” to a very useful and informative addition”. I feel that we could make use of the screens to advertise our activities.

General Comments • We have renewed our member ship of the NAPP and have joined Community First New Forest. • Dr Cole has been approached to start the walks again and our help has been requested. Ann Harmston has volunteered to help. Any further help will be welcome.

• The introduction of the website, the revised booklet and perhaps use of the screens will help us to improve our communication with patients and lead to greater patient participation. • We have been requested to fund raise to purchase a reserve Blood Pressure machine for patient use. • Our first activity this year will be to raise funds for this from various grant making bodies and local industry • Finally The General Medical Services Contract 2011/2012 includes the following –

For the first time key requirements of the patient participation arrangements agreed by negotiators are that GP practices:

develop a structure that gains the views of patients and enables the practice to obtain feedback from the practice population, e.g. a patient reference group; agree areas of priority with their patient reference group; collate patient views through a patient survey; agree an action plan with their patient reference group; publicise the results of the patient survey; publicise the actions taken and what is achieved as a result.

• Since we formed in 2008 we have satisfied all these requirements and continue to do so.

Thanks to Sue Harding, Jackie Kemish and Gary Young for their help and support during the last year.

John Carr Hon Chairman Waterside and Blackfield Health Centres Joint Patient Group

Appendix 13: Patient Group Meeting June 2011

WATERSIDE AND BLACKFIELD HEALTH CENTRES JOINT PATIENT GROUP MEETING

Monday 6th June 2011 Waterside Health Centre

Attendance: John Carr (Chair), Gary Young, Jackie Kemish, Audrey Howe, George Howe, Isabel Smedley, Margaret McNaught, John Moore, Betty Moore, Ron Last, Muriel Abbott, Sara Taylor, Stuart Harding, Ann Harmston

Apologies: Adam Smith-Connor, Sue Harding

1. Election for Vice Chairman: Sara Taylor was proposed - Proposer RL, Seconded by GH – therefore ST is duly elected.

2. Minutes of Previous Meeting: Betty Moore was missed off the attendees.

3. Matters Arising: Fundraising – JC has had a response back from Community First to which there are 8/9 charities locally who would be willing to donate monies for a request such as ours. Before we send letters to each one JC would need more information about the BP Machine such as how often used etc. GY also suggested we write to Esso again, JC will do so but use Sara’s details instead.

Walks – AH has printed off all the walks from the website and is happy to organise a trial walk in September so we have time to advertise. GY had a stock of hard copies of walks which he gave to AH to pass on to interested parties. JC will organise advertising, Herald? Need to put information on Patient Screens – wording to be agreed between AH and JC.

Website – ASC had sent a message via JC for all members to go to the website and click on Facebook or Twitter to push our ratings up; however everyone who had tried found that the link doesn’t work. There is now a link from the Red and Green Website to the Patient Group websites.

4. Health Centres Update (GY):

Pharmacy Update – The licence was applied for a pharmacy at the Blackfield HC, but was turned down by the Hampshire PCT, was then taken further to Leeds but was still turned down. The main reason was that there was a bona fide chemist only 300 yards away; however GY still thinks this still might be a possibility by going for a 100 hrs licence. The good news is that at Waterside the Day Lewis Pharmacy will be on site before the end of September with a definite opening before Christmas. So Contractors will be on site out of hours to complete the work taking into consideration parking etc.

Refurbishment - The refurbishment has been on-going at Waterside again out of hours so as not to upset the day to day business, all clinical rooms have been done, just all the common room areas to complete which will be done nearer to September, when the Waiting Room will be refurbished. GH wanted it put on record that the new chairs would be positioned in such a way that one could see the Patient Screen and secondly that there was ample parking facilities for disabled patients.

JC asked GY if there would be any change to the telephone system as part of the refurbishment, to which there will be no change.

The PPG would like to support the new build and agreed to create an A5 leaflet giving advance warning of any disruption in the future – can be put out the same time as the new PPG leaflet.

Minor Illness Clinic (MIC) - Pilot Scheme – This was researched over 9 months by a core group of GPs/Nurses and Management and the new system for appointments has been working well over the last 7 weeks. Initially the figures for appointments waiting time at Blackfield was 5-7 days but this increased in 2011 to 10-14 days. At Waterside waiting time has been 12-14 days over the past 18 months, now they are 12 days waiting time at Blackfield and 6 days at Waterside. Thereby proving that the new system works well. The MIC Nurse deals with non-urgent cases up to a certain level and then refers to the MIC GP immediately. AH had experienced the service and was very impressed. This system will be implemented at Blackfield in August.

The resulting service was rolled out at Waterside on a trial basis in April 2011 and a patient satisfaction survey was undertaken to gauge patient response to the changes.

The results to date: Over the 5-weeks (from w/e 29th April to 27th May) 99% of patients at Waterside Health Centre thought opening times were Good/Excellent, 84% said they could normally get a same day appointment while 76% said they could normally get an advance appointment. The improvement in satisfaction with "advance appointments" is significant as it has improved year on year from just 32% in 2006/07 to the current level of 76%. What was not expected was the improvement in satisfaction with opening hours which has also improved year on year from 76% in 2006/07 to 92% before starting the MIC to 99% since the new clinic started.

Hythe Phlebotomy – AH has experienced problems again with getting an appointment for blood tests at Hythe, had to go to Lymington on two occasions. GY agreed that there had been other patient complaints and had spoken to Hythe Hospital only last week. JC confirmed that Hythe had been having problems with trying to meet the demand for appointments, but there are only two staff and should one be sick this restricts the amount appointments available. This service used to be for Green & Red Practice patients only, but is now used by all Practices in the area hence the problem, he believes that extra staff are being brought in to help alleviate this situation. GY asked that this be put back on as an Agenda Item so we can monitor the situation.

AH brought up that those who are hard of hearing go to Audiology at Hythe for an appointment, only to be referred to Lymington who sort out any problems – why is this so? AH to speak to JC outside of this meeting.

5. Finance: Nil of note – balance on account remains the same.

6. Speakers: JC confirmed that AH will be the Speaker at the next Meeting in July, and he had spoken to Michelle Morran-Ryan about coming back to speak again as her role has changed she last came to see us, book up for September? as no August Meeting.

7. Booklet: Sara had re-run the PPG booklet to include proposed suggestions from last meeting; JC handed out hard copies and will forward other copies via e-mail. Please check through and report any changes or suggestions to JC.

8. ‘Hythe Activity Day 2011’: JC has provisionally booked a site for the PPG to have a stall on Saturday 23rd July, we shall need the Gazebo (at Blackfield) new pamphlets, information about new Walks, conduct a survey on blood test appointments, procure balloons and helium gas instead of sweets for the children (JK will look into). We shall need volunteers for the day, Adam to put on the website asking for helpers, volunteers so far: ST/ RL/ JK please let JC know.

9. AOB: RL attended a Public Meeting held by SUHT, it was well organised and with 5 different organisations and speakers asking for views from the public on their services offered, but the public turnout was really bad, no-one seems interested. Consequently he felt really proud of what we have achieved through the PPG and the services we had in our locality.

10. Date of Next Meeting: Monday 4th July 7.00 pm Blackfield Health Centre – Apologies from Muriel Abbott.

Appendix 14: Hythe and Blackfield Patient Groups Newsletter July 2011

Appendix 15: Patient Survey Form – Spring 2011

Appendix 16: Minor Illness Clinic Information Screens

You asked us to improve our Appointment System

1. We now have more doctors

Seeing your regular GP will improve continuity of care 2. We now have more appointments You can book GP appointments up to 2-weeks in advance 3. We have made our appointment system easier We have introduced a Minor Illness Clinic to see you quicker

We now offer THREE types of Appointment

1. Emergency Doctor

Same day GP appointment for urgent problems 2. Minor Illness Clinic Same day Senior Nurse appointment for minor illnesses 3. Regular GP Book same day or up to 2-weeks in advance

EMERGENCY DOCTOR

1. If your condition is LIFE THREATENING

Choking, Chest Pain, Blood Loss - CALL 999 IMMEDIATLY 2. If your condition is URGENT to be seen today Pain, Breathlessness, Suicidal, Unwell Children – BOOK TODAY 3. If your are UNSURE Ask to speak to the Emergency Doctor/Duty Team

MINOR ILLNESS CLINIC

1. A GP and Senior Nurse working together

A Duty Doctor and Nurse work together to offer you the best care 2. Call today and get seen today You cannot pre-book but you will be seen on the day you call 3. What can we see? The next screen lists typical Minor Illnesses…

MINOR ILLNESS CLINIC

• We can see:

Ear Ache, Eye Infections, Sinus Problems, Rashes, Eczema, Boils, Skin Infections (including bites/stings/ticks), New Hay Fever and Allergic Reactions, Thrush, Cystitis • We will call you back before we book:

Flu-like Symptoms, Diarrhoea or Vomiting, Dizziness, Nausea, Worms/Nits, Conjunctivitis, Recurring Hay Fever, Contraception, Urinary Symptoms, Minor Injuries, Sore Throat, Runny Nose

REGULAR GP

1. Book Up to 2-Weeks in Advance

You can book Today, Tomorrow and up to 2-weeks in Advance 2. Ask to See Your Regular GP Help us by always asking to see your regular GP first 3. Telephone Consultations If you prefer advice, ask your regular GP to call you back

Reception are here to help

1. Repeat Prescription or Medication Requests

Ask reception first, it may avoid an unnecessary GP appointment 2. Test Results Mornings are very busy, please call in the afternoon, before 4pm 3. Tell us Your Symptoms It helps to add a note to the appointment screen when you book

IF YOU NEED TO CANCEL AN APPOINTMENT

1. Tell Us Quickly

Even short notice helps us free the appointment for someone else 2. Four Ways to Cancel Phone, Text, Email, Web – ask for details at reception 3. Opening Hours Monday to Thursday 8:00am to 8:00pm; Friday 8:00am to 6:30pm

Tell Us What You Think

1. You Asked – We Listened

Your feedback and Patient Groups helped us shape our service 2. Complete a Survey Ask at reception for a survey form – tell us if you like the changes 3. THANK YOU Keep telling us what you think and we’ll try to keep improving

Appendix 17: Patient Group Meeting 19th March 2012

WATERSIDE AND BLACKFIELD HEALTH CENTRES

JOINT PATIENT REFERENCE GROUP MEETING

MONDAY 19TH MARCH 2012

Group Members John Moore Audrey Howe George Howe Elizabeth Moore Murial Abbott Isabel Smedley Margaret McNaught Ron Last John Carr (Chair) Karen Newman Sue Tona Stuart Harding Gill Wallbridge Sue Harding Ann Harmiston Jackie Kemish Sara Taylor Adam Smith-Conner

Present: Gary Young, Muriel Abbott, Sara Taylor, Sue Tona, John Carr, Sara Taylor, Margaret McNaught, Isabel Smedley, Ron Last, Stuart Harding,

Apologies: Jackie Kemish, Sue Harding

Presentation and discussion of the practice report supporting the Patient Participation DES 2011/12

Open by discussing that pro-active involvement in practice decision making is not quite the linear, tick-box exercise prescribed by the DES. It was agreed at the previous meeting that we needed to have a report from the Practice detailing work so far in connection with the Patient Participation DES 2011/12. This document was first discussed by the group with the Practice Manager at our meeting in April 2011. At this meeting we agreed and minuted that we believed that we meet the DES requirements (and many times since) but it seems we need to be called a ‘Patient Representative Group’, not a ‘Patient Participation Group’ to tick the right boxes.

Action 1. It was proposed by Gary Young, seconded by John Carr that the name of the group should formally be changed to the Waterside and Blackfield Health centres Joint Patient Reference Group. This proposal was passed unanimously. It was noted that the nature and activities of the group were unlikely to change and that ‘Patient Group’ would be used as a working title. Although we have conducted surveys in the past the DES prescribes we need a bigger group. As such a group will possibly be too big to meet effectively; the suggestion is we create a virtual group

Action 2. We will continue to develop a much larger group whose opinions and views can be sought via e-mail and at meetings. The development of this ‘virtual’ group will be an area of focus for 2012/13. The group agreed to proceed with this action.

The group who have signed our recent petition regarding parking at Blackfield are being asked if they wish to increase their involvement by joining the virtual Patient Reference Group. Initial indications are that the majority that gave email addresses (some 120 persons) will sign up. Feedback obtained from this virtual group will form the basis of discussions, decisions and

recommendations made by the existing face to face group. It is quite possible that members of the virtual group will be invited to attend larger meetings to discuss major developments or proposed changes.

Gary then reviewed the work of the group since it started and various points were made and discussed, including his view that what we do, and how we do it, is different to some other patient groups we have met: we are not “friends”, “charity fundraisers”, “GP lapdogs”, or “practice critics”; we are a group that has been actively involved in decision making from day 1 and made notable contributions to supporting and improving services for patients, including:

2008 – Blood Tests. The group has made representation at locality and PCT board level, and it took 4 years but today’s press release confirming SHIP PCT commitment to continue providing the improved level of service at Hythe Hospital over the past 12 months or so will be “maintained and meets the needs of local patients in the Waterside area” is tangible success of the group’s ongoing pressure to improve local health services for our patients.

2009 – Merger. The group led public engagement and ensured effective scrutiny on practices as merging, and acted as a conduit for pt and public concerns.

2010 – Prescription Survey. Patients recognised an issue with pharmacy provision in Blackfield and a locality survey evidenced the shortfall. Supported by the group, the practice applied for a pharmacy licence: although not successful, the process highlighted issues and this in turn improved service provision.

2011 – Access. Pt satisfaction with access started at 32% when group formed in 2008: ongoing engagement and support for service improvement, including the Minor Illness Clinic, saw pt satisfaction rise to 80%+ by late 2011.

More recently the group has discussed with a GP the importance of continuity of care

To complete the report, we need to profile our group members by age, sex, ethnicity and, if possible, if any learning disabilities, nursing or care home residents, or wheelchair users. This was agreed in December 2011 but some member information is still outstanding. This info is needed ASAP. More recently the group has discussed with a GP the importance of continuity of care

Action 3. It was agreed that a further area of focus for the next year should be based around continuity of care.

Gary Young then led a detailed a detailed presentation concerning Access

2011/12 - ACCESS

The report will focus on group involvement in decision making that changed the practice appointment pathway in 2011, all of which was noted in minutes. We undertook a 5-week local survey (29/4-27/5) comparing Minor Illness Clinic (MiC) pilot at Waterside to unchanged appointment pathway at Blackfield, and reported results in June minutes. This identified access as a priority area and the practice agreed to keep monitoring patient satisfaction.

In July, we again reported results plus positive impact on waiting times for pre-bookable appointments and reported results to patients in the group’s July newsletter. The group agreed the practice should trial MiC at Blackfield.

In September, group fed back positive reaction to changes to Dr Gregory and Practice Sister Biddlecombe and introduced the “continuity question”.

At October meeting, the group reflected that changes to continuity needed to be patient driven and Gary reported this back to GPs.

In November the MiC pilot started at Blackfield and patient feedback to the group was positive.

At January meeting, we discussed 10 months of MiC at Waterside and first 2 months at Blackfield. The patient “want” for better continuity through surveys and suggestion cards again noted and discussion on impact on A&E data.

In February, Gary Young reported he and four GPs visited a practice in Weymouth who had made major changes to continuity – lots to think about.

March, we again noted difficulty in forming the virtual group and that Blackfield parking petition offered opportunity to seed a virtual group?

Slides: report longitudinal measurement of average waiting times to next available pre- bookable appointment now 4 working days (or 6 inc weekends) at each surgery and has been stable since start of MiC. This compares to 7-10 days at Blackfield and 10-12 days at Waterside (sometimes 15 days).

Presentation showing collated survey results April to September shows consistency of satisfaction after change. Survey stopped end of September as staff/patients reported being “survey weary”. Results for Jan to March not collated yet but scanning the results indicates similar to April-September – we can identify cause and effect.

Survey shows satisfaction with reception & whole practice improved, not just with access. Conclude when patients can access appointments they need, and receptionists act as a guide rather than seen as a barrier, it is welcomed. Evidenced by a growing list, when new patients are asked “how did your hear of us” 95%+ cite recommendation from family or friend, or ex- patients returning to the practice.

Action 4. Given the evidence, the practice proposes keeping the MiC; does the group support this? This proposal was passed unanimously.

2012/13 - CONTINUITY

Action 5. Propose initial local survey to establish if patients “want” improved continuity, i.e. the ability to see the same doctor each time they visit. Two example questions were discussed reflecting previous national survey questions, so we can measure changes to historic patient satisfaction with continuity. Agreed unanimously.

We discussed if those with long term conditions may have a different view to whole patient population and if access to MiC can be differentiated. Agreed for local survey to use national survey questions and then introduce these factors into the bigger survey later in the year when we know overall broad pt view.

Action 6. Propose rational for choosing continuity is the topic has emerged on comment section of surveys and repeated on feedback ‘suggestion’ cards and logical expectation of patients, not least once access has improved. Agreed unanimously.

Discuss if other areas should be considered as the primary focus in 2012? Blood tests = great outcome and issues with Blackfield parking in hand with volunteer group ready to patrol the gate at afternoon school time, so continuity is the natural choice for the group, especially given our super-aging population.

Action 7. Discuss if future surveys should remain ‘anonymous’ of practice or group header. Agreed, that better kept as is, although we could look at adding note at bottom of survey indicating survey jointly operated by Group and practice.

Action 8. The group agreed for Gary to create the initial local survey for group approval and then operate the survey (say 250 – 500 responses) and collect, collate and report results to the group by June/July meeting. Agreed unanimously.

At June/July meeting, the group will reflect on initial survey results and then formally agree if appropriate as a priority area for improvement in 2012/13, as well as making any revisions to questions to help identify how patients want continuity to improve.

Action 9. The group agreed for Gary to inform the partnership that continuity of care will be the group focus for improvement in 2012/13. The group expects to create a larger survey along lines of previous access survey, which achieved over 1,500 responses, last summer.

Action 10. The group reviewed progress since formation in April 2008, achievements and compliance with the DES criteria for 2011/12 and agreed the focus for 2012/13, along with the 10 action points agreed, and agreed inclusion within the final report.

Meeting opened 19:00 and closed 20:45

Patient Group Meeting

19th March 2012

Satisfaction with Access to Advance Appointments

WS PE8 BF PE8

100%

90%

80%

70%

60%

50%

40%

30%

9 0 1 1 1 1 1 1 1 1 1 1 1 /0 /1 /1 /1 /1 /1 /1 /1 /1 /1 /1 /1 /1 8 9 5 5 6 6 7 7 7 8 8 8 8 06/07 0 0 /0 /0 /0 0 /0 /0 0 0 0 6 7/0 0 7/0 1/0 8/07/115 2/0 2/0 9 6 2 2007/082 2 0 13/05/1120/05/112 03/06/111 1 24/06/110 0 1 2 29/07/1105/ 1 1 2 02/09/1109/09/11

Overall Satisfaction with Administration/Reception

WS Overall Admin BF Overall Admin

105%

100%

95%

90%

85%

80%

75%

0 1 1 1 1 1 1 1 1 1 1 1 1 1 /07 /08 /09 /11 /11 /11 /1 /1 /1 /11 /11 /11 /1 /1 /1 /1 5 5 5 7 7 7 06 07 08 /0 /0 /0 /05 /06 /06 /0 /0 /0 /07 /08 /08 /08 0 0 0 6 3 0 7 3 0 8 5 2 9 5 2 9 2 2 2 2009/10 1 2 2 0 1 17/06/124/06/101/07/10 1 2 2 0 1 1 26/08/102/09/109/09/1

Overall Satisfaction Score

WS Overall Score BF Overall Score

100%

95%

90%

85%

80%

75%

70%

8 1 1 1 1 1 1 1 1 1 1 /0 /10 /1 /11 1 /1 /11 1 /1 1 /11 1 /1 1 /11 /1 7 8/099 6/11 7/11 8/11 0 /05 05 /05/ 0 /06 06 /07/ 0 /07 07 /08/ 0 /08 09 /09 0 6 7 0 1 5 5 9 9 2006/07200 2 2000 13/05/1120/ 2 03/ 1 17/06/1124/ 0 08/ 1 22/07/29/ 0 12/ 1 26/08/02/ 0

Attached Document 1

Demographic Profile Age of Population 2011 - 2016

Waterside, South East New Forest and Totton

Gary Young

7 February 2011 Demographic Profile Age of Population 2011 - 2016

Waterside, South East New Forest and Totton

Summary

Considered as a whole area, Waterside (WS), South East New Forest (SENF) and Totton (TTN) localities have an estimated population of 84,400 in 2011. The size of population is unlikely to change considerably by 2016 but, significantly, the number of people of pensionable age in the WS, SENF and TTN area will increase to nearly 20,000 within the next 5-years, representing over 23% of the whole area population in 2016.

By comparison, the percentage of national (English) population of pensionable age (over 60 for women, over 65 for men) is not expected to reach 23% until 2034. The whole WS, SENF and TTN area will reach this level eighteen years ahead of the national picture.

The trend of a population aging faster than the English national average is common throughout the New Forest. However, within the WS, SENF and TTN area there are pockets of super-ageing, the most notable being Hythe West and Langdown, Ashurst and Brockenhurst. Here, neighbourhoods already exceed the 2034 national forecast for those 65+. When looking at the very old (85+), Brockenhurst, Hythe West and Langdown are forecast to have 5% - 6% of their local populations aged 85 years or older, by 2016.

In the immediate vicinity of Hythe Hospital, Hythe and Dibden currently have more than 4,500 people aged over 65; the adjacent area of Holbury and Blackfield has a further 3,200: a total of 7,700 currently aged over 65. The number of over 65’s in this area is forecast to increase to 5,000 and 3,700 respectively, an estimated total of 8,700 in 2016.

The number of people aged over 75 in the Hythe and Blackfield area is forecast to exceed 4,200 by 2016, while those over 85 years will exceed 1,300 by 2016. Looking at the whole WS, SENF and TTN area, there will be nearly 10,000 people aged 75 or older by 2016, of which a third will be 85 years or older.

With Hythe West and Langdown, and Holbury and North Blackfield both recognised as areas of high multiple deprivation (including elderly income deprivation)1 and changes in household composition leading to more people living on their own2, the outlook is that, by 2016, some 8,000 people over the age of 65 will live in the direct vicinity of Hythe Hospital. A significant portion of this elderly population will be income deprived and/or living on their own. When extended to the whole WS, SENF and TTN area, the number of those aged 65+ more than doubles to nearly 20,000 people, approximately half of whom will be over 75 years, with more than 3,300 over the age of 85.

1 - NHS Hampshire: English Indices of Deprivation 2007: New Forest Summary Report (2007, updated 2008) 2 - Strategy and Information Group: The Demographic Future of Hampshire: 2006-2026 (July 2007)

Gary Young 7 February 2011 1/11

The New Forest compared to Hampshire 1

The overall size of population has changed by less than 1% since 2001 and the New Forest is forecast to decline by just over 100 people between 2009 and 2016.

Significantly, the New Forest working age populations account for a much lower proportion of the total population than is the case for Hampshire as a whole. This trend is forecast to continue to 2016, with 52.9 % of the New Forest population forecast to be of working age compared to 59.5 % of Hampshire’s population as a whole. All districts are set to see a rise in the number of elderly people in relation to the young. The New Forest already has the largest number of old people to young with an estimated 170 to every 100 children in 2009, rising to close to 200 by 2016, (graph below).

The New Forest has the highest proportion of the population above state pensionable age in 2009 (28.2 %) as well as those forecast in 2016 (31.2 %), an increase of 5,000 people. When looking at the very old (aged 85+) this trend of an ageing population continues, with all of the thirteen districts in Hampshire expected to experience an increase in the percentage of their population aged 85 years and over. However, the New Forest is expected to remain the district with the highest proportion of its population aged 85 and over at 5.3 % in 2016 and see the largest increase in the number of its residents that fall into this age group, increasing from 7,500 to 9,200 people.

All Hampshire districts are set to see a rise in Total Dependency Ratios over the period to 2016, with the New Forest expected to remain with the highest total dependency ratio, rising from 81.1 per 100 people of working age in 2009 to 89.0 in 2016.

1 - Hampshire County Council: A Demographic Profile of Hampshire: 2009-2016 (March 2010)

Gary Young 7 February 2011 2/11

WS, SENF and TTN - Compared to the National Picture at 2034

By 2034, 23% of the English national population is forecast to be aged over 65 years1.

In 2011, Brockenhurst and Forest South East (32.46%), Hythe West and Langdown (27.01%), Ashurst, Copythorne and Netley Marsh (24.91%), and Totton East (22.43%) are about to reach, or have already surpassed the over 65’s per 1,000 population forecast nationally by 2034 - some 23 years ahead of the national picture.

Forecasts show that by 2016, 23.38% of the whole SENF, WS and TTN area will be over 65, some 18-years ahead of the national picture. With the exception of Hardley, Holbury, Marchwood, Totton North and West, the entire SENF, WS and TTN area, by ward (neighbourhood), will have reached the 2034 national forecast.

1 - ONS: Population: Aging - Fastest increase in the ‘oldest old’ (June 2010)

Gary Young 7 February 2011 3/11

Methodology – Population

There is a +/- 2.5% variance across the population estimates and forecasts, at a whole area and neighbourhood level, due to differing data sources and methodology employed on those data sources. The ONS produces population estimates for geographical areas smaller than local authorities, and relies on the Ratio Change method. The Strategy and Information Group (i.e. Demographic Future of Hampshire) forecasts are based on Hampshire County Council’s current long-term projections at 2006. Hampshire County Council’s “Long term projections of Hampshire’s demographic future” in 2009 uses the Chelmer model, developed by the Population and Housing Research Group.

To establish a robust estimate of population, the ONS/2001 Census data3 confirms the 2001 population of this area as 83,171. The population is estimated to have grown by 0.90% from 2001 to 20114. When applied to 2001 census data, the forecast for SENF, WS and TTN is 83,919. When considered with Small Area Population Forecasts and the demographic forecast for Hampshire, 84,000 is a robust estimate for the area in 2011.

1 - Hampshire County Environment Department's 2009 - 2016 Small Area Population Forecasts (Wards: 2011) 2 - Hampshire County Environment Department's 2009 - 2016 Small Area Population Forecasts (Parishes: 2011) 3 – Office for National Statistics: 2001 Census: Neighbourhood Statistics: Age Structure KS02 (2001) 4 - Hampshire County Council: A Demographic Profile of Hampshire: 2009-2016 (March 2010)

Gary Young 7 February 2011 4/11

Methodology - Areas

The SENF, WS & TTN area comprises three localities, with estimated population.

South East New Forest (SENF) 6,993 Waterside (WS) 42,619 Totton (TTN) 34,815 Total Estimated Population 84,427

Within the localities, there are six sub-localities:

SENF Brockenhurst and Forest South East 5,986

WS Hythe and Dibden 19,311 WS Holbury, Blackfield and Fawley 17,200 WS Marchwood 6,468

TTN Totton 29,615 TTN Ashurst, Copythorne and Netley Marsh 5,908

Within the sub-localities, there are fourteen wards:

SENF Brockenhurst and Forest South East 5,986

WS Butts Ash and Dibden Purlieu 6,721 WS Dibden and Hythe East 5,780 WS Hythe West and Langdown 6,809

WS Fawley, Blackfield and Langley 6,333 WS Furzedown and Hardley 3,636 WS Holbury and North Blackfield 7,231

WS Marchwood 6,468

TTN Ashurst, Copythorne and Netley Marsh 5,908 TTN Totton Central 5,451 TTN Totton East 6,260 TTN Totton North 6,622 TTN Totton South 6,154 TTN Totton West 5,127

Gary Young 7 February 2011 5/11

Methodology - Ageing

Using the Small Area Population Forecasts1, the current population by age band can be estimated in numbers and as a percentage of population in 2011 and forward forecasted to 2016. These can be compared to estimates and forecasts for the over 65’s in 2011 and 2016 at local (New Forest)1, regional (South East)1 and National (English)2 levels.

Over 65’s (estimated as percentage of population in 2011)

SENF/WS/TTN Area 20.48% New Forest 22.61% South East 16.35% England 15.89%

SENF/WS/TTN has 4.59% more population aged over 65 than national average.

Over 65’s (estimated as percentage of population by ward in 2011)

SENF Brockenhurst and Forest South East 32.46%

WS Butts Ash and Dibden Purlieu 21.33% WS Dibden and Hythe East 21.94% WS Hythe West and Langdown 27.01%

WS Fawley, Blackfield and Langley 21.84% WS Furzedown and Hardley 18.60% WS Holbury and North Blackfield 16.38%

WS Marchwood 14.65%

TTN Ashurst, Copythorne and Netley Marsh 24.91% TTN Totton Central 18.29% TTN Totton East 22.43% TTN Totton North 12.98% TTN Totton South 19.29% TTN Totton West 13.87%

Marchwood, Totton North and West have younger than national average populations (<15.89%). Brockenhurst and Forest South East, Hythe West and Langdown, Ashurst, Copythorne and Netley Marsh, and Totton East have near/older populations than New Forest average (<22.61%). Brockenhurst and Forest South East and Hythe West and Langdown approximately double the national average of over 65’s per 1,000 population.

1 – Hampshire County Environment Department’s 2009 – 2016 Small Area Population Forecasts (Wards: 2011) 2 – Office for National Statistics: 2001 Census: Neighbourhood Statistics: Age Structure KS02 (2001)

Gary Young 7 February 2011 6/11

Over 65’s (estimated as percentage of population in 2016)

SENF/WS/TTN Area 23.38% New Forest 26.05% South East 18.84% England 18.31%

SENF/WS/TTN has 5.07% more population aged over 65 than national average.

While the SENF/WS/TTN area does not have the same percentage of population over 65 as New Forest (2011 or forecast in 2016), the overall picture is the SENF/WS/TTN area will age at a faster rate (4.59% rising to 5.07%) than those over 65 nationally.

Over 65’s (estimated as percentage of population by ward in 2016)

SENF Brockenhurst and Forest South East 36.18%

WS Butts Ash and Dibden Purlieu 23.44% WS Dibden and Hythe East 25.34% WS Hythe West and Langdown 29.65%

WS Fawley, Blackfield and Langley 25.25% WS Furzedown and Hardley 20.64% WS Holbury and North Blackfield 18.89%

WS Marchwood 19.28%

TTN Ashurst, Copythorne and Netley Marsh 27.66% TTN Totton Central 21.24% TTN Totton East 23.77% TTN Totton North 16.08% TTN Totton South 22.17% TTN Totton West 16.37%

When forecasting the aging population at ward/neighbourhood level in 2016, only Totton North and Totton West are forecast to have younger than English national average and South East regional populations. Four of the wards are forecast to be older per 1,000 population than South East regional and English national average populations and eight wards are forecast near or older than the New Forest average by 2016.

Gary Young 7 February 2011 7/11

Aging Population (estimated numbers in 2011)

District Ward/Neighbourhood 45 + 55 + 65 + 75 + 85 + SENF Brockenhurst and Forest South East 3,629 2,880 1,943 1,006 315

WS Butts Ash and Dibden Purlieu 3,490 2,375 1,434 734 218 WS Dibden and Hythe East 2,867 2,091 1,268 617 196 WS Hythe West and Langdown 3,671 2,744 1,839 956 306 WS Hythe and Dibden sub-total 10,029 7,210 4,541 2,307 721

WS Fawley, Blackfield and Langley 3,399 2,445 1,383 652 183 WS Furzedown and Hardley 1,611 1,096 676 311 75 WS Holbury and North Blackfield 3,131 2,082 1,185 529 141 WS Holbury, Blackfield & Fawley sub-total 8,141 5,623 3,244 1,492 399

WS Marchwood 2,690 1,727 947 493 165

TTN Ashurst, Copythorne and Netley Marsh 3,545 2,492 1,472 751 209 TTN Totton Central 2,526 1,642 997 556 197 TTN Totton East 3,097 2,191 1,404 768 227 TTN Totton North 2,630 1,661 860 425 151 TTN Totton South 2,809 1,906 1,187 595 206 TTN Totton West 2,135 1,355 711 361 136 TTN Totton area sub-total 16,743 11,246 6,631 3,456 1,126

Area Totals 41,233 28,687 17,306 8,754 2,725

In the immediate Hythe Hospital sub-locality of Waterside, there currently an estimated 8,732 adults over the age of 65, of which 4,292 are over 75 years and 1,285 over 85 years of age. SENF and Totton double the over 65’s to 17,306 in total while the over 75’s rise to 8,754 and over 85’s to 2,725, respectively.

Gary Young 7 February 2011 8/11

Aging Population (forecast numbers in 2016)

District Ward/Neighbourhood 45 + 55 + 65 + 75 + 85 + SENF Brockenhurst and Forest South East 3791 3047 2208 1143 382

WS Butts Ash and Dibden Purlieu 3590 2495 1552 792 275 WS Dibden and Hythe East 2974 2232 1458 707 240 WS Hythe West and Langdown 3806 2840 2008 1046 360 WS Hythe and Dibden sub-total 10,370 7,567 5,018 2,545 876

WS Fawley, Blackfield and Langley 3517 2592 1583 736 221 WS Furzedown and Hardley 1652 1144 742 358 99 WS Holbury and North Blackfield 3298 2230 1344 601 162 Holbury, Blackfield & Fawley sub-total 8,468 5,966 3,668 1,694 482

WS Marchwood 2929 1987 1225 622 235

TTN Ashurst, Copythorne and Netley Marsh 3673 2629 1629 793 233 TTN Totton Central 2764 1862 1166 656 264 TTN Totton East 3381 2377 1555 841 300 TTN Totton North 2784 1772 1054 450 168 TTN Totton South 2914 1992 1304 631 236 TTN Totton West 2328 1568 861 391 169 TTN Totton area sub-total 17,844 12,200 7,570 3,762 1,369

Area Totals 43,400 30,766 19,689 9,766 3,343

In the Hythe Hospital sub-locality of Waterside, there will be a forecast 9,911 adults over the age of 65, an increase of 1,179 at 2011. In the Waterside area, those over 75 will increase by 569 to 4,861 and those over 85 years of age will increase by 308 to 1,593.

Looking at the area as a whole, there will be a forecast 19,689 adults over the age of 65, an increase of 2,383 at 2011. In the whole area, those over 75 will increase by 1,012 to 9,766 and those over 85 years of age will increase by 618 to 3,343.

Gary Young 7 February 2011 9/11

Aging Population (estimated percentages in 2011)

District Ward/Neighbourhood 45 + 55 + 65 + 75 + 85 + SENF Brockenhurst and Forest South East 60.63% 48.11% 32.46% 16.81% 5.27%

WS Butts Ash and Dibden Purlieu 51.92% 35.33% 21.33% 10.92% 3.25% WS Dibden and Hythe East 49.61% 36.17% 21.94% 10.68% 3.39% WS Hythe West and Langdown 53.92% 40.30% 27.01% 14.04% 4.49% WS Hythe and Dibden sub-total 49.23% 35.39% 22.29% 11.33% 3.54%

WS Fawley, Blackfield and Langley 53.67% 38.61% 21.84% 10.29% 2.88% WS Furzedown and Hardley 44.31% 30.15% 18.60% 8.56% 2.06% WS Holbury and North Blackfield 43.30% 28.79% 16.38% 7.31% 1.96% WS Holbury, Blackfield & Fawley sub-total 44.87% 30.99% 17.88% 8.22% 2.20%

WS Marchwood 41.59% 26.70% 14.65% 7.62% 2.54%

TTN Ashurst, Copythorne and Netley Marsh 60.00% 42.18% 24.91% 12.71% 3.54% TTN Totton Central 46.33% 30.11% 18.29% 10.20% 3.62% TTN Totton East 49.48% 35.00% 22.43% 12.27% 3.62% TTN Totton North 39.72% 25.08% 12.98% 6.42% 2.28% TTN Totton South 45.65% 30.98% 19.29% 9.67% 3.34% TTN Totton West 41.65% 26.42% 13.87% 7.04% 2.65% TTN Totton area sub-total 44.68% 30.01% 17.69% 9.22% 3.00%

Area Totals 46.26% 33.95% 20.48% 10.36% 3.23%

In the immediate Hythe Hospital sub-locality of Waterside, 22.29% of the population in 2011, making this sub-locality at a level of ageing forecast nationally by 2034, with Hythe West and Langdown significantly ahead of all wards, except Brockenhurst/SENF.

Gary Young 7 February 2011 10/11

Aging Population (forecast percentages in 2016)

District Ward/Neighbourhood 45 + 55 + 65 + 75 + 85 + SENF Brockenhurst and Forest South East 62.13% 49.93% 36.18% 18.73% 6.25%

WS Butts Ash and Dibden Purlieu 54.21% 37.68% 23.44% 11.96% 4.16% WS Dibden and Hythe East 51.68% 38.79% 25.34% 12.28% 4.17% WS Hythe West and Langdown 56.19% 41.94% 29.65% 15.44% 5.32% WS Hythe and Dibden sub-total 51.33% 37.46% 24.84% 12.60% 4.34%

WS Fawley, Blackfield and Langley 56.11% 41.34% 25.25% 11.73% 3.53% WS Furzedown and Hardley 45.96% 31.82% 20.64% 9.97% 2.75% WS Holbury and North Blackfield 46.38% 31.36% 18.89% 8.45% 2.27% WS Holbury, Blackfield & Fawley sub-total 47.29% 33.31% 20.49% 9.46% 2.69%

WS Marchwood 46.11% 31.28% 19.28% 9.79% 3.70%

TTN Ashurst, Copythorne and Netley Marsh 62.38% 44.65% 27.66% 13.47% 3.95% TTN Totton Central 50.35% 33.93% 21.24% 11.95% 4.80% TTN Totton East 51.69% 36.33% 23.77% 12.85% 4.58% TTN Totton North 42.45% 27.02% 16.08% 6.86% 2.56% TTN Totton South 49.52% 33.86% 22.17% 10.73% 4.01% TTN Totton West 44.25% 29.80% 16.37% 7.44% 3.21% TTN Totton area sub-total 47.48% 32.46% 20.14% 10.01% 3.64%

Area Totals 48.86% 36.54% 23.38% 11.60% 3.97%

In the Hythe Hospital sub-locality of Waterside, all wards will be ahead of the 2034 national forecast for over 65’s per 1,000 head of population by 2016, closely followed by Holbury and Blackfield and the Totton area. The Brockenhurst/SENF area will have a significantly older population than the area as a whole.

Looking at the area as a whole, the national average of over 65’s forecast for 2034, is reached in 2016, eighteen years ahead of the national picture.

Gary Young 7 February 2011 11/11