Wayfinding at Kentish Town Health Centre

Gill Scott – February 2024

Summary of a wayfinding survey conducted by the James Wigg Practice Patient Participation Group (PPG). This document can be reviewed here.

Covid Report on Patient Questionnaire

Gill Walt – July 2020

The PPG undertook a small study to capture the experience of a few James Wigg patients during lockdown. They approached people they knew personally, so the study is highly selective.

Five questions were asked:

1. Have you been in touch with the Practice during lockdown (since 23 March)?
2. What was the process of getting in touch (telephone, email, e-consult etc)?
3. Was your first attempt to get in touch successful?
4. Were you satisfied with the outcome of your contact?
5. Do you feel the Practice communicated well with you during the period?

Findings were from 20 interviews of those who had been in touch with the practice. They were conducted by 5 PPG members. The respondents, 11 of whom were female, 9 male, fell largely into the susceptible-to- Covid group: 4 in their 80s, 10 in their 70s, 2 in their 60s, 2 in their 50s and 2 under 40.

Contact with the Practice, was mostly self-initiated, although 3 people had been contacted directly by the Practice.

Telephone system. All respondents had used the telephone system, and most were then directed to the website, to fill in the e-consult form, or were phoned back by the duty doctor, sometimes their own named GP.

All respondents who spoke to a doctor expressed deep satisfaction and appreciation for the telephone consultation.  One patient felt that the mid-June call, initiated by the doctor to check blood pressure and general health, could have come earlier.  Most said that they would be happy to continue with telephone consultations in the future, rather than having to go into KTHC.  One person felt the attention received was ‘better than before the pandemic’.

None of those interviewed had had a video consultation. One patient in her 70s was asked by the doctor whether she could send a picture, but said that was difficult for her to arrange. Another patient said a video consultation would have been helpful but was not offered.

Some dissatisfaction was expressed with the length of the message patients get when phoning the practice, with the wording (one respondent felt it was discouraging patients to get in touch), and with the receptionists’ answers to queries.  One respondent felt the telephone system was ‘clunky’, though ‘you got there in the end’.

E-consult. Most of those who used the e-consult form found it easy.  One found it overly long, and repetitive. Another took a long time filling it in, and on reaching the end, was told that the information just provided would not be kept, and she should call the surgery. She assumed this was because the e-consult programme judged her case to need urgent consultation, but she was annoyed to have to phone the practice again, wait for a doctor to call back, and to have to explain the problem all over again.

Communication. The main issues for respondents were around communication. Sometimes these were between the pharmacy, the practice and the patient. For example, one patient got a message on the prescription form from the pharmacy to check blood, but then had difficulty finding out whether it was urgent or not; several respondents found the website unhelpful, and ‘difficult to navigate’, and the website was criticized for being useless for making appointments.  A few respondents had had email communications with their own doctors, which they found helpful. One patient in her 80s, who had been in hospital twice, had had no follow up call from the practice having been discharged with ongoing health issues.  A few patients expressed some dissatisfaction with receptionists’ attitudes (sometimes perceived as ‘blocking’ the patient from speaking to a doctor, or not having information the patient felt they should have eg on using the e-consult form, or not wearing masks).

Conclusion. This was a very limited study, and covered the views of only a few highly selected patients.  For this group of patients, the practice met their needs, although not always as smoothly as they would have liked.  Telephone consultations were found very acceptable, and the great majority of patients found the consultation with the doctor highly satisfactory.

Given that poor communication was a clearly identified issue in this particular study, attention needs to be given to the way patients understand the working of the practice in the future. For example, some patients feel that there will be no chance for face to face consultations; others fear that the telephone consultations will be shorter and less satisfactory than they were under lockdown, and that there will be a return to waiting for a long time to talk to a doctor. There are also questions about the extent to which patients have access to the internet and are able to use the e-consult form, among others. Is there a role for the PPG to play in helping inform and communicate with patients?

Feedback on ‘Working the Queue’ at the Kentish Town Health Centre

Mimi Colahan, Kirsten de Keyser, Judy Hildebrand and Gill Walt, 20 March – 4 April 2019

Aims:

• Help reception staff manage the queue
• Increase the number of patients registering for Patient Access
• Improve patient experience in Reception

Four volunteers attended four mornings in the week (Monday to Thursday) for a couple of hours. Each wore an NHS volunteer lanyard and offered help to anyone queuing at Reception.

Results:

1. All four volunteers felt they had helped in a number of ways:

• • showing people how to check in on check-in machines
  • directing people to various services or rooms (for blood, mammography, scans, specific clinics, CAB, etc)
  • showing people where to leave specimens, or where to pick up specimen bottles & forms
  • reassuring those who had In-health appointments not to check in but to wait in Reception
  • listening to people who were distressed or annoyed
  • showing people how to use the blood pressure machine

Volunteers were absolutely positive that they had saved Reception staff time, and had been helpful to people waiting. Many people expressed appreciation for the attention or information they received from the volunteers. Some went out of their way to say thank you on departure. It was less clear that there had been any significant increase in the number of patients registering for Patient Access.

We recommend that if the Practice wants to increase Patient Access registrations, other methods need to be applied. For example, all paper prescriptions should have attached to them a separate note explaining the value of Patient Access especially for repeat prescriptions. New patients should be strongly encouraged to join Patient Access when registering initially.

2. Most uncertainty comes from In-Health patients, who do not always understand they are being seen by In-Health, or are upset that they cannot check in. They feel insecure just sitting in Reception waiting to be called, especially when the service is running late.

We recommend that the patient list for In-Health is given to the volunteer, so that they can check the name on the list, and reassure the patient they will be called if they wait in Reception.

3. Building on this experience, it would be useful to draw up a list of information for volunteers, so that they can answer queries that come up. Such a list could include:

• • CAB service only provided on Wednesdays. Appointments have to be made, and clients need to check in on the machines.
  • A list of the different services offered by In-Health (eg Ultrasound & Audiology), and other independent services (eg Mammograms, Mosaic, Dentist)
  • Which rooms are used for regular services (eg Diabetes clinic)
  • Local taxi phone numbers
  • Basic information (which volunteers will gain with experience)
    • Eg when people report that the check-in machines do not work, establishthat they have put in the correct information, what service the person is checking into, whether they are late.

We recommend that JW staff provide volunteers with services information. The volunteers will draw up a list of useful tips for future volunteers.

4. A number of observations would improve patients’ and visitors’ experiences

• • the notice about a Café is removed;
  • a notice for Specimens is put on the Reception Counter;
  • local taxi phone numbers are prominently displayed on notice boards.

Informing patients who telephone that there are several people staffing the phones, and queues move relatively quickly.

5. It was noted that Interpreters often arrived late, and kept patients and doctors waiting. Also that interpreters often had to queue to get signed off, because the doctor had not done so.

At a meeting between volunteers and Reception and Practice managers on Monday 15^th April it was agreed:

• The Practice will attach information about Patient Access to all paper prescriptions. Action: Sarah
• Each morning the list of patients for In-health will be left at the Hub, so volunteers can check names for appointments Action: Sarah
• The Practice Manager will give a list of other services in the KTHC and make the list available to volunteers, for referral. Action: Siobhan
• Volunteers will draw up a list based on experience to pass on to new volunteers Action: volunteers
• The PPG Chair will write to the management of KTHC to suggest the sign for Café is removed Action: Gill
• A notice for Specimens is put on the counter, and is moved to the Hub Action: Sarah
• Local taxi phone numbers are displayed more prominently on notice boards, and that a list is available at the Hub, with other services information. Action: Siobhan
• Interpreters should be asked to arrive 15 minutes before the actual appointment. This might help if they are running late, and will give a chance to meet with and talk to, the patient. Reception will email doctors to remind them to sign off the interpreters’ papers before they leave the consultation room. Action: Siobhan and Sarah.

Study on patient satisfaction with GPs: summary report

Gill Walt, February 2017

The PPG undertook a small study for the Practice, based on selected results from the last national GP Patient Survey 2016 (https://gp-patient.co.uk/). The GP Patient survey found the following:

83 % JW patients said the last GP they saw or spoke to was good at listening to them (89% nationally)

76% JW patients said last GP they saw or spoke to was good at involving them in decisions about their care (82% nationally)

80% JW patients said last GP they saw or spoke to was good at treating them with care and concern (85% nationally).

The PPG undertook a small study on one morning in January 2017, and asked the same questions of patients as they exited from their GP appointment. Four PPG volunteers introduced themselves to patients, and then asked the same three questions as the GP Patient Survey:

1. Do you feel the GP you have just seen listened to you?
2. Do you feel the GP you have just seen involved you in decisions about your care?
3. Do you feel the GP you have just seen treated you with care and concern?

Results

Sixty one interviews were completed (with two refusals). Ninety seven % of interviewees answered yes to all three questions. Three % answered no to one or two questions.

The great majority of patients expressed satisfaction with their appointment. One patient said ‘The doctor was really understanding and her positive attitude about my concerns and problem made my worries disappear. The doctor was also helpful giving me clear and positive understanding about my health problem that made me feel less fearful towards the future’. Another said ‘I liked the way he looked me in the eye when I came in. Often they are glued to the computer screen, and I think you can assess a patient by the way they walk into a room’. To the third question about care and concern many added ‘definitely’, ‘yes, with a smile’, ‘110%’!

Lack of satisfaction was expressed as: poor explanation; lack of knowledge of the medical history; and in two cases there was disagreement between doctor and patient about treatment. Eg one patient wanted a blood test, which the doctor felt was unnecessary (but finally agreed to); one patient did not want a blood test, which the doctor felt was necessary!

Conclusions

While the positive responses are heartening, there are a number of weaknesses in the study, and with small numbers it is difficult to generalise. Of the 7 doctors on duty, two were senior GPs, the others were STI 1, 2 and 3, on six-monthly or one year contracts. There was no difference between them in patient response.

However, the PPG volunteers made a number of observations, which the Practice might take into account in the future. For example, protocol on arrival upstairs is unclear (patients registering their presence at Reception are told where to go, but those registering on-line receive no instructions beyond what office number to go to. Patients did not always know whether to wait outside the doctor’s office or to knock on the door, and there was no signage to suggest what they should do. Some doctors came to the door and invited patients in, others waited for patients to knock. One volunteer saw 3 different doctors come out and say ‘Oh, Mrs X, I didn’t realise you were there. Come in’. They noted though, that the waiting area is spacious and peaceful.

Signage is still a bit of a problem – especially for Child Services.