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How we turned round our ‘devastating’ survey results

The Tiptree Medical Centre has just won an award after transforming its previously disappointing patient survey results. Dr Shane Gordon explains how the practice turned things around

The Tiptree Medical Centre has just won an award after transforming its previously disappointing patient survey results. Dr Shane Gordon explains how the practice turned things around

The problem

Our practice is Tiptree Medical Centre, an 11,000-patient practice in Colchester, Essex, which was recently awarded a 2009 NHS Alliance Acorn Award for ‘responsiveness in general practice'.

But we were not always so successful. In June 2008 we received our results for the QOF patient experience indicators – satisfaction rates for 2007/8 had fallen from previous years and were below the national averages.

The results prompted the SHA to ask the PCT to meet us to uncover the reasons for the low satisfaction rates and how we planned to address them.

We were devastated. Access and demand management had always been key issues at the practice and there had been many discussions on how those demands could be met and patient expectation satisfied.

Despite various attempts at solving our problems with demand management, which included employing a salaried doctor, expanding the nursing team and changing the configuration of the appointment system, problems remained.

Complaints were frequent both at a local level and directly to the PCT.

How we turned things around

Analysing the problems

The partners and managers met to discuss the way forward. Practice business manager Wendy Collett was asked to undertake a systematic review of not just access but all operational processes at the practice.

The managers spent several weeks answering the phones and in reception to understand the problems from a ground level.

This was very successful and became the catalyst for a programme of improvements that have transformed not only access for patients but also working conditions for all staff.

It became apparent at an early stage that triage was going to be crucial to making sure the right patients were seeing the right clinicians at the right time to make the best use of our most valuable asset: our staff.

Patients were making appointments with GPs for problems that could be dealt with by nurses or administrators, or before test results were back, causing them to make return appointments.

With managers taking a hands-on approach, demand for appointments began to be met on a daily basis, patients were finding access to the practice easier, complaints lessened and much to our delight we began to receive compliments.

Consulting with patients

It was important the changes we were planning were not based on our analysis and assumptions alone – it is very easy for doctors to assume they know what patients want only to discover they have got it entirely wrong.

We formed a patient participation group and worked closely with them on discovering their needs and wants.

We were careful to gain the views of a cross-segment of our population – the needs of the elderly are very different from those of commuters.

After consulting patients and finding out their needs, we decided to sign up to the extended hours LES and began offering appointments both early in the morning and in the evenings. This has proven hugely popular and sessions are always full.

Changing the practice philosophy

We moved from simply doing our best with limited resources, to a focus on meeting the needs and expectations of our customers in creative and innovative ways.

Quantitative and qualitative data was collected and analysed, with the focus on doing things in the best way for patients (see diagram).

Obstacles to overcome

A number of obstacles threatened the success of the project. The first was finding time for the project along with the day-to-day demands of the practice workload.

Another was the lack of confidence from some members of the practice that improvements could be made and would have an effect on patient survey scores, given that patients often seemed to have reported on historical experiences rather than more recent ones. But we pressed on.

Making changes

We produced a series of recommendations and developed an action plan with clear timescales.

Some recommendations were implemented fairly quickly, such as not giving test results via the telephone until after 3pm, to ease the demand on phones during peak times.

Others were longer-term plans, such as commissioning a new website to focus on patient convenience.

Our website

The website took a great deal of planning, involving all members of staff and patients.

The key outcome was to reduce traffic of patients through the practice by allowing them to access our services and information from home 24 hours a day, seven days a week.

The website offers online booking of appointments, repeat prescription requests and the opportunity to ask doctors questions online. Visit it at www.tiptree-medcentre.co.uk.

Revamp of practice environment

As part of the message to patients that the practice was changing, we felt it important they could actually see this and so we went ahead with a long-needed refurbishment.

Automatic doors were fitted, an open-fronted reception desk installed and the waiting room was refurnished.

At the suggestion of our patient participation group, a drinks dispenser, a touch-screen, self-check-in, a digital calling system and a plasma-screen information TV were all installed in the waiting room and art commissioned from a local artist.

Communication and PR

We began producing a quarterly newsletter to inform patients about our work.

We also run articles such as how to treat minor ailments, how to access services properly and the effects of patients not attending appointments.

We decided to get our GPs out into the community to make them more visible. We even attended a local fete to promote healthy living.

In June this year, a year on from our bad results, we held an open day to show the improvements we had made, launch our new website and let patients know we would continue to listen to them. Patients were invited to meet the doctors and staff informally.

Our patient group also attended and explained how they worked with us.

Tours of the building were given to show what goes on behind the scenes and we gave demonstrations of our new website.

The results

In the latest patient survey results, our access figures improved by 42% for patients reporting they could book an appointment within two days and 35% for booking appointments more than two days in advance.

There was also an independent report commissioned by the PCT that was glowing in its praise.

We still have a way to go but in a very short time we have made a huge difference. Patients are more confident of getting a satisfactory contact with the practice, and so are more relaxed when we speak to them, which makes it easier to meet their needs.

Fewer patients have to call or visit a second time, leading to less congestion on the phone and in reception. The queues of anxious patients outside the surgery before we opened have disappeared.

Fewer patients have to attend the surgery for administrative tasks and visits are limited to clinical contacts wherever possible.

Better triage ensures our team see the right mix of patients, leading to less double-handling – where the patient sees the nurse and has to see the doctor as well.

As a result our clinicians are now muchless pressured and so have the time to fully use alternative pathways for patients using schemes such as GPSIs, direct-access diagnostic tests and specialist nurse teams as alternatives to secondary care referrals.

Before it was a case of getting on to the next patient as quickly as possible, which often meant referring. Now Tiptree Medical Centre has the lowest referral rate in the PCT.

Dr Shane Gordon is a GP in Colchester, Essex

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