The PPG met five times during 2018, welcomed new patients to the Thursday meetings and the email list, and undertook a number of different activities. Dr Natasha Smeaton, the link doctor between the Practice and the PPG, attended all meetings, and at the September meeting, when she handed over the role to Dr Dilini Kalupuhana, she was warmly thanked by PPG members for her support and interest in the PPG over the past three years.
During the year the Practice Manager, Loni Booker and the Associate Practice Manager, Siobhan Moriarty, also joined PPG meetings regularly. Between 10 – 15 patients participated in meetings, with agendas and minutes going out to an email list of about 100.
In July the PPG held its ‘Meet Your Practice’ evening in the gym. Dr Jonathan Levy, senior partner, made a short presentation of what the Practice had been doing over the past year, and people present asked a number of questions related to activities and events in the Practice, and also raised concerns over specific issues such as appointments. After the meeting refreshments were served in the garden.
PPG activities during 2018
- Meetings were held between the PPG and Reception staff. A new telephone system was introduced early in the year, which included, among other things, a message which told patients where they were in the waiting queue. Several patients expressed appreciation of this improvement.
- The new PPG at Queens Crescent Practice joined a James Wigg PPG meeting, and discussed the role of the PPG.
- Another focus of interest for the PPG was supporting carers in the practice. A number of discussions were held and a letter was sent out to the practice’s 80 registered carers, to see what sort of support might be helpful. Representatives from both Camden Carers and Age UK met with PPG members. Response from carers to the letter sent out was limited, but three carers attended one PPG meeting, and led a lively discussion on their different needs.
- Self help week 12-18 November. PPG members helped the Practice with this national initiative on self-care. They
- attended one of the sessions devoted to diabetes.
- set up a stand in the reception area, to answer any queries about the role of living wills.
- worked the reception queue. As a result of this action, one PPG member JudyHildebrand, volunteered to help with the reception queue on a regular basis.
- The PPG wrote two letters to the manager of the Kentish Town Health Centre, pointing out continuing patient confusion around signage, check-in, and where to go in the building. The matter remains to be satisfactorily addressed. The PPG also helped the Practice change the wording of letters going to patients who are registered at the Practice but who move or live outside the catchment area.
The PPG met five times during 2017, welcomed new patients to the Thursday meetings and the email list, and undertook a number of different activities.
Thursday meetings were attended by the link doctor, Natasha Smeaton, and the practice manager, Loni Booker. Other doctors and staff members also attended some meetings. Between 10 – 15 patients participated in meetings, with agendas and minutes going out to an email list of about 70.
In July at a ‘Meet Your Practice’ evening 130 people squeezed into the gym, but in spite of the crowd, patients expressed appreciation for being able to voice their concerns, and an interest in hearing more about how the practice is run. Issues raised by patients included waiting times for appointments, not seeing the same doctor each visit, and outsourced services, among other things. Patients were introduced to the neighbourhood structure for NW5 GP practices and to the new clinical pharmacist. This was the first time that an invitation to a PPG meeting had been texted to patients with a mobile phone.
Reception staff invited PPG members to one of their regular lunch-time meetings, and a full discussion took place. PPG members learned about the different roles reception staff play, and some of the issues that arise for them in communicating and dealing with patients. PPG members were able to voice concerns about the way patients are greeted and the system to deal with long queues, among other things.
Another focus of interest for the PPG was supporting carers in the practice. A number of discussions were held and a letter was sent out to the practice’s 80 registered carers, to see what sort of support might be helpful. Representatives from both Camden Carers and Age UK met with PPG members, and attended PPG meetings to talk about what services are available. It was noted that one care navigator is attached to the practice, and the support she offers to patients is highly valued.
Response from carers to the letter sent out was limited, but three carers attended one PPG meeting, and led a lively discussion on their different needs. Part of ongoing activities for the PPG will explore whether there is any wish for a carer support group, run by and for carers.
Several presentations were made at PPG meetings during the year initiating discussion:
- Daniel Davis, geriatrician and epidemiologist from UCL explained to PPG members the aims of the NHS linkage research study, which was recruiting patients from the practice. The study focuses on the impact of hospital admittance and discharge on elderly people.
- Anna Wright, Deputy Director of Healthwatch, Camden provided a brief overview of the aims and objectives of the organization, and went on to talk about a couple of Healthwatch studies which had been completed during the past few months, including one on care homes.
- Asif Dewan described the newly instituted clinical pharmacist scheme, whereby a clinical pharmacist would see patients taking multiple medicines in the practice on referral from their GP. The first clinical pharmacist was introduced at the PPG meeting in July.
- Another new scheme – Physician Associates – was initiated in the practice during the year, and a new recruit explained the role of PA’s in the practice.
- The Care Navigation Manager from Age UK spoke to the PPG about the work of Care navigators and described services available for carers in Camden.
- The Wellbeing Hub Manager presented what services the hub in reception offers to patients.
- PPG members were asked to comment on the design of the new website.
- The PPG chair gave a brief talk about the PPG to the regular James Wigg staff meeting.
Communication: information exchange
Several newsletters were produced by the Practice Manager during the year, with inputs from the PPG, and distributed in reception and through the PPG email list.
NAPP (National Association on Patients Participation) produces a number of regular e-bulletins, and these were disseminated through the email list. They also occasionally conduct surveys which the PPG or Chair respond to, or distribute to the email list for PPG members to act on.
A survey run by the Practice (on knowledge of patients about access to their records) was disseminated through the email list, as was a letter to patients explaining the new extended hours service.
A number of consultations initiated by NHS England to hear patients’ views (on changes in prescription medicines, long term conditions services, the future of mental health acute day units) were shared with the PPG or disseminated through the email list.
Camden Patients Participation and Engagement Group (CPPEG)
CPPEG is part of the Camden Clinical Commissioning Group (CCG). Two PPG members (Gill Walt and Kathy Graham-Harrison) were elected to CPPEG in 2016 and 2017, and attended monthly meetings during the year, half of which were open meetings, which all PPG members are welcome to attend. The PPG representatives serve on a number of different CCG committees.
At each PPG meeting there was feedback from CPPEG, so that members were kept informed about wider changes affecting Health services in Camden. Examples include the introduction of GP neighbourhoods and the GP Federation, new commissions for outsourced services, such as Muscular Skeletal services being taken over by UCL, and the extended hours’ service run by AT Medics.
The PPG met regularly in 2016, with members participating in a number of different activities internal to the Practice as well as in Camden-wide events.
External participation in activities
A presentation on the newly launched Camden Integrated Digital Records (CIDR) was provided by Nigel Slator from the Camden CCG in February, to bring members up to date on how access to records is being shared and protected within Camden health and care services.
A member of the PPG, Kathy Graham-Harrison, was elected to join CPPEG – Camden Patient Public Engagement Group – and the PPG received regular and valuable feedback from her on CPPEG discussions and health policy issues in Camden. CPPEG open meetings were held regularly during the year, and were attended by several members of the PPG. At the last one in November, Loni Booker (Associate Practice Manager) and Gill Walt (Chair) did a short presentation on how the PPG and the Practice work together.
The Care Quality Commission inspected the James Wigg Practice on 22 September. Two members of the PPG attended the presentation made by Philip Posner to the members of the CQC team, and were later interviewed by the head of the CQC team. One of the CQC team talked to patients in the reception area. The results were published in January, and are available on the CQC website. The Practice did very well, was judged to be good, and the only area ‘needing improvement’ was in relation to patient access to appointments and telephone services. This was not unknown, and is probably common to every GP Practice in London.
The PPG is also a member of the National Association of Patients Participation (N.A.P.P), whose newsletters are uploaded on the PPG page of the James Wigg Practice website, and are also sent to the PPG email list.
Internal participation activities
In March PPG members designed and carried out a small study on nursing in the Practice, to ascertain whether these had improved after some changes had been made in services. Six questions were asked of patients exiting from nurse appointments, regarding their satisfaction with the service. The results were reassuring and demonstrated a high degree of satisfaction.
From late September to October a PPG-initiated Advance Care Planning month took place during the period devoted especially to Flu Clinics. Leaflets about advance care planning were printed and distributed to patients; information was made available on the TV screens in reception; and posters were put in the corridor. Lessons were learned from the experience – eg the need to make front-line staff more aware about what advance care planning is – so that they would be more pro-active in their interactions with patients. The PPG and Practice will work together to repeat the experience in 2017 in order to raise consciousness among patients about advance care planning.
In October PPG members met staff from Reception, and a very lively meeting resulted in a number of proposals for improving patients’ experience in queuing for Reception, among other things. PPG members found it useful to learn of the different tasks undertaken by Reception staff, and it was agreed to hold another meeting in six months’ time.
A number of activities were undertaken to try to widen participation in the PPG. The PPG leaflet (explaining what the PPG is and does and how to participate in it) was redesigned and made simpler. In June – during National PPG week – PPG members handed out the leaflets to patients entering or leaving the Kentish Town Health Centre – and spoke to those interested. It was felt afterwards that this was not a particularly helpful way to reach patients or encourage participation.
PPG meetings have led to information exchanges between the Practice and patients on a number of different issues (prescriptions, telephone service, patient on-line services, out of hour services, new appointments among many other things). PPG meetings have also raised wider issues, such as concerns over the Sustainability and Transformation Plans (STPs). From some of these discussions actions have been taken, in the form of writing letters (eg to ensure the phlebotomy service was not moved from KTHC) to changes in letters going from the Practice to patients who failed to turn up to appointments. The PPG also worked with the Practice on the production of a newsletter which is informative for both patients and staff.
In summary, the year was a positive one for the relationship between the PPG and the Practice. The Chair and Vice-Chair met regularly – before each PPG meeting – with the Lead GP link, Natasha Smeaton, and the Associate Practice Manager, Loni Booker, who both attended all PPG meetings. Other GPs from the Practice also attended some PPG meetings. The meeting between Reception staff and PPG members was perceived by all to have been a valuable exchange. From these on-going discussions issues have been identified and acted on where possible, to facilitate and improve the relationship between patients and the Practice.
In January 2014 the PPG (consisting of patient members and practice representatives) developed and adopted new terms of reference, which outlined the objectives of the PPG, membership, and general rules about the running of meetings. A new chair and deputy chair were proposed from among the patient members.
The Terms of Reference appear on the PPG page of the James Wigg practice website: Terms of Reference
Setting up an email account
One of the first activities of 2014 was to try to extend representation of patients on the PPG, and to provide a forum for feedback and information exchange through a dedicated email address. Two sub-groups were established: one to look at initiating a specific email address for the PPG, which was separate from the Practice, and two, to discuss ways of enlarging the membership of the PPG and PPG email list, to include younger patients and those from different ethnic groups.
The email was set up at [email protected] and is now used as one of the main ways the PPG communicates with members. Agendas and minutes are circulated to the PPG email list from this address, and members can raise issues through the email which can be brought to meetings for discussion. The email address is managed by the Deputy Chair.
Widening representation was a more difficult task, and the PPG started by designing and then printing a leaflet about the PPG and what it does, and giving the new email contact. During a week in October, several members of the PPG attended Reception, the Mother and Baby and Flu clinics to hand out the leaflet, to talk to patients about the PPG and to add names and email addresses to the PPG email list. Several other initiatives were undertaken to talk to others about widening participation. As a result of the exercise 20 names were added to the email list, and a poster, similar to the leaflet, was designed and is now posted in the glass noticeboards at either end of the corridor in Reception.
Improving the website
The PPG has been active in trying to get improvements to the website, both generally and to the PPG page. It has been a frustrating year in this regard, and only small changes have been made to basic design flaws, uploading of new material, updating and maintaining the website, and creating a section on feedback. Efforts to improve the situation are continuing, but the Practice has been hampered by poor service from Boilerhouse, the original designers who retain control, and insufficient dedicated personnel.
Feedback on appointments and complaints
The appointment system continued to be a factor of some concern to some patients. In the week long survey conducted by the PPG (see above) getting appointments with named doctors, in a timely manner, and waiting times, were common sources of expressed dissatisfaction. These are complex issues for the Practice, not helped by a GP practice in Camden Road being closed and the resulting inflow of new registrations, demands from NHS England and general reforms and budget cuts introduced through the Health and Social Care Act.
The PPG asked the Practice for more information on complaints and how they were dealt with, and also observed that the website did not make clear how patients could give feedback – whether negative or positive.
Details of complaints logged at the Practice as well as those posted on the NHS website were tabled at the November meeting. Results from NHS showed that there had been an increase in complaints but PPG members were sceptical about how to interpret these, as they are anonymous. The Practice does ask those who complain anonymously to get in touch.
The Practice produced a summary of complaints made to the Practice. This summary – from both Queens Crescent (approx. 3300 patients) and James Wigg (approx. 20,500 patients) practices was welcomed by the PPG, and members noted that the total number of complaints was lower in 2014 than in 2013 although they did not cover the whole of the year. This information will be available for all meetings.
Information and Communication
During the year, a number of initiatives which affected the Practice were outlined to the PPG members, and noted in minutes. These included, for example, the Friends and Family test (FFT) which sent texts to 10% of patients (ie about 100 patients of the 1000 seen at the Wigg Practice every week) to rank their experience by answering a question such as: ‘How likely are you to recommend our GP practice to friends and family if they require similar treatment’. The FFT is currently being run by the Practice.
Other information regarding data sharing was discussed. For example, the PPG was informed about the proposal Camden Integrated Digital Record (CIDR) which will go live in 2015. This is a local initiative which will allow individual health and social care information to be accessed by health professionals in Camden in order to provide better, integrated care.
Support group initiated
Two PPG members initiated a support group for Cancer patients and carers, which meets on the first Tuesday of every month, at the Kentish Town health Centre, and provides an opportunity to exchange and learn from others’ experiences around issues to do with cancer. A Diabetes Support Group also meets regularly at KTHC, on the first Monday of every month.
External to the Practice
A PPG member volunteered to become a member of the Camden Public Participation and Engagement group, (CPPEG), from early 2015, and will report back on CPPEG meetings. CPPEG is part of the CCG (Clinical Commissioning Group). The chair and deputy attended a number of open meetings run by CPPEG on aspects on health in Camden. These meetings are open to anyone interested, and cover a wide variety of areas, such as 111 and Out of Hours Services, Care for the elderly in Camden, and the results of a survey of the Somali community in Camden, and their experience of health care. PPG members are welcome to attend these open meetings, and information about them is circulated to the email list.
The PPG is a member of the National Association for Patient Participation, and any patient can access information on their website: www.napp.org.uk to help improve GP services. An electronic newsletter is available through the website.
The PPG currently consists of 34 active patient members of the practice plus at least 2 practice members which includes one of the partners and the Deputy Practice Manager.
Profile of the PPG by age and sex:
Profile of the PPG by ethnicicty:
Profile of registered patients by age and sex:
Profile of registered patients by recorded ethnicity:
The PPG and the practice acknowledge the difficulty in try to ensure that such a large and diverse population as seen at the James Wigg Practice has representation and a consensus was agreed that, while it may be difficult to ensure that there is an active PPG member from each demographic, that increased effort should be made in making the PPG as accessible as possible and these initial efforts are described later in this report.
In May 2013 the PPG discussed areas of concern and decided to conduct a patient survey to assess opinion on the external services that patients were referred to such as physiotherapy, podiatry etc.
The surveys were distributed to doctors to hand to patients at the point of contact and also left in the waiting room for patients to complete.
Despite over 60 forms being distributed only 3 were returned, one commented on the difficulty obtaining an appointment, one indicated that the physiotherapy service had been good and the other on the advantage of having a phlebotomy service in the practice.
Feedback from clinicians felt that there may have been a delay between the referral to the service and the appointment possibly leading to the patient forgetting about the survey and lack of time to explain the form during the consultation and also the fact that the survey was carried out over the summer when many of the usual clinicians were on leave. Overall it was felt to be a very disappointing response.
The issue around appointments was discussed in detail at the PPG meeting in July as this had been the subject of a number of administrative complaints received by the practice. Key action points were identified as follows:
1) Lack of information regarding the new appointment system
2) To consistently be able to book appointments at least 4 weeks in advance
3)Address concerns about the apparent reduced availability of on-the-day appointments.
The practice responded by acknowledging that there had been a problem with the introduction of a new appointment system and that some of the key issues were around lack of information available for patients and has subsequently produced an information leaflet for patients which is readily available at the reception desk and also around training for reception staff – this has resulted in any ongoing training programme for reception staff.The practice acknowledges that while some of the problem had been due to the reorganisation of Health Education England and a delay in information regarding staff on the Foundation year programme being given to practices in a timely fashion, there was also a local problem around staff requesting leave once the rota had been finalised which caused unacceptable delays. The practice has now a strict policy of a minimum of 6 weeks’ notice for leave.The practice also agreed to address concerns about the availability of on-the-day appointments.Further research done within the practice showed peak demands for these appointments on Mondays and the appointment system has been adjusted further to accommodate this demand.Core opening hours of the practice are 8.30am – 6.30pm Monday-Friday with extended hours appointments being available from 7.30-8.00am on Monday, Wednesday and Thursday mornings and from 6.30-8.00pm on Tuesday and Thursday evenings. During core hours patients can access services either by presenting to the reception desk, telephoning or, for non-urgent requests sending an e-mail to the practice e-mail address which is [email protected] further concern, throughout the year attendance at the PPG had been falling and in Autumn the practice took the decision to suspend the PPG in order to look at ways of improving representation and direction.This resulted in several positive outcomes.The existing members of the PPG met independently of the practice and identified the following key areas for the PPG to act on:
1) Terms of reference for the PPG
2) Appointing a patient chair to run the meetings
3) A subgroup to look at increasing representation on the PPG
4) A subgroup to look at setting up a “virtual” PPG in order to improve communication between meetings and improve the profile of the PPG within the practice.
This was fed back to the practice in January 2014 and to date the terms of reference have been agreed and the members of the subgroup have been appointed.The practice and the PPG are continuing to work to ensure that as many patients as possible can access the PPG and that the PPG can continue to work with the practice in what has historically been a very positive and productive way.A cancer support group with the aim of providing a network of support for patients and carers who have been affected by a diagnosis of cancer has also been set up by some members of the PPG and the inaugural meeting took place recently and was extremely well attended and received. The idea for this came from members of the PPG and has been resourced and developed purely by them with some administrative support from the practice in order to publicise the group.
This report was discussed at the most recent PPG meeting held on 20th March 2014.