Surgery Premises Update

This is the latest in the series about our proposed new medical centre. Unfortunately I have little to report since the last installment. We have broad agreement on the size and layout of a building. The PCT (our “bosses”) are fully supportive and the Parish Council and their project manager have had meetings with all interested parties. The summer holidays have stalled things with various key people being away. Hopefully we will now get things moving so that I have some real news for the next newsletter.

Edwin Thompson


A polite reminder concerning appointments:

The doctor does not want to run late any more than you wish to be kept waiting, so please remember

• Arrive on time for your appointment. If you are more than 10mins late you have missed it. The receptionist will ask the doctor if he is able to fit you in, but you may have to rebook for another time.
• Your appointment is 10mins long which is usually enough to deal with only one problem.
• You can book a double appointment (20 mins) if necessary.
• The appointment is for one person only, not two or three!
• Repeat prescriptions, insurance claim forms etc can be dealt with through reception.

Thank you.

From Dr Macdonald (recent retiree)

I have now been retired nearly 3 months, and so far it doesn't hurt a bit! I was greatly touched by the large number of cards and messages and kind words I received from patients wishing me well in my retirement—I shall always treasure them. There were also a substantial number of gifts, and I am delighted to say in consequence that my toolshed is better equipped, and our garden looking better cared for and more colourful than for many a long year.

Many have commented that I look too young to retire (62 years old, actually), and several have wondered what on earth I am going to do instead of work. So far I have had barely a moment to think about the long-term future, but of course home and family come top of the list. In the first three weeks, I gardened and golfed and played cricket and (most foolishly of all) went for a run in Lyme Park, so I spent the 2 subsequent weeks nursing a strained back. Learning from my mistakes is clearly something I will have to continue to do. Anne and I are not moving away from the area; I have already happily bumped into several of you in places I barely knew existed (supermarkets, coffee bars, department stores etc). I hope however that I may see some of you also at forthcoming Barnby choir and Chorale concerts - singing and other forms of music making will fill much of my time in future. Details of the choirs’ programmes will appear on the surgery waiting room walls in Sept/Oct. If you come to any of our performances, do come and say hello in the interval.

I am leaving the practice with many happy memories and count myself very privileged to have worked all these years in such a pleasant environment and with such able colleagues. Thank you again for your kindness and generosity.

Buxton Mountain Rescue Team – Update

Since my last newsletter article I have qualified as full team member and now sport my prized “Red Jacket” with immense pride. The training took 18 months and I have learned a huge amount and will continue to do so.

The collection boxes in Alderley and Prestbury surgeries have raised £85 and continue to be filled. We have also had patients make larger and regular donations to the team and I would like to extend grateful thanks on behalf of the team for your extremely generous donations both large and small in these difficult financial times. My friends and colleagues also generously sponsored me for the Yorkshire 3 Peaks walk which I completed two months ago. Our finance manager’s son, James Martin, also completed an impressive fundraising coast-to-coast walk, raising £380 for the team and getting involved in a rescue of his own en-route! Read all about it on our website: www.buxtonmrt.org.uk

Local pharmacist Jack from Cedric’s generously donates all our team drugs and dressings, many of which have been put to active use in recent weeks.

Our most recent fundraiser was Chatsworth Country Fair on 4th-6th September where team members sold programmes on the gates and the team received a donation for each one sold. We also did a demonstration in the Grand Ring each afternoon although this had to be abandoned on the Friday because of a search and the team had to leave early on Sunday for a rescue! We also found a few missing children at the fair during the course of the weekend. This is an annual event so please come and join us next year.

Dr Vicki Gilmore, September 2009

From our new partner, Dr Cunliffe

Well, I'm really glad to be working back here in Alderley Edge and Prestbury, even if I do have the impossible task of following in the footsteps of Dr Macdonald. As some of you may remember I was a registrar here a couple of years ago but since then I've been working as a GP in London both in the NHS and in the Private Sector. It is always good to have different professional experiences and the private work gave me this. (Plus, I got to look after a few celebrities!)

Like many GPs I consider myself a generalist but have particular areas of interest which for me are Elderly Medicine, Palliative Care and Sexual Health.

When I'm not working I spend most of my time enjoying the company of my friends and I have a real passion for wine and cooking. I also try to keep fit so some of you might see me at the gym.

Anthony

New registrars:

We welcome two new registrars to the practice, Dr Vasavi Pasupuleti and Dr Naureen Hanif. Vasavi will be with us until February 2010 and Naureen will be with us until next August.

Both Vasavi and Naureen are fully qualified doctors, having spent several years in hospital medicine and they are now learning about general practice with us. We always enjoy the company of our registrars and depend on them to keep us up-to-date!

We are sorry to say good-bye to Dr Vicki Tuthill and Dr Ravi Arya, who left us in August to go on to pastures new.

Patient Experience Survey 2008-2009

The practice patient survey was distributed to patients during November and December 2008.
We used the GPAQ survey, as last year to allow comparisons to be made. The scores across all domains were high, and considerably higher than the national averages. There were small improvements in the questions relating to access, including opening hours which reflects our extended hours with late evening surgeries. Our on line appointment booking which was introduced since last year also makes it easier to book routine appointments

The survey was discussed at a whole practice meeting on 1st April 2009. Although there was general satisfaction with the survey results it was felt that the comments received pointed to some problems with urgent appointments, Urgent morning appointments were limited and patients were being asked to phone back after 2pm if no morning appointment was available to be able to book an urgent afternoon appointment. An action plan was produced as follows.

1. Every day to be covered by the named Duty Dr for that day.
2. The duty doctor to have all urgent appointments ie only bookable on the day, except for 4 pre booked appointments at the beginning of morning surgery when it was unlikely that these would be filled by urgents.
3. The other doctors to have all pre booked appointments ie no urgents.
4. The duty doctor to have one hour mid morning when they will be available to do urgent visits or phone calls without disrupting their appointments. Historically visits have to wait until the end of morning surgery and hospital admissions tend to be in the early afternoon leading to a “bulge” in GP requests for admission. Our system should have benefits for secondary care in getting admissions in to hospital earlier in the day, as well as giving ill patients greater priority.

The new appointment system started on 1st May 2009. In the short time it has been in operation it seems to be a great improvement with staff being more able to easily provide patients with appropriate appointments. The demand for both routine and urgent appointments will be monitored to ensure that the balance is right and that improved urgent access does not reduce routine appointments

A brief review was undertaken at a practice meeting on 9.6.09 with minor modifications agreed.

2 year priorities.

• To maintain and improve on our current excellent access figures.
• To monitor appointment demand and supply and respond appropriately
• To respond to patient suggestions positively as we have done with this system

Practice Lead: Carol Janion Practice Manager.

This meeting was held on the 2nd July 08. The purpose of the meeting was to review the results of the GPAQ questionnaire, with staff and with patient representatives, and to discuss how the practice should provide extended opening hours.

The meeting divided into 2 slots – the first hour was spent in discussion with doctors and staff within the practice. In the second hour, we were joined by 10 patients from the practice. The patients were recruited by putting a notice out in reception, in Alderley Edge and Prestbury surgeries, asking for volunteers to attend the meeting. The patients were sent copies of the questionnaire and summary of the results to study before the meeting and were also told that we would be eliciting their views on extended hours.

Staff Meeting

There were 15 members of staff at this meeting. This included 4 doctors, the practice manager, 3 nurses, a secretary, the accounts manager and 4 members of the admin/reception staff.
We organised our thoughts by addressing 3 broad questions:

1) What are your thoughts, seeing the results of the survey?

Replies:

a) Very pleased with results of survey – in every area we were well ahead for the national average, and in most areas we had improved on last year’s, already excellent, figures.
b) It was gratifying to note that satisfaction was high across the board ie with reception staff as well as with the medical consultation. In fact, satisfaction with reception staff had increased by 8% from last year, to 85%.
c) Telephone access was also very good – both to get through to the practice, and to speak to the doctor.
d) Waiting time in surgery had decreased significantly ie doctors were running to time. Receptionists commented that this makes for a much happier atmosphere in the waiting room, and makes their job easier.
e) We noted that, although we have a patient group who tend to have very high expectations, we were managing to achieve this high level of satisfaction.

2) If you could do one thing to make the practice better, what would it be?

Replies:

a) New premises, better car parking. Related to this – having the chest clinic in an upstairs room causes problems for the elderly. This would be addressed by new premises.
b) Improve our practice leaflet, both in its appearance and in the quality of information in it.
c) Improve the provision of nursing appointments for chronic disease management at Prestbury.
d) Strive to manage availability of appointments better, particularly during holiday periods when there are fewer doctors consulting.
e) Be clear about practice boundaries – patients disputing these cause a lot of stress for receptionists.

We will spend time over the next few months addressing these issues.

3) How should we provide extended opening hours?

Replies:

a) We noted that the majority of patients were happy with existing hours and that we were one of the best practices in Eastern Cheshire for accessibility.
b) Our experience with Saturday opening in the past has not been positive – it was extremely difficult to staff and was not sensibly used by our patients.
c) Generally the idea of evening opening was favoured. We discussed how this should be staffed. The best plan seemed to be for 2 doctors to be consulting at one time, one evening a week, from 6.30-8.30. (We noted that the doctor would be unlikely to get away before 9-9.30 by the time letters, admin etc from the surgery had been competed.) As the phones will be diverted to OOH services during this period, it should be possible for 1 receptionist to man the clinic. This will need to be reviewed in the light of experience.

Patient meeting

10 patient volunteers attended this meeting.
Dr Hall welcomed them, managed introductions and checked their understanding of the survey results.
She then summarised for them the discussions that had taken place in the previous hour, with practice staff.
The patients were then asked for their views on the survey and on extended hours. This took the form of an open comment, question and answer session.

Replies:

a) Several patients commented on how they found reception staff courteous, helpful and excellent. A patient who has recently joined the practice commented that dealing with our surgery is a pleasant and totally different experience from her previous practice (in Leicestershire)
b) A patient said that it can be difficult getting through at 8.30 in the morning. We advised her that lines are actually open from 8 am. We explained how many lines are open (two) and why it was not possible to have more lines due to availability of reception staff. Since our last survey, we have provided an extra member of staff in reception for the first 45 mins in the morning, specifically to answer the phone.
c) A patient asked how we manage our emergency slots in the morning and afternoon surgeries and we explained the system to her.
d) A patient asked how health advice could be obtained without actually disturbing a doctor. She was advised of NHS Direct role in this. We also advised how requests to speak to the doctor are dealt with in the practice.
e) It was suggested that, in future, the questionnaire could appear online, on our website, so that it could be answered by people who do not necessarily come to the surgery regularly. Also, some people may feel happier doing it in the comfort of their own home and e-mailing the results directly back to us. We agreed this may also sample a wider range of patients and make the results more valid. We will look in to this possibility for the future. We will also try to publish the results of the survey on line.

f) Extended Hours

One patient commented that, as our accessibility results are so good and the questionnaire indicated a high level of satisfaction with opening hours, she could not see why we needed to extend our hours. A male patient said “If it ain’t broke, don’t fix it!”
We discussed the point of extended hours i.e. providing appointments after normal working hours for working patients, not to deal with acute illness, but to deal with chronic health problems. We acknowledged that, in practice, patients with acute problems will drop in and we need to cater for this as we would not feel able to turn them away from the door!
The patients at the meeting were interested in, and satisfied with, our proposals for opening late one evening a week with 2 doctors and 1 receptionist. They suggested we should put this information online so people know of its existence. It was also suggested that we should display our opening hours and practice newsletter in the public notice boards in the village.
It was suggested that we monitor our extended consulting time to make sure it is used appropriately, by the right group of patients, and if it is being abused we should stop doing it.

Alderley Edge Medical Practice Newsletter December 2007

PRACTICE PREMISES

Since our last News Letter there has been a considerable advance in the plans to relocate the surgery in the Festival Hall. You may well have read in the October issue of the Wilmslow Express that Macclesfield Borough Council have agreed to return the Festival Hall to the Alderley Edge Parish Council subject to a mutual funding arrangement between the Borough and the Parish Council. In anticipation of a successful outcome, preliminary plans have been drawn up to locate the surgery at the front of the hall. Details of the plans will have to go to public consultation, which hopefully will not delay permission to go ahead with the development. Approval of the plans will be the signal to proceed with the alteration work, which is expected to be during next year. The main body of the hall will be retained by the Parish Council. It will be refurbished, and continue to be used for functions and the local community. For those patients who use the Prestbury branch surgery there will be no change in service. You will have noticed we are now open 5 days per week , and have more appointments for blood tests to keep up with demand for this service.

We will continue to provide updates on our premises as plans progress.

Prestbury Update

You will be aware that the Prestbury surgery is a converted house. Access from Shirley’s car park is a concession granted by the Macclesfield Borough Council Planning Department, the normal access being from Macclesfield Road. The rear access cannot be made suitable for disabled people, and disabled access is via the front door. People using the rear entrance must use the paved path to the steps. Our insurers have insisted that no members of the public must walk past the side of the building on the unpaved drive because of the risk of incoming cars. In addition this entrance must be closd by a gate, and outside surgery hours the back gate and the proposed new gate must be closed and locked. While this may inconvenience some people, we have no option because of the terms of our public liability insurance.

Excellent Results!

Recently, an independent survey was performed by the Health Service to look at how easily patients can get an appointment with their GP, or speak to him or her on the telephone.

They looked at patient satisfaction in 4 areas

1) Ability to get an appointment in 48 hours
2) Ability to book an appointment in advance at a time of your choice
3) Ability to get an appointment with the GP of your choice
4) Ability to speak to your GP on the telephone

We scored very highly in all areas, with scores of:

93% (national average 86%),
94% (national average 75%),
96% (national average 88%),
and 98% (national average 87%), respectively.

In all areas, we were in the top 4 of the 19 practices in the Macclesfield area.

Plea from Prestbury Receptionists

Please could patients use their repeat prescription slips to order their medications, rather than telephoningPrestbury surgery. The receptionist is there on her own dealing with the surgery, requests for appointments etc and it makes it very difficult if the telephone is constantly ringing for prescription requests.

Good News from Sister Brenda Merchant

I would like to thank everyone who donated baby clothes, toys and other items to Charis House in Buxton. Can I also draw your attention to the Alderley Institute Trust. Details can be found on the notice board at the front of the Somerfield Supermarket and on the Surgery Carer’s Notice Board. The Charity has funds available for good causes that benefit the Alderley Edge Area and it’s residents.

Application forms can be obtained from Mr. K. Ranshaw at the Festival Hall, Talbot Road, Alderley Edge.

Children’s Health Page

It’s winter time and more than ever it is very important to keep healthy and warm. By doing the apropriate exercises and eating the right food you will keep healthy, fit warm and nourished to face these cold, yet refreshing, frosty dark mornings and warm you up on your arrival home after a tiring day at school.

Dear Mums and Dads, here are a few suggestions for a quick and economical home made nourishing “fast food” Italian style!

Eggs, and Courgettes Soup (15 minutes)

Ingredients

1 Courgettes; 2 Eggs; 1 Onion; 2tbs grated parmesan cheese;
500 ml. water pinch of salt; a few basil leaves; olive oil; oregano

Method

Thinly slice the onion
Fry in a tablespoon of olive oil in a pan until golden
Slice the courgettes in 4 sections and slide them thinly
Add the courgettes to the onion
Add salt, oregano and basil leaves
Stir-fry for a few seconds until the courgettes are golden and soft
Add cold water and bring to the boil
Mix two beaten eggs with parmesan cheese
Add to the boiling water with courgettes and onions
Stir for a few minutes, serve warm with fresh ciabatta bread or on it’s own or with a bruschetta con aglio (Italian style).

Steamed Parmesane Aubergines (Melanzane alla Parmigiana) (20 Minutes)

Ingredients:

3 Aubergines one and a half tins of tomato or half a kilo of fresh tomato
30 grs grated parmesan cheese; 30grs mild chedar cheese or mozzarella
Method Thinly slice the aubergines length wise. Place them in a non -stick pan on a low heat and cover with a lid for a few minutes until soft

In the meantime prepare a tomato sauce

Put the tomato (fresh or from the tin) in a pan. Add a pinch of of salt, 1 teaspoon of olive oil, 1 clove of garlic,
a pinch of oregano, a few basil leaves. Bring to the boil and let cook for 5 minutes.

When all the aubergines are steamed,

layer them in an oven proof dish with the tomato sauce, the parmesan cheese and the cheddar or mozzarella cheese.
Cook in the oven for 5/10 minutes on a medium heat 180 - 200 degrees.

Serve with some fresh green salad or creamed or roasted potatoes.

Merendine (Fairy Cup Cakes) (15 minutes)

Ingredients

100 grs self raising flour - 100 grs sugar - 100 grs butter - 2 eggs

Method

Mix the butter with sugar. Sieve and add the flour. Add the beaten eggs.
Mix into a creamy dough. Scoop into 12 cup cases. Bake for 10 minutes in a warm oven gas mark 180 degrees

Dear Mums and Dads, or Grannies and Grandads

I hope you agee with me (The vegetarian Wolf) that this is an affordable “fast food” meal, Italian style, low on energy consumption, low on preparation time, low on calories but high on nutrients, tasty and full of proteins, vitamins, minerals and fibres.

If you want the best for your children a little investment will take you and them a long way!
Even small children can help you prepare this easy three meals combination: a soup, a main meal and dessert !

Enjoy the experience!

Best wishes,
Anna Maria Forti Sheikh

Alderley Edge News, updated April 2007

The Practice Survey

For those of you who completed a questionnaire about the practice, you may be interested in what we do with the results. Here follows a summary of our practice meeting following the survey and some feedback from our patients.

Analysis of IPQ Patient Questionnaire

Present: Practice Manager, all doctors, practice nurses and HCA, reception and admin staff.

The report from the questionnaire, produced by CFEP UK Surveys, was circulated among all staff in the practice, prior to this meeting. Photocopies of the relevant pages were produced for people to refer to during the meeting. The meeting was conducted by splitting into 4 small groups to discuss various aspects of the report, with a plenary to summarise the groups’ ideas, between each section of the analysis.

The following questions were asked:

1) Which responses were most positive?
2) Which responses were less positive?
3) Of all the individual comments made in the report, which suggested areas for improvement?
4) What actions shall we commit to, in order to improve patient satisfaction?

Answers

1) Consistently good across all categories. We exceeded national averages in every category, with an overall score of 75% compared with national average of 62%.

Compared with the last 2 years, there was a big improvement in satisfaction with reception staff (up from 70% in 2005 to 77% in this survey – compared with national average of 66%)

There was also an improvement in the use of reminder systems by the practice and in the ability to give compliments or make complaints.

Patient satisfaction was as good for patients who had joined the practice in the last 5 yrs as for long-standing patients. This suggests that the good results are valid – not just due to loyalty of old patients. Patients who have recently joined would have been able to compare their experience with their last practice.

2) We looked at the questions which had scored the lowest marks (albeit still a long way above national figures.) These were:

Seeing practitioner of choice.
Seeing practitioner within 48 hrs.
Chance to speak to Dr on the phone.
Comfort of waiting room.

3) We then read through all the comments and each group came up with ideas for area in which we could improve. These were:

Ability to get through on phone in morning.
Comfort of waiting-room, old magazines.
Longer opening hours.
Suggestion box more conveniently placed so easier for people to make comments/complaints/compliments.
Telephone consultations - ? start a booked system for this.
Internet/e-mail for making appointments & ordering repeat prescriptions.
Patients can hear consultations from upstairs waiting-room and chat in back office.
Access – issues to do with opening hours, ability to see Dr of choice etc
Travel and smear clinics – shortage of appointments.
Give more notice and display it more prominently when the surgery is going to be closed for staff training.

4) Action Points

The following areas were agreed for action:

a) Move premises – plans are underway regarding this, and we hope to be moving to the Festival Hall site. This should go some way to solving parking problems and improving comfort of premises.

b) Re-decorate – while waiting for the move, we will undertake necessary decorations e.g. of waiting-room, entrance hall and will also try to improve the lighting.

c) The practice manager will talk to other practices about the feasibility of starting internet appointment booking and ordering repeat scripts. Practice manager and reception staff will discuss ways to improve telephone answering between 8.30 and 10am, e.g. using other admin staff for this period of the morning.

d) We will operate a music system in both upstairs and downstairs waiting-rooms – this will hopefully help mask conversations in back office & in Drs consulting-room upstairs.

e) The suggestions box will be moved form the porch, where it is never used, to inside the waiting-room, and paper & pens supplied beside it.

f) Partners will discuss the feasibility of telephone appointments

g) An item will go in the next newsletter, encouraging patients to walk or cycle to the surgery, thus reducing pressure on parking space.

h) Nursing duties are being reorganised to free up more travel clinic appointments & smear appointments – by greater use of HCA to relieve pressure on nurse appointments, by new practice nurse taking on smears and by greater flexibility in use of practice nurse appointments.

i) We will insert an item into the practice leaflet informing patients of the existence of staff training afternoons on the first Wednesday in the month. We will put up a notice about the meetings on the reception desk, at least 2 weeks before the meeting happens. We will add a similar notice to the practice website.

Another item arose, not directly from the survey – i.e. staff favour the idea of having a reception uniform. They think this will add to smartness & professionalism. They will discuss this further at their next staff meeting.

Patient Feedback

The results of our IPQ survey were given to a representative group of patients, in February 07. We asked then to look through the tables and the patient comments and then discuss with us both their general impressions and any ideas it gave them for improving the practice.

Method

Each of the 5 partners gave out a copy of the survey results to one patient, during a surgery in February. The patients were chosen because we felt they would be able to understand the feedback format (use of tables, percentages, benchmarks etc), and also because they were regular users of the practice. We tried to include a range of ages and male & female patients. 3 of the patients were retired, with ages between 60 & 85, 1 was a mother in her early 30s with 2 young children and the last set was given to a middle-aged mother & her teenage daughter. They had been with the practice between 5 years and 68 years and had links with the local community.

Dr Hall then phoned each of these patients in the first 3 weeks of March to get their feedback.

Results

All patients were very happy to have been asked and very willing to participate. They had all studied the results in detail.

They all commented that the figures were very good, in comparison with national averages and all said this confirmed their own opinions that the practice gave a good service which exceeded that experienced by many of their friends in other practices. It was also noticed that our figures had been good for the last 3 years and were improving slightly from a high starting point. Phrases such as “glowing report”, “very good”, “reflects my own experience – always delighted with care and attention and accurate diagnoses”, “I support very positive tone of answers” were used. It was noted that scores for satisfaction with consultations were particularly good.

Patients then commented on the individual comments which had been made in the survey. On the whole, they felt that some people had unrealistic expectations e.g. open 24/7. Three felt that Saturday or late night opening would be helpful for working people, but one (a business consultant) said she totally disagreed with this and she felt if people had chronic illnesses that required attendance at the doctors, most employers would be reasonable about people taking time off for this.

One person said they felt e-mail appointments and repeat prescriptions would be a good idea.

Although parking was mentioned by some patients in the original survey, the five I spoke to on the phone all said they did not think this was our responsibility. Two picked up on one or two slightly negative comments about “snappy” receptionists but they felt this was an exception and, on the whole, they were happy with reception. One commented an improvement in these scores over the last 3 years as evidence that we are constantly striving to improve, and not “resting on out laurels”.

One of the people I spoke to said he thought that waiting time to see the doctor (in the waiting room) should not necessarily be viewed as a negative factor – he took it to be a sign the doctor was giving every patient as long as they needed and this made him feel confident about the time the doctor would give to him.

One person felt we should reply to some of the comments in a newsletter, stating why some suggestions were unreasonable or unobtainable and asserting the positive aspects of out practice e.g. a good appointment system which allows patients to book well in advance with the doctor of their choice – something which is not available in practices adopting a strict 48hr booking policy.

Overall, the telephone conversations reflected a high level of satisfaction. As one patient said – “nothing jumps out of this survey that needs to be done.”