a review of gp services in luton - healthwatch luton...6 - healthwatch luton - gp services review...

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Your Health & Social Care Champion

A Review of GP Services in Luton

39Visits

680Recommendations

962Patient Surveys

2 - HealthWatch Luton - GP Services Review

ContentsForeword 3

Acknowledgements 4

Executive Summary 6

About Luton 8

About Healthwatch Luton 9

Background 10

Planning our review 11

Preparing our review 13

Methodology 14

Key Findings 15

Our Vision and Overall Results 16

Next Steps 38

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ForewordI am pleased to present our first report, the combined effort of volunteers and the team, has been tremendous.

It is important to understand the context of our work, the lived experiences of people who use services can support commissioners and the wider health and social care community to understand what matters to people resulting in better outcomes and improved quality.

The hard work begins now, we hope health leaders, patient groups and a Luton wide audience will use this report to talk about their GP experiences, get involved and be part of improving care for all.

On behalf of the board I look forward to that conversation.

Beth Gregson, Healthwatch Luton Chair

In my position as the Healthwatch Luton Board Member for Primary Care I am very pleased with the outcomes of this review. I would like to personally thank Healthwatch Luton volunteers, staff and members of the community who assisted us in this large and complex review.

Our findings have led to many recommendations being submitted to GP surgeries and while we understand the complexities and challenges that are faced for services, it is positive to know that the conversations to improve services have begun. We will continue to work closely with patients and service providers in Luton to ensure that the highest standard of quality is being delivered.

The vast amount of current primary data that we have been able to collate is truly an achievement. I hope that the data can be used to create conversations and further local research into this area.

I would again like to express my gratitude to all the volunteers and members of the community that helped us achieve such a huge task. Without their efforts we could not have been successful.

Thank you everyone.

Dr Shaobo Zhou


AcknowledgmentsIn the months of September to December 2013 Healthwatch Luton carried out a review of GP services to assess patient experience and satisfaction. This report outlines our results and our recommendations based on our findings.

Throughout this review Healthwatch Luton worked closely with other organisations and received an overwhelming level of assistance from our volunteers. We would like to formally acknowledge and thank the following individuals and organisations for all their hard work and assistance. We could not have completed this work without this support.

Alan FletcherAmar SagooAmbreen KauserAndy AssanAngela AndrewsBeth GregsonBilal HafeezEwa DepkaFarah NaveedFarrah Gilani

Hannah NeilHeather RoyJamu PatelJane FosterJean ForrestJohn SimmonsDr Karl SylvesterKazia AjayiLilima BegumMichelle Kiansumba

Nahida AhadNastaran RoushanNikki KellyNoelette HanleyNoorud-deen RashidRegina IlungaRon GreenhamDr Shaobo ZhouSid PurkayasthaTerri Brooks

Changing LivesEmbrace Life LutonIslamic Home TuitionLuton Sixth FormLuton Borough Council Carers Network

Oasis CentreUniversity of BedfordshireLuton MelaLuton Irish Forum

Luton Clinical Commissioning Group Dr Nasrin Razzaq Dr Nina Pearson Paul Lindars Penny Fletcher

NHS England Catherine Pelley Pam Lewin

Care Quality Commission Louise Trainor

Bedfordshire Clinical Commissioning Group Emma Moorbey Sian Pither

Bedfordshire and Hertfordshire Local Medical Committee Ltd Carl Raybold

Volunteers

Organisations

Staff

Thank you to all of the practice managers, staff and doctors for their support, assistance and willingness to work with Healthwatch Luton.

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“NHS England welcomes the opportunity to work with Healthwatch Luton and the GP practices in Luton in responding to the recommendations within this report. The Hertfordshire & South Midlands Area Team are committed to working with all partners including patients to improve the overall quality and patient experience of primary care”.

Beverley Flowers, Director of Commissioning, Hertfordshire & South Midlands Area Team, NHS England

“High quality and responsive primary care is vital for us to improve health and reduce the health inequalities we see in Luton. An understanding of Luton residents’ experience of primary care will help to identify both good practice and where we need to focus our efforts to meet Luton’s needs. On behalf of Luton Borough Council and as Chair of the Health and Wellbeing Board, I welcome the work of Luton Healthwatch in looking into this important issue. I am sure it will support partners on the Health and Wellbeing Board to ensure we have the good quality primary care that our residents need and deserve”.

Councillor Hazel Simmons, Leader of Luton Borough Council, Chair of Luton’s Health and Wellbeing Board.

“Luton CCG recognises the extensive piece of work undertaken by Healthwatch Luton and the pressure which practices are under with high demand for healthcare in Luton. The CCG will support practices to address the areas of improvement which are within their capacity to deliver”.

Carol Hill, Chief Officer, Luton Clinical Commissioning Group


Executive SummaryThere has been a lot of discussion in Luton about the quality of GP services, the news is full of headlines about difficulties in getting an appointment. It is easy to go along with the edict “If something is repeated often enough it becomes a truth”.

Our aim was to gather patient views and to use the evidence to see if there was room for service improvements. What would a good GP service look like, on the face of it 90% said they were happy with their GP and 85% felt involved in their care. When asked if they would recommend their surgery 80% said they would and when asked to rate their surgery as a whole 71% said it was either good or excellent.

There is a disparity between people being happy with their care and their overall experience. We have to ask ourselves why? What can be done to increase the percentages to reflect the satisfaction rates?

People told us they were generally happy, however there were some

specific things that could improve their experiences. Better access to online appointment bookings, getting through to the surgery on the telephone, patient confidentiality, appointment availability, long waiting times and satisfaction with doctors all came up.

Physical access was a particular concern under the Public Sector Equality Duty within the Equality Act 2010 there is a duty to ensure there are no physical barriers which prevent people from using services, or make it unreasonably difficult for someone to do so. We have identified 26 practices which can do more to improve physical access for disabled people with mobility impairments.

We wanted to gather information about equality of access for disabled people. During October 2013 we asked NHS England for information about the number of complaints for each surgery in Luton, along with the number of registered carers, disabled people including those with hearing impairments and the number of people registered blind or partially

sighted. Unfortunately this data is not collected by NHS England and we were advised locally that this information may not be collected by all surgeries or may not be easily available - we were unable to include this information in our report.

Our hope is that Luton residents, Patient Representative Groups and the Luton health community including GP’s take on board the experiences and views expressed in our patient questionnaire results and work towards excellent health care. There are many positives in this report and as with any piece of work it raises more questions. This was a random sample survey, it maybe different groups of people will have other experiences however our review and findings creates a starting point.

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Recommendations and Observations• Disabled people and Carers experiences; while we have not focused on this specifically, the lack of physical access,

lack of clarity on the collection of data and a clear process for identifying carers, raises concerns that this group of people may not have their needs met under the Equality Act 2010 and requires some collective focus to test this observation.

• It is welcomed that many practices have acted on our recommendations immediately and welcomed our review, while others have viewed our work differently. This report is a snap shot and we want to work with practices to put patients at the heart of their work in a more rounded way.

• The disparity between a 90% satisfaction rate with the overall care and 71% rating of good or excellent shows the importance of the overall patient experience and understanding the definition of good patient satisfaction. We recognise the increasing pressure and demands on surgeries however, we will continue to struggle to attract quality staff if we cannot narrow the gap between the best rated and worst.

• Extended opening hours and seven day working across health is a government priority which presents a massive challenge for Luton, more work is needed to create a Luton solution that works for patients as well as the surgeries. It is clear that information, education and communication will need to be clear and consistent within this process.

• Patient representative groups are vital in driving improvements forward, 19 surgeries do not currently have Patient Participation Groups, we know some practices have very active groups. The Luton wide Patient Reference Group, supported by Luton Clinical Commissioning Group, are keen to widen participation and develop the patient voice. Healthwatch Luton welcomes this drive to increase patient representation and participation within all surgeries across Luton.


About LutonLuton is a densely populated urban authority, divided into 19 wards, with more similarities to some London boroughs than to the surrounding towns and cities in its region. The official estimate of the population of Luton in 2011 was 203,600.

According to the 2011 Census, the age structure of Luton’s population differs from that of the population as a whole. Luton has a younger population than that of England and the eastern region. The under 15 age group account for 22% of the Luton population compared with 18% regionally and nationally. The 15-64 age group account for 67% of the Luton population compared with 66% nationally and 65% in the eastern region. The “Over 65” age group represents 12% of the Luton population compared with 16% nationally and 18% regionally.

The town is ethnically diverse, with over half (55.4%) of the population being of black and minority ethnic origin, with significant Pakistani, Bangladeshi, Indian and African Caribbean communities.

Luton is ranked as the 69th (out of 326) most deprived local authority. In 2007 Luton was ranked as the 87th most deprived local authority and in 2004 as the 101st. This indicates that Luton is becoming relatively more deprived in comparison to the other local authorities of England. Luton has nine output areas in the top 10% most deprived areas in the country. Two of these are in Biscot, Dallow and Northwell wards and one each in Farley, High Town and South wards.

Using the NHS England ‘any town’ typology, Luton is typical of an urban area with one feature of a suburban archetype, which is a higher than average prevalence of long term conditions in the population.


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About Healthwatch LutonCreated on 1st April 2013 by the Health and Social Care Act 2012, Healthwatch Luton is the independent local consumer champion for health and social care services in Luton. We are in place to bring together people’s views and experiences in order to improve services and enable people to access advice and information about local services and understand the choices available.

The Healthwatch Network is made up of 152 Local Healthwatch organisations and Healthwatch England is in place to offer leadership, guidance and support to Local Healthwatch. Healthwatch England works with Local Healthwatch organisations to identify trends and gaps within services in order to influence national policy, advice and guidance.

Under the Health and Social Care Act 2012 Healthwatch Luton has the following powers and functions:

• A duty on service providers and commissioners to respond to requests of information within 20 working days.

• A duty on service providers and commissioners to respond to recommendations made by Healthwatch Luton within 20 working days.

• Make reports and recommendations about services known to commissioners, providers and regulators of health and social care services in Luton

• A duty on service providers to allow entry to authorised Healthwatch Luton members to conduct announced or unannounced ‘enter and view’ visits to assess services.

• A seat on Luton’s Health and Wellbeing Board, to promote health improvements and tackle health inequalities.

• A mechanism to make recommendations to Healthwatch England, which may include advising the Care Quality Commission about special reviews or investigations to conduct.


BackgroundWhy did we do this?In July 2013 we held our launch event at the University of Bedfordshire and it was attended by over 200 people from the local community, including professionals within the health and social care sector and approximately 40 local organisations. During this event we asked all attendees to assist us in identifying specific areas of activity within our 6 priority areas. For General Practices (GP’s) we received the following feedback:

• 30% of all attendees stated that Healthwatch Luton should review GP Accessibility: appointment systems and patient environment.

• 28% of all attendees stated that Healthwatch Luton should review The patient experience. • 20% of all attendees stated that Healthwatch Luton should review Comparing GP standards and meeting local needs.

Following this feedback, we contacted Luton Clinical Commissioning Group (LCCG), the Care Quality Commission (CQC) and NHS England to begin planning this review. We carried out research and reviewed the data sets and results from the national annual patient survey (conducted by Ipsos MORI). It became apparent that there is a lack of publically available data for a number of areas within GP services including:

The Physical Environment

Communication Needs

Language Barriers

Literature and Information

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In May 2013 the Leader of Luton Borough Council/Chair of the Health and Wellbeing Board applied to Central Government for a place on the System Leadership Programme. The breakthrough issue selected by the Health and Wellbeing Board was “addressing the variation of General Practice in Luton”.

The issue of GP accessibility has been gaining national attention and since December 2013 NHS England have been inviting GP surgeries to apply for part of a £50m ‘Challenge Fund’ to pilot improvements in access to appointments for up to half a million patients. As part of the Challenge Fund a minimum of nine pilots will be set up with at least one in each region of England to support the spread of innovation.

From the feedback received from our launch event and after assessing the existing data available, discussions were held with Healthwatch Luton Board Champions for Primary Care and a decision was made to conduct a review of GP Services in Luton.

Planning our reviewThere are 39 individual GP surgeries in Luton, including branch surgeries.

To gather the views of people from across the town it would be essential to speak with as many patients as possible and our most practical method was to use a patient survey in a questionnaire form. This would ensure that the same questions are being asked to all patients so that each surgery can be assessed equally and fairly. A questionnaire can be completed quite quickly and anonymously. We wanted to include a set of questions that had not been previously asked, and assess the patient experience in line with the new consumer rights published by Healthwatch England.


Live in a healthy

environment

1 http://www.healthwatch.co.uk/rights 2 http://rcnpublishing.com/doi/pdfplus/10.7748/ns2011.06.25.41.12.p5640

The Healthwatch England rights draw on the UN guidelines for Consumer Protection and were developed in consultation with patients and service users. The eight health and social care consumer rights issued by Healthwatch England1 are a right to:

Choose

Information & Education

A safe, dignified and

quality service

Access

Be Listened

To

Essential Services

Be Involved

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The Healthwatch network strongly believes that all users of health and social care services are entitled to these rights. We wanted to use these rights as a way of benchmarking patient satisfaction and experience.

Within the context of the Healthwatch Rights and the lack of publically available data about the physical environment of surgeries in Luton, we decided to conduct unannounced “Enter and View” visits.

Under the Health and Social Care Act 2012, Local Healthwatch can conduct announced or unannounced visits to any public funded service. Unannounced visits provide real insight into the standard of care being delivered by service providers as services are viewed and assessed during a “normal working day”.

In June 2011, the Royal College of Nursing issued an article that stated “Unannounced visits reveal the best and worst of Today’s NHS”2. Conducting unannounced enter and view visits provide Local Healthwatch with an effective tool to view and assess a service accurately at the point of service delivery from a “lay person’s” perspective.

When planning this review, we assessed the national annual GP patient survey and identified a lack of information in the following areas:

• Physical environment• Communication needs • Language barriers• Literature and informationIn consideration of this and the Healthwatch Rights, we created our enter and view assessment criteria and patient questionnaire.

Preparing our review In order to ensure all relevant staff and stakeholders were made aware of our planned review, we took the following steps:

1. We contacted NHS England as the body responsible for commissioning GP services in Luton to make them aware of our proposals. NHS England were fully supportive and viewed our planned review as extremely positive.

2. We wrote to every GP practice in Luton to inform them of our planned review and requested dates that we should avoid to conduct our visit in order to minimise disruption to services.

3. We contacted Luton Clinical Commissioning Group (LCCG) to inform them and they were fully supportive. The Chair of LCCG, Dr Nina Pearson also wrote to every GP practice to highlight the importance of our review and to encourage surgeries to assist us.

4. We attended the local GP Practice Managers meeting to present an outline of our planned review.

5. We contacted the Local Medical Committee, as a statutory body which represents the interest of GPs, and informed them of our review.

6. We were informed by NHS England that there are two surgeries in Luton which are supported by Bedfordshire Clinical Commissioning Group (BCCG), therefore we contacted BCCG to advise them of our planned review.

7. We contacted Healthwatch Central Bedfordshire to advise them of our planned review.

8. We contacted the Care Quality Commission, as the national regulator for health and social care, and informed them of our planned review.

We would again like to express our thanks to the above organisations for their willingness to assist and support our work.


MethodologyWe completed all 39 unannounced enter and view visits at all GP surgeries in Luton between the months of September to December 2013.

Enter and ViewEach unannounced enter and view visit was carried out by at least one trained member of staff and the information recorded on our assessment forms were compiled through observations made and information provided from available staff at the surgery.

Patient QuestionnaireThe patient questionnaire was completed with people at every GP surgery, and was also completed at a series of community events across the town.

Trained Healthwatch Luton volunteers and staff completed the survey questionnaire in person with randomly selected individuals.

In order to maximise the diversity of our respondents we translated the questionnaire into Urdu, Bengali, Gujarati and Polish. In some instances hard copies of translated questionnaires were distributed to people but in most cases the questionnaire was verbally delivered in a second language by our multi-lingual volunteers. This was an essential step to ensure that individuals who are often unable to express their views had an opportunity to do so.

Random sampling was used to select our questionnaire respondents. By using random sampling in our selection method we could take advantage of the theory of extrapolation where a random sample can be extrapolated against a larger population to represent their views. For example, YouGov polls frequently extrapolate the surveys delivered to a thousand people to reflect the opinions of the wider population.

All Healthwatch Luton staff and trained volunteers followed the questions in the questionnaire entirely and recorded all information on the questionnaire in verbatim.

In order to capture the “lived experience” we compiled a questionnaire which collected qualitative and quantitative data.

All questionnaires were conducted anonymously as no personal or identifiable information was recorded however demographic information including age, gender, disability and ethnicity were collected where possible. By collecting demographic information we were able to monitor the diversity of our sample to ensure that it was representative of the town.

The majority of questionnaires conducted at the GP surgeries took place outside the surgery in order to uphold patient confidentiality and anonymity which in turn increased the likelihood of people willing to share their views and experiences. In total we completed 962 valid survey questionnaires.

On completion of our enter and view visits and patient questionnaire’s we created an individual report for each of the 39 GP surgeries in Luton. Based on the results, we formulated a series of recommendations for each surgery. The results and recommendations were issued to the senior partner and practice manager for each surgery.

Each surgery had 20 working days to provide a response to our report and recommendations. All 39 surgeries provided a response to each recommendation for their surgery.

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Key FindingsOverall the findings were positive, the Healthwatch Rights in Health and Social Care are a good way to benchmark what is important to people. Many of the surgeries have taken the recommendations on board and have already implemented some of them.

This report is not about “you must do”, it is a starting point where we hope patients and surgeries can use this report to have the conversation about how to improve patient care and experience. We recognise that some surgeries are struggling to recruit people onto patient participation groups, we see our review of GP services as a key driver towards strengthening the relationships between patients and practices.

Q. Overall, are you happy with the quality of care, treatment and service you receive at your surgery?

YES 864 90%

NO 98 10%

864 respondents stated they were happy with the quality of care, treatment and service which they receive at their surgery. 98 respondents stated that they were not happy with the quality of care, treatment and service which they receive at their surgery.

Q. Would you recommend your surgery to other people?

YES 772 80.3%

NO 188 19.5%

NOT SURE 2 0.2%

772 respondents would recommend their surgery to other people. 188 respondents would not recommend their surgery to other people.

Q. How would you score your doctor’s surgery?

Very Poor 14 1%

Poor 46 5%

Ok 217 23%

Good 441 46%

Excellent 244 25%

685 respondents scored their surgery as good or excellent. 217 scored their surgery as okay and 60 respondents scored their surgery as poor or very poor.


Essential ServicesEssential services are vital, by ensuring the right care is delivered in a way that people need and support patients to use the most appropriate services. We know that Accident and Emergency services are under increasing pressure, many people will admit to using this route to health care when they cannot get an appointment for when then need it.

The government has set 7 day working as a priority, we know this is a big shift and massive challenge in healthcare. Many practices do offer some extended opening hours, but people told us there was a mismatch between what was offered and what was needed.

25 surgeries have been recommended to consider extending their opening hours to include early mornings, evenings and weekends.

Our vision for rights in health and social care


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Q. Can you get an appointment for when you need it?

YES 481 50%

NO 481 50%

481 all respondents stated that they could not get an appointment for when they needed it.

Q. How long after your appointment time do you normally wait to be seen?

Less than 5 minutes 114 12%

5 to 15 minutes 414 43%

More than 15 minutes 421 43.7%

Cannot Remember 10 1%

No Specific Time 3 0.3%

421 respondents stated that they normally wait more than 15 minutes to be seen.

In addition to looking at waiting times, 43% of people we spoke to are waiting more than 15 minutes for their appointment. Delays can happen, ensuring people are told the reason for a delay helps people make a choice about waiting or re-booking and information is a powerful tool in improving people’s experience and satisfaction of a service.

QAre you happy

with your surgery’s opening hours? A

YES - 794 (82.5%)NO - 162 (17%)

NOT SURE - 6 (0.5%)

162 respondents stated that they were unhappy with their surgery’s opening hours.

There was a mixed reception to this recommendation, some surgeries were happy to carry out a review, we see this as a first step in the conversation between the surgeries and patients, in addition 26 surgeries have been recommended to conduct a review of their appointment availability and appointment booking system.

25 surgeries have been recommended to consider extending their opening hours to include early mornings, evenings and weekends

43% of people are waiting more than 15 minutes for their appointment

50% of people cannot get an appointment for when they need it


AccessAccess is about more than the ability to physically get into a building, it is about having information in an accessible format whether that is “easy read” or translated. It is also about being able to get through on the phone or having the ability to make online appointments.

Perceiving a service as accessible is really important. The Equality Act 2010 is clear about the need to ensure reasonable adjustments are made for disabled people. 28 Surgeries do not have a hearing loop system in place.

26 surgeries do not have easy access for wheelchair/pushchair users, many responses we received mentioned the difficulty in overcoming these challenges, reasons including finance, not owning the property and providing services from an old building. There is a duty to consider access, we would encourage surgeries to have discussions with patients about their access needs and how this could be resolved. With two-thirds of surgeries having limited access it means disabled residents in Luton are significantly disadvantaged.



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Q. Can you book your appointment online?

YES 171 18%

NO 304 32%

NOT SURE 487 50%

487 respondents were not sure if they could book their appointment online.

QAre you happy with wheelchair access/

pram access? A YES - 357 (37%)NO - 227 (24%)

NOT SURE - 378 (39%)

605 respondents were either unhappy or not sure if they were happy with the wheelchair access/pram access.

Recognising that we live in a technological age, with a young population it becomes increasingly important to offer online appointments, the majority of practices do have this in place and feedback from some practices is that they will actively look into this. 26 surgeries currently have an online appointment booking services in place however more needs to ensure the service and system in place is user friendly and patients are encouraged to take advantage of an online appointment booking service. 50% of people we spoke to were not sure if they could book their appointment online.

Q. Would you use this service if available?

YES 469 49%

NO 415 43%

NOT SURE 78 8%

28 Surgeries do not have a hearing loop system in place

26 Surgeries do not have easy access for wheelchair/pushchair users


Q. Are there any language barriers when communicating with staff or doctors?

YES 65 7%

NO 892 92.5%

NOT SURE 5 0.5%

892 respondents stated that they did not have any language barriers when communicating with staff or doctors.

QIs it easy to get through to your surgery on the

telephone? A YES - 653 (68%)

NO - 304 (31.5%)DID NOT SAY - 5 (0.5%)

304 respondents stated that it was not easy to get through to the surgery on the telephone.

32 surgeries do not have a sign stating that a translation service can be booked if required

7 surgeries have been recommended to replace their 0844 telephone number with a local number

Luton has a changing population, with many new residents drawn from a diverse range of countries and cultures. 32 surgeries do not have a sign stating that a translation service can be booked if required, we received feedback from some surgeries they would welcome some help to achieve this, having accessible information, posters and “easy read” pictorial literature may help to break down barriers and improve patient knowledge and awareness about choices and the appropriate use of services.

In addition to health inequalities, there is a lot of deprivation and poverty, having expensive telephone numbers creates an unnecessary barrier for people who may already be reluctant to contact their local GP for a check up. 7 surgeries have been recommended to replace their 0844 telephone number with a local number. It is welcomed that many of the surgeries have either changed or plan to change this.

If we consider access from both the surgery perspective and patients, some of the issues can be resolved and would lead to better health outcomes, and cost savings as people would understand the offer, their responsibilities and how to navigate the system.

Access results continued


A Safe, Dignified and Quality ServiceIt is important people feel valued and listened to, being kept informed of waiting times is both essential for a good patient experience; it can be the difference between seeing the surgery in a good or bad light. We have identified 32 surgeries where patients can be waiting over 15 minutes after their appointment time before being seen. This is a very high number, and if people have limited time and they have a long wait this will influence how they perceive their care. More work is needed to unpick if some doctors spend more or less with patients than other doctors, and why that is.

Patients often need to discuss matters that they may wish to keep private, 35 surgeries do not have sufficient privacy within their reception area, offering a choice is very important in terms of respecting dignity.

We know people strive to offer a good service, but placing patients at the heart of the service and having the dialogue can foster a sense of quality, the vast majority of people felt they were happy with the service yet told us about some of the frustrations. Waiting times and privacy are really important to people.



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Q. Is the waiting room child friendly?

YES 293 30.5%

NO 232 24%

NOT SURE 437 45.5%

232 respondents stated that waiting rooms were not child friendly.

QAre you happy

with the waiting room? A

YES - 861 (90%)NO - 69 (7%)

NOT SURE - 32 (3%)

861 respondents stated that they were happy with the waiting room.

32 surgeries where patients can be waiting over 15 minutes after their appointment time before being seen

Q. Overall, how do you rate the doctors at your surgery?

Very Poor 13 1%

Poor 35 4%

Ok 178 18.5%

Good 509 53%

Excellent 225 23.3%

Not Sure 2 0.2%

734 respondents rated the doctors as good or excellent. 48 respondents rated the doctors as poor or very poor.

Q. Is there enough privacy to talk to reception in confidence?

YES 444 46%

NO 510 53%

NOT SURE 8 1%

510 respondents stated that there was not enough privacy to talk to reception in confidence.

35 surgeries do not have sufficient privacy within their reception area


Quality Service results continued

QAre the staff (reception/

practice manager) at your surgery helpful

and understanding? A YES - 848 (88%)NO - 114 (12%)

114 respondents stated that staff are not helpful and understanding.

Q. Overall, how do you rate the staff at your surgery?

Very Poor 18 2%

Poor 56 5.8%

Ok 145 15%

Good 509 53%

Excellent 232 24%

Not Sure 2 0.2%

741 respondents rated the staff as good or excellent and 74 respondents rated the staff as poor or very poor.

Q. Do staff treat you with respect?

YES 891 92.6%

NO 70 7.3%

NOT SURE 1 0.1%

70 respondents stated that staff do not treat them with respect.


Information and EducationWe are awash with information, but having the right information at the appropriate time is key. While 27 surgeries have a text message appointment reminder service in place, many people were either unaware of the service or had not signed up for it. There maybe more work to do with patients about what kind of information they need.

With new and emerging communities in Luton it is important to review how we educate people in what their rights and responsibilities in health and social care are, what to expect and how to make best use of the Luton health service. Understanding what matters to people, why people make certain decisions about the way they access and perceive services is very important for surgeries.



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Q. Would it be/is it helpful to you?

YES 695 72%

NO 185 19%

NOT SURE 82 9%

695 respondents stated that a reminder text message is/would be helpful to them.

QDoes your surgery send

you an appointment reminder text message? A

YES - 293 (30%)NO - 616 (64%)

NOT SURE - 53 (6%)

616 respondents stated that their surgery does not send them an appointment reminder text message.

27 surgeries have a text message appointment reminder service in place

Q. Is it clear for you to know when it is time to see your doctor (system in reception for alerting you to see your doctor)?

YES 823 85.6

NO 137 14.2

NOT SURE 2 0.2

137 respondents stated that the system to alert them to see their doctor is unclear.

People are not taught how to be patients, some of the feedback in the more deprived areas of the town indicated a need to break down the barriers and develop appropriate information.


To ChooseIt is important people understand they have a choice, from being able to see the doctor they wish to see but equally people need to understand that sometimes that might mean a limited choice of times and days.



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Q. Do you avoid any doctors?

YES 218 22.6%

NO 731 76%

NOT SURE 13 1.4%

218 respondents stated they avoid a certain doctor.

QDo you only see a certain doctor in your surgery? A

YES - 312 (32%)NO - 644 (67%)

NOT SURE - 6 (1%)

312 respondents stated that they would only see a certain doctor.

Preference is a subjective view, there is a lot of work and discussion about tacking the disparity between good clinical care and bad

Some feedback from practices asked us if people had said why they preferred one doctor or another, this may be a good area to understand patient need and choice. Preference is a subjective view, there is a lot of work and discussion about tacking the disparity between good clinical care and bad. There is variation, we hope this report will enable dialogue with patients about their care and choices.


To Be Listened ToSometimes patients are reluctant to complain, make comments or talk to staff if they are concerned or have an issue, this can be for a variety of reasons. It is important that surgeries provide the opportunity for people to make suggestions anonymously, while making patients aware of who it is that they can talk to if they wish. 32 surgeries do not have a comments box, including pens and comment cards, in an area away from reception, we have therefore recommended that this is addressed.

7 surgeries have been recommended to create an action plan for improving the patient experience when speaking to reception staff, people told us they felt they had a poor experience or were not listened to when dealing with reception staff. The receptionists are the first point of access, listening to patients and asking what matters to them is really key. Making judgements about patients without doing this can lead to a breakdown in communication and poor outcomes.



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Q. Do you feel your doctor listens to you and considers your opinion?

YES 851 88.5%

NO 108 11%

NOT SURE 3 0.5%

851 respondents felt that their doctor listens to them and considers their opinion.

QDo staff listen

to you?

A YES - 879 (91%)

NO - 83 (9%)

879 respondents stated that staff do listen to them.

14 surgeries have been recommended to create an action plan for improving the patient experience when seeing a doctor. People told us that at times they did not feel listened to or part of their care, a good doctor patient relationship results in better clinical care and outcomes.

32 surgeries do not have a comments box, including pens and comment cards, in an area away from reception

14 surgeries have been recommended to create an action plan for improving the patient experience when seeing a doctor

7 surgeries have been recommended to create an action plan for improving the patient experience when speaking to reception staff


To Be InvolvedPatients are key to reducing the variation in surgeries, having strong patient voice and involvement in partnership with surgery staff helps to break down barriers, increases understanding on both sides and ultimately helps clinical care and patient experience. 19 surgeries do not have a patient participation group.

Feedback tells us that some surgeries are really struggling with this, we know the Clinical Commissioning Group are prioritising work to support this over the coming months. We see this report as a means to encourage involvement.



33

Q. Do you feel you have enough time with your doctor?

YES 798 83%

NO 162 16.8%

NOT SURE 2 0.2%

162 respondents felt that they did not have enough time with their doctor.

QDo you have

confidence and trust in your doctor? A

YES - 859 (89%)NO - 96 (10%)

NOT SURE - 7 (1%)

859 respondents stated that they have confidence and trust in the doctor they see.

19 Surgeries do not have a patient participation group

Q. Do you feel you are involved in decisions about your care and treatment?

YES 823 85.6

NO 137 14.2

NOT SURE 2 0.2

823 respondents felt they were involved in decisions about their care and treatment.


To Live in a Healthy EnvironmentHospital cross infection rates fell when hand sanitsers were readily available, people attend GP surgeries with a variety of illnesses and some patients may have compromised immune systems. 16 surgeries do not have hand sanitiser available in the waiting area, feedback in the main was a concern that children will play with them, there are ways to combat this from having some on the counter out of children’s reach or wall mounted at adult height.

Promoting self-care is vital across health care, to reduce the reliance on GP’s, particularly when its due to a lack of confidence or knowledge. While 35 surgeries have a range of literature and information available to patients, it is important to review them and make more use of this method to inform and educate people. We do not teach people how to be patients, 89% of people said there was the right amount of information but our observations showed that it was often limited.



35

Q. Do you think your surgery should have water available in the waiting room for all patients?

YES 793 82.5%

NO 139 14.5%

NOT SURE 30 3%

793 respondents felt water should be made available in the waiting room.

QIs there the right

information/leaflets available at your surgery

of specific interest to you? A

YES - 852 (89%)NO - 90 (9%)

NOT SURE - 20 (2%)

852 respondents stated that there is the right amount of information/leaflets available at their surgery. 16 surgeries do

not have hand sanitiser available in the waiting area

35 surgeries have a range of literature and information available to patients


Demographics of our patient questionnaire sample

350

300

250

200

150

100

50

0UNDER 18 18-25 26-40 41-65 65+

AGE RANGE

ETHNICITY GENDER

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GENDER Frequency Percentage

FEMALE 592 61%

MALE 363 38%

DID NOT SAY 7 1%

AGE RANGEUnder 18 41 4%

18-25 102 11%

26-40 266 28%

41-65 321 33%

65+ 232 24%

DISABILITYYes 133 13.8%

No 827 86%

Did not say 2 0.2%

ETHNICITYAfrican 47 Middle Eastern 2

Afghani 1 Mixed Race 2

Algerian 1 Moroccan 1

Bangladeshi 76 Nepalese 1

Black British 2 Nigerian 1

Caribbean 46 Pakistani 190

Chinese 1 Polish 18

Did not say 40 Portuguese 1

Filipino 1 Romanian 1

Hungarian 1 Slovakian 1

Indian 56 Somali 1

Iranian 1 Spanish 1

Irish 92 Sri Lankan 2

Italian 3 Turkish 4

Mediterranean 1 White British 367


Our overall results identify both positive and negative aspects of the service provided by General Practices within the Borough of Luton. These results provide an overview of patient experience and satisfaction. The results for the 39 GP Surgeries within Luton provide a unique set of results and recommendations for each surgery and collectively form the complete picture of patient experience and satisfaction of GP Services within Luton. Individual surgery results can be accessed on our website or by contacting our office, call 01582 817060. To access the individual surgery results online, please visit http://www.healthwatchluton.co.uk/gp-report.

We would like to thank all of the Staff, Doctors and Practice Managers for their co-operation and willingness to work with us in response to the patient views and experiences that we have gathered. Some recommendations are more challenging than others to implement and we welcome the opportunity to work with GP surgeries, Patient Groups, Luton Residents, NHS England, Luton Health and Wellbeing Board, Luton and Bedfordshire Clinical Commissioning Group and any other relevant organisations to find ways to resolve these challenges.

We will now continue to champion the patient voice and work with General Practices and all leaders involved in health services for Luton.

Next Steps

Healthwatch Luton102 Hitchin Road, Luton LU2 0ES

Telephone 01582 817060Email [email protected]

Website www.healthwatchluton.co.uk

Facebook: Healthwatch.Luton Twitter: HWLuton

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