patient participation report – north leeds medical web viewthe distribution of our population...

Patient Participation Report – North Leeds Medical Practice

PATIENT PARTICIPATION REPORT

Patient Participation DES 2013-2014

North Leeds Medical Practice

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INTRODUCTION TO OUR PRACTICE

The North Leeds Medical Practice serves 14,542 patients. We have 2 surgeries. One is the Milan Street Surgery (MS), which serves 6,140 patients, and the other is the Harrogate Road Surgery (HR), which serves 8,402 patients (figures according to the GP Capitation Report, run on 12/3/14). The number of registered patients has increased by 644 since last year. We have 199 new patients at HR and 445 new patients at MS.

The distribution of our population per sex and age is as follows:

HARROGATE ROAD SURGERY MILAN STREET SURGERY

Age Range Male Female Total Age Range

Me Female Total

0 – 17 987 897 1884 0 – 17 1060 1076 2136

18-29 587 683 1270 18-29 656 592 1248

30-44 1248 1213 2461 30-44 919 749 1668

45-64 802 866 1668 45-64 443 364 807

65-74 238 271 509 65-74 59 79 138

75+ 205 405 610 75+ 51 92 143

Total 4067 4335 8402 Total 3188 2952 6140

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Age Range Male Female Total

0 – 17 2047 1973 4020

18-29 1243 1275 2518

30-44 2167 1962 4129

45-64 1245 1230 2475

65-74 297 350 647

75+ 256 497 753

Total 7255 7287 14542


Ethnicity is recorded at just under 80%. We are unable to provide an accurate breakdown of ethnicity between our two sites as the method of recording does not allow for this. From the information we have, we are able to identify that at the Harrogate Road surgery the vast majority of patients are white , most are white British. We also have a good percentage of Indian, Pakistani and other Asian ethnic groups. At the Milan Street surgery the great majority of patients belong to the Pakistani, Indian or other Asian ethnic groups. We also have a good representation of Afro- Caribbean community. In both surgeries we have patients of other ethnic groups.

Our prevalence of medical conditions is similar to the national average for many of them, according to our QOF register. For example our prevalence of asthma is 6.2%, hypertension 9.6%, heart failure 0.7%, , dementia 0.5%, mental health 1%, etc

Both surgeries are open from Monday to Friday from 8am to 6pm. We also offer extended hours, late opening to 8pm from Monday to Thursday. Our rota for extended hours is as follows:

- Monday: Dr Marcus Julier and 2 nurses (Lesley Cook and Sally Anne Corry) at HR

- Tuesdays: Dr Maricarmen Ruiz-Huertas at MS

- Wednesdays: Dr Manjit Purewal or Dr Teresa Carroll and one nurse (Sally Christie) at MS

- Thursdays: Dr Katherine Hickman at HR

Patients can request an appointment with the doctor or a home visit through reception, as detailed in our Practice Leaflet:

“Appointments

Please ring reception to book an appointment on 0113 268 0066 (HR) or 0113 249 0598 (MS)

Telephone triage: If you need an appointment on the same day, please ring reception from 8am to 12pm. Your name will be added to a “telephone consultation” list and a doctor will ring you back. They will decide if it is best for you to see a doctor or a nurse or suggest treatment you can do yourself or give you general advice.

You can also ask to speak to the doctor on the telephone consultation for other medical queries.

Please do not use the telephone consultation for prescription requests.

If your condition is not urgent, please book your appointment through reception. You can expect to see a GP within two working days, though you may have to wait longer if you want to see a particular GP. If you want to be attended by a particular practitioner,

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please ask the receptionist when arranging your appointment. You can pre-book an appointment up to 6 weeks in advance.

Please don’t use the telephone triage for non-urgent appointments; if you don’t need an appointment on the day please book through reception in the usual way.

Please note an appointment is just for one person.

Please also note the doctor has only 10 minutes allocated for each appointment. If your problem is complex you can be reassured your doctor will give you as much time as you need. If you have more than one problem and you think you will need more than 10 minutes, then please book a double appointment or book two separate appointments. This will help the doctor keep to time and prevent the other patients waiting unnecessarily.

If you are not able to attend your appointment, please let us know as soon as possible so that appointment can be used by another patient. You can cancel your appointment in person, by phone or you can also text us on: 0793 806 6866. Please text name, date of birth and appointment details.

Home Visits

Our doctors typically see four patients in the time it takes to do a single home visit. For this reason, we ask our patients to come to the practice if at all possible.

However, we can visit you at home if your condition means you cannot attend one of our practices. Please ring before 10am to arrange a visit and let us know if your condition is urgent. The doctor will visit between 12 and 6pm. “

Other services can also be accessed through reception: phlebotomist, ECG, spirometry, antenatal care, baby clinics, childhood immunisations, travel clinic and travel vaccinations, smear test, chronic conditions clinics, occupational health, NHS Health Checks, Family Planning services (including IUD, IUS and subderrmal fitting and removal) and Active Lifestyle services; also private services , such as DVLA reports, insurance reports, etc.

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OUR PATIENT PARTICIPATION GROUP (PPG)

As explained in previous Patient Participation Reports, our practice established what we called the Patient Forum Group before the introduction of the Patient Participation DES . Recruitment started in March 2010 and its first meeting was on 19/05/2010. After that we put a notice board and a suggestion box in both surgeries devoted to our patients, for information and suggestions. The group created a pro-forma, so patients interested in joining the group could leave their details. One of the members of the group volunteered to translate it into Urdu. The group had 8 members.

The group started well but due to different issues it never fully got off the ground. The doctor who led the group unfortunately went on long term sick leave so I took over the group. This was around the time the DES came out. At that point the group consisted of 5 members, all registered patients.

Since then we have been trying to recruit more members as detailed in our Patient Participation Reports from 2011/12 and 2012/13. Four more members joined in the first year. Some members have left and others have taken their place. Last year we had 15 members at the time of writing the report, some of them belonging to the virtual group.

This year we have 13 members who attend meetings and 4 virtual members. Other 16 patients have shown an interest but they haven’t made a commitment yet to either be a virtual member or to attend meetings. All the patients who have shown an interest have been contacted by one of the members by phone or e-mail and given information about the group. If they have requested more information such as the minutes of the minutes, our action plan or information about PCCG, this has been sent to them.

Although we have a diverse group, covering different ages and different health needs, we know our PPG is not fully representative of our population. It would be helpful to have a wider range of patients involved such as: younger people, parents of young children, Asian patients, Ethnic minorities, patients with mental health problems, patients with social problems, disabled patients.

We will continue working to try to ensure representation of as many groups as possible. We need to think of new ideas to create interest, make it attractive for more people and recruit new members.

In the meantime we will continue our efforts to try to involve patients using several methods, some of whom can also be used to provide feedback when needed:

1. Forms to fill in for patients interested in joining the group located on the notice board and reception and accessible to everyone coming into the surgery. They give the option of joining the virtual group, the “physical” group or both. We also have a red box for comments patients want to make even if they don’t want to join the group. Of course patients can also give feedback through NHS Choices.

2. From time to time notes attached to the repeat prescriptions and other prescriptions requested through reception, to try to reach a population with chronic conditions and also people requesting acute items

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3. Question added to “New patient registration form” asking if they would be interested in joining the group, either in person or through email contact.

4. One of the members, X, attended a Practice Health Champions meeting and made comments about the PPG to raise awareness. There were other 8 of our patients in that meeting and none of them knew much or anything about the Patient group. All gave X their e-mails and said they would like to know more. X sent them our Action plan and will contact them to let them know when we are to have our next meeting. They are mostly young women of different ethnicities, we are hoping they do become interested in the Patient group as well as PHC, they would make our group more representative or our population.

5. Information about the group is in the Practice Leaflet.

6. Question in our Patient Survey asking if they knew the group existed to try to create awareness.

7. Week long ‘pushes’ where forms are handed out to patients by reception staff.

8. Information about the group in our Newsletter.

9. Information about the group will be added to our website.

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DESIGNING THE LOCAL PATIENT SURVEY AND SEEKING PATIENT VIEWS

We held a meeting on 14/10/13. One of the main points in the agenda was to talk about the new patient survey. We discussed ideas, comments were made and it was agreed that I would put together a simpler questionnaire than last year, with shorter questions. I sent it by e-mail it to the group so the members could give gave feedback via e-mail if they were not happy with anything or if they wanted to add something to it. The result was our Patient Survey for this year. We also agreed I would create an on-line version of the questionnaire and add the link to our website.

During two months we tried to reach as many patients as possible, to recruit a representative section of our patient population:

1. Receptionists at MS and HR handed the questionnaires to patients approaching the reception for appointments, prescriptions or any other needs.

2. Questionnaires were also available in the waiting areas for patients to complete and deposit in a box.

3. One of the members of the group kindly decided to offer her time to sit in the waiting room at MS and HR for a few hours to ask patients to fill in the questionnaire and help them to complete it if needed. This was a successful method last year and this year too.

4. We created an on-line questionnaire via Survey Monkey. The link was added to our website and made clearly visible.

5. Information about the questionnaire on paper and on-line was in our Newsletter.

6. We sent text messages to all the patients who had given consent to receive information by text messages. More than 7,000 texts were sent asking patients for their participation.

We had a total of 198 questionnaires completed and returned, which is 1.4% of our patient population. Of those, 115 were traditional paper questionnaire replies and 85 were on-line replies through our website.

As the on-line questionnaire was already on Survey Monkey, we added manually all the “paper replies” and then we analysed the data using the tools provided in Survey Monkey. We exported the data to a PDF.

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FEEDING BACK THE FINDINGS OF THE PATIENT SURVEY TO THE PPG AND AGREEING AN ACTION PLAN

Once the data were analysed we scheduled a meeting to discuss those findings and to agree on an action plan.

The following is the summary of the questionnaire results. It was e-mailed to the members of the PRG. A copy of this summary can also be found on the notice board at HR and MS. It will also be posted on the Practice website to replace last year’s summary.

SUMMARY OF THE ‘PATIENT QUESTIONNAIRE’ RESULTS 2013/14

198 questionnaires were returned, 101 from Harrogate Road and 92 from Milan Street. 5 patients didn’t tick the box to say which surgery they were registered with.

This was a general improvement compared with previous years, in the total number as well as in participation from Milan Street patients, although fewer questionnaires were returned from Harrogate Road patients this year:

- 2012/13: 180 questionnaires back, 128 from Harrogate Road and 52 from Milan Street

- 2011/12: 133 questionnaires back, 91 from Harrogate Road and 42 from Milan Street.

This year we used the option of an on-line survey as well as the traditional paper questionnaire. From the 198 questionnaires, 83 were on-line answers and 115 were paper answers.

Demographics:

67.4% female and 32.6% male.

Most age groups were represented but, as in previous years, we received very few responses from the under 18 years group, and these were all Milan Street patients. Most responses belonged to the 30-44 years age group, in both surgeries. At Milan Street 39.5% of responses were from people aged under 30, but only 13% of Harrogate Road patients were under 30.

Ethnicity:

- At Harrogate Road: 71.4% White British, 15.3% Asian / Asian British

- At Milan Street: 17.9% White British, 59.6% Asian / Asian British and also representation from other groups (such as 9% Black/Black British)

Frequency in using the Practice:

About half of the people (52.7%) use the practice every few months.

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When looking at both surgeries, 18.2% of Harrogate Road patients use the practice weekly or monthly, in contrast with 40.9% of Milan Street patients (maybe because they have young children and need it more often?)

Satisfaction with opening hours

82% are happy or very happy with the opening hours (78.8% HR and 86.2% MS)

54.6% would like additional opening hours, especially the groups from 18 to 64 years (this may be because of University and work?).

Of those, 43.3% would like the additional opening hours to be on Saturdays (especially at Milan Street, 51% versus 37% at Harrogate Road); 39.4% would prefer the surgery to open after 6pm (especially at Harrogate Road, 46.3% versus 32.7% at Milan Street); 12.5% would prefer an early start and 4.8% would prefer a Sunday opening (last two similar in both groups).

Triage

71.4% have used the telephone triage in the past 6 months (similar in both surgeries).

Of those, only 5.8% were unhappy or very unhappy with the consultation (similar in both surgeries).

69.4% said they liked how the triage system worked and 10.4% said they didn’t like how the triage system worked.

20.2% said they didn’t know how the system worked.

Seeing a GP of your choice

35% are not bothered about which doctor they see as long as they are seen.

27.3% prefer to see any regular GP.

15.1% say it is difficult or very difficult to book an appointment in advance with the GP of their choice.

66.1% say it is easy or very easy to book an appointment in advance with any regular GP, but 10.3% still say it is difficult or very difficult.

How difficult is it ...?

50.6% find it easy or very easy to see the nurse for a chronic condition check up, but 13.5% say it is difficult or very difficult.

57% find it easy or very easy to book an appointment for a blood test, but 14% say it is difficult or very difficult.

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Did you know?

33.2% still don’t know we have a website (especially at Milan Street, 51.2%) - better than last year (48.3%)

50.3% still don’t know they can request prescriptions on line (especially at Milan Street, 63.9%); last year 55%.

69.3% still don’t know they can view their medical record and cancel appointments on line.

58% still don’t know they can book up to 6 weeks in advance (especially at Harrogate Road, 67%). Much better than last year (91.1%)

44.6% still don’t know we offer extended hours from 6.-8pm 4 days per week

61.8% still don’t know we have a Patient Participation Group and they can join if they wish. A bit better than last year (65%).

Getting feedback / information

The preferred method to receive information would be via text message (absolute favourite, 63.9%) , followed by the notice board (second favourite at Milan Street, 45.2%) and the website(second favourite at Harrogate Road, 44.2%), a poster , a newsletter or a leaflet handed by the doctor or nurse (similar scores) .

When asking about what kind of information they would like to be given, there are many different answers but the most repeated answers are: information about the doctors , opening times, any new and important changes, any services offered, any updates, and a regular newsletter.

Services and satisfaction with the surgery

79% say they are happy or very happy with the range of health services we provide

82% are happy or very happy with the care they get at the surgery.

80.1% would recommend the surgery to someone else.

Positive comments

Many positive and encouraging comments about the receptionists, nurses, doctors, services we provide and the Practice in general (89 patients added positive comments).

Negative comments

There are a number of issues (65 negative comments) but they are not really consistent.

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Some of them are not just negative comments or suggestions for improvement but complaints that should really be dealt with through our “complaints procedure” if the patients who wrote them wish to follow that route.

The ones which come up repeatedly are:

- Parking difficulty.

- Premises, especially the reception area and waiting rooms.

- Information on notice boards and walls, crowded and repeated.

- Dealing with reception can be difficult sometimes, in person and over the phone.

- Getting through the phones can be difficult.

- Too much waiting to be seen.

- What’s the name of the doctor who you are going to see.

The meeting to discuss the results of the survey and to agree on an action plan took place on 10/2/14 at Harrogate Road. Eleven members attended this meeting (and five apologised for not coming).

The minutes of that meeting are as follows:

MINUTES OF PATIENT GROUP MEETING

HARROGATE ROAD SURGERY – 10 FEBRUARY 2014

Present:

Dr Maricarmen Ruiz-Huertas

Pat Tansey (P.A.)

11 members (names deleted for confidentiality)

Apologies: 5 members (names deleted for confidentiality)

1. Welcome.

(name deleted for confidentiality) welcomed everyone and thanked for attending – there were some new faces and this was good to see.

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2. Update of PCCG meeting from (name deleted for confidentiality)

Meeting held in January 2014 at Leafield House. (name deleted for confidentiality) explained that at this meeting they were informed that a small portion of the £247 million pounds (i.e. £2¼M) allocated to the Leeds North CCG for the next two years could be influenced by patients. The groups were given nine choices to discuss and offer our opinions as to which four should be given first priority for 2014 - 2015 and then the second four for 2015 - 2016. They were also asked to decide which could be removed for the time being.

Discussions were also to take place within many groups, communities etc and in due course these would be analysed and decisions made. Copies of these nine choices were handed out to NLMP patient group on 10th February 2014 so that they could see what choices had been offered. (name deleted for confidentiality) said that as soon as the results had been made known she would inform the NLMP group.

However the practice representatives felt they had not been given the paperwork early enough to analyse, and this had been a small drawback they felt worth mentioning for the record.

3. Questionnaire Results and Suggestions for Action Plan

Maricarmen (Dr Ruiz-Huertas) went through the results one by one and these will be posted on the Practice website for all our patients to consider so they will not be repeated in these Minutes. However, comments made by the group regarding the questions and wording will be noted.

We had received an approximate 50/50 split of completed questionnaires from the two sites, which was an improvement on last year. There was also a more representative group in relation to age and gender.

Question 5 was generally felt not to be specific enough, i.e. some patients might visit the doctor only rarely, but if they had recently been ill that might have changed. It was felt that next time a questionnaire was given it should include the word ‘usually’ to avoid confusion.

It was felt that the next questionnaire should specify ‘Are you aware…?” with regard to opening hours, as it was clear from many of the answers that people were unaware of our extended opening hours.

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It was apparent that the majority of patients were happy with the telephone consultation system but it was generally felt by the group that there was not enough information about how this worked.

There was a lack of understanding within the group regarding doctors who were partners or salaried and doctors who were locums. Maricarmen explained the basic difference, i.e. that partners and salaried doctors were permanent and locums just came on a sessional basis to replace someone who was ill or on holiday. The group felt it was better to have more permanent doctors, whether they were partners or salaried, than locum doctors as does the Practice.

This also led to a discussion about names and photographs of the doctors. It was agreed this can only be a good thing and the Practice would try and get this up and running again.

Not everyone realised patients could book appointments 6 weeks in advance. It was suggested a newsletter/handout was “handed” to patients for a short (perhaps 3 months) but intensive period, which would include core facts.

Many patients felt it was difficult to see a particular doctor. Maricarmen explained that this is only difficult if patients try to book at short notice. This was felt to be fairly reasonable.

There is a shortage of nursing appointments at the moment but patients can still go to Chapel Allerton for blood tests. Again it was felt that this information ought to be more freely available.

A member of the Group, (name deleted for confidentiality) , used to work in market research and she volunteered to help with wording questions, as this can obviously make a big difference with regard to the answers we receive.

Patients were also unaware they could speak to the nurse on the telephone.

Only 50% of the patients who completed a questionnaire knew about the online services.

78% were happy overall

80% were happy with the care they received

79% would recommend the Practice.

The action plan will be displayed on the Practice website as soon as this has been written but the main factors decided on were:

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i. Core facts leaflet to “hand” to patients rather than leave for them to pick up. It was felt that the important factor here was that it was actually given to patients. This would be an intensive exercise over about 3 months to see if this would improve patients knowledge of the basic services the Practice offered. A ‘Did You Know….?’ Newsletter.

ii. Doctors, nurses and admin/reception staff to wear name badges. To display photographs of the doctors.

iii. To publish a newsletter at least twice a year advertising any changes, developments, campaigns etc.

After the meeting I put together the ideas for the action plan and sent it by e-mail to the group. A copy will be displayed in the notice board at HR and MS, together with the summary of the questionnaire results and the full Patient Participation Report, and also added to the website to be available for the rest of our patients.

PRACTICE ACTION PLAN : “Improving communication and information “ (again)

Last year we said we would improve communication and information as it was agreed that the practice provides a very good service but unfortunately patients may not be aware of some of the services offered.

Some examples: we started a Newsletter with current information, opening hours and how to book an appointment. We put up signs at the entrance doors and reception to make patients aware of the possibility of pre-booking an appointment up to 6 weeks in advance (also on Newsletter). Extended hours are advertised in the Newsletter, website and panel outside the surgery. Information about prescriptions on line is in reception, pick up cards are available in the waiting rooms, notes on scripts, …

Despite all, one of the main problems still seems to be a lack of information and perhaps how we communicate that information to our patients.

We decided that this year we are going to continue focusing on addressing these issues. Doing so will ensure more patients are aware of the services we provide and how to access them. This will have an impact on their care and in their general satisfaction with the practice. Hopefully it will also help to attract more members for the group and will encourage more patients to provide opinions and comments.

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SPECIFIC POINTS RELATED TO THE SURVEY RESULTS

1. DEMOGRAPHICS:

We are still struggling to get young people to complete the survey. We have done much better regarding ethnicity and achieving a more representative sample in each surgery, especially at MS.

2. SATISFACTION WITH OPENING HOURS, TRIAGE AND BOOKING APPOINTMENTS IN ADVANCE:

- We felt patients may not be aware of our opening hours and that we are already offering late opening 4 days a week (44.6% don’t know we offer extended hours). 54.6% of patients would like additional opening hours, 39.4% of them would like the surgery to open late, which we are already doing. This needs to be promoted so that more of our patients are aware and can utilise this service.

- We felt that patients were still not aware of their options when booking an appointment. It should be better publicised as to when and how to use triage and also of the option of pre-booking an appointment as 58% still don’t know they can do this.

- Receptionists should be clearer about this when the patient phones to ask for an appointment.

- Advantages of triage, opening hours , extended hours and the possibility of pre-booking an appointment should be publicised in a newsletter and on the website.

3. GETTING AN APPOINTMENT WITH THE GP OF YOUR CHOICE:

- Any special interests or skills should be advertised.

- Getting to see the preferred GP for a routine problem or a review is easier if the patient asks for a routine appointment (it can be pre-booked up to 6 weeks in advance). Not everyone needs an appointment on the same day. Again, patients need to know about the possibility of booking appointments in advance.

- Many patients still don’t know which doctors are regular at the surgery and when they work etc. This needs to be publicised better.

4. NURSES:

- About half of the patients find it difficult or very difficult seeing the nurse for a chronic condition check up. We are considering the employment of a Nurse Practitioner.

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- More than half of the patients find it difficult or very difficult to get an appointment for a blood test. It needs to be made clear to them that if there is a long wait for an appointment at the surgery they can attend one of the hospitals to have their blood taken if they wish. This needs to be publicised and patients should also be made aware by reception staff.

5. MISCELLANEOUS:

- 33.2% of our patients still don’t know we have a website.

- 50.3% of our patients still don’t know they can request repeat prescriptions online.

- 69.3% don’t know they can view their medical record and cancel appointment online.

- 61.8% still don’t know about the PRG.

- All this needs to be better advertised.

6. POSITIVE COMMENTS: These need to be displayed in order to encourage staff and improve morale. Notifications to be sent when these are received and perhaps talk about them at the next in-house TARGET meeting.

7. NEGATIVE COMMENTS: The repeated negative comments were about the following:

- Lack of parking at Harrogate Road: this is due solely to lack of space and unfortunately there is little we can do at present. This is a matter for the future.

- Premises: the need for more privacy in reception and waiting rooms, mainly due to layout of the building. Hopefully it will improve in future if we are able to obtain more space; we would then also hope to provide additional services.

- Notice boards and walls; these are crowded and information repeated. We try but it is not easy to find the time to keep them up to date.

- Dealing with reception can be difficult sometimes, in person and over the phone. This is something that can be discussed at staff meetings. I will let the HR partner know.

- Getting through on the phones can be difficult. We are in the process of updating the telephone system, so hopefully this will begin to improve shortly.

- Waiting too long to be seen. Unfortunately there is little we can do about this. Sometimes we face unexpected problems or very complex patients and that can make us late. We can only apologise when this happens.

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- The name of the doctor whom you are going to see. The receptionist should tell you this when you book an appointment. Information about the doctors should be displayed.

HOW ARE WE GOING TO IMPROVE COMMUNICATION AND INFORMATION?

1. WEBSITE : this is a powerful tool that we should use to a greater extent than now.

- Ensure it is kept up to date. Look at a new design which is more attractive to patients.

- Updated practice leaflet: include a downloadable PDF.

- Virtual notice board: make it more noticeable and include up to date information regarding the PRG (see details below), use it to publicise any seasonal campaign such as flu injections or the practice newsletter (see details below).

- Information about the PRG: include an explanation of what it is, why it exists, rules of the group, expectations and the difference between virtual and face to face group. Keep it updated with the agenda for the next meeting, with an invitation to join in, and with the minutes of meetings. Also include the latest survey results, Action Plan and Local Patient Participation Report.

2. NOTICE BOARDS:

- Notice board exclusively dedicated to PRG: ensure it is not used for anything else. Include information as outlined above.

- Notice boards in waiting rooms: try to keep them tidy and only use up to date information. Rotate posters so that regular patients don’t get bored seeing the same subjects again and again, and then perhaps they will pay more attention to the information displayed.

3. PRACTICE LEAFLET: Keep it up to date. Make it available in the reception area to “take away” and also on the notice board and practice website.

4. TEXT MESSAGES: according to the survey it is the preferred method of patients by which to receive information from the Practice. Try to use it more often; for example, this year we have used it to improve the uptake of flu vaccination and to inform patients about the online survey.

5. NEWSLETTER: We’ll produce one twice a year. The newsletter will be available from reception and also from the website.

We agreed the next one (due end of March or beginning of April) should focus on “Did you know you can…?”. This will give clear and to the point information about what patients can do

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and what they might not know, such as booking an appointment up to 6 weeks in advance, requesting scripts online etc. This specific newsletter will be handed out by doctors and nurses during a period of 3 to 6 months (yet to be decided) to all the patients who are seen; hopefully ensuring this information reaches the greatest number of patients.

6. FEEDBACK AND INFORMATION ABOUT RECEPTIONISTS, NURSES, DOCTORS AND THE PRACTICE

- To send notifications to doctors, nurses and receptionists to let them know about the positive and negative comments made by the patients.

- To discuss these comments, perhaps at an in-house TARGET meeting, and make the HR Partner aware so that they can be discussed at the next Staff Meeting.

- To discuss at the next business meeting the possibility of putting up a poster at the entrance with the names and pictures of all the receptionists, nurses and regular doctors. To also discuss the matter of receptionists wearing name badges and regular doctors and nurses using their nameplates on consulting room doors.

- Ensure there is up to date information about all the regular doctors on the website, the practice leaflet and the next Newsletter: where and when they are working, if female or male, if any special skill, and if they speak other languages etc.

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