Enter and view: Boundary House Surgery

Healthwatch Bracknell Forest collects and collates feedback and intelligence on local services. Primary care, i.e. GP surgeries, is the service we receive the most information about.  Over the last 18 months trends have been identified including issues with - booking and access to appointments, waiting times, privacy (reception), staff attitudes, cleanliness and suitability of waiting areas, disability access and communication. A programme of Enter and View visits to all surgeries in the Bracknell and Ascot Clinical Commissioning Group (BACCG) area was initiated in November 2015. All surgeries will receive an individual report and, at the end of the programme (est. April 2016), these will be collated to form one report to BACCG to inform future commissioning (such as extended hours), identify issues – specific to individual surgeries and also across the whole primary care service and finally, highlight areas of good practice leading to positive patient experience which can be shared across the area.

Purpose of the visit:

• Observe patients engaging with the staff and their surroundings.
• Capture the experience of patients and to record any ideas they may have for change to improve patient experience.

Summary of findings:

At the time of our visit, the evidence is that:

• The majority of patients are happy with the quality of the care and treatment they receive and feel their consultation time is adequate to deal with their issues. Two patients did express concern that standards have been slipping.
• Concern has been raised by 3 patients over the standard of care received by patients with a mental health problem. 
• There is both positive and negative feedback about appointment accessibility.
•  Telephone access to the surgery from the evidence and feedback we have collected is not, in our opinion, of an acceptable standard and is causing frustration.
• The surgery is mainly accessible for patients with mobility issues but the automatic doors were out of order during our visit.
• On the day of our visit 68.5% of patients were seen within 5 minutes of their appointment time but 21% had a wait of over 20 minutes (maximum 50 minutes). Staff and patients reported this was unusual (there was an issue with staff sickness during our visit) and although negative feedback was received about the issue receptionists keeping patients informed of anticipated waiting times prevented more.
• During our visit 78% of patients did use the electronic booking-in system patients but were observed having difficulties and one patient reported it was not easy to use.
• There is lots of information available for patients in the waiting room which is well presented but leaflets and flyers attached to the reception desk looked dirty and old.
• The television information screen was not switched on / operational at the time of our visit.
• Although the Practice Manager has stated that triage is not carried out some patients perceive that they have been triaged, mainly be receptionists.
• Of the 7 patients who stated they required a follow-up appointment, 4 were able to make that appointment before they left the surgery.
• Of the 8 patients we spoke to who were over the age of 75, 7 patients had a named GP but only 3 patients were able to see their named GP.
• The surgery website has a good layout and information was easy to find. The online services available were also well placed for easy navigation. The site has good accessibility functions however the accessibility statement would benefit from the inclusion of the information about changing the language. Although the Patient Group section is comprehensive it could do with an update. The website’s privacy statement states the site does not use cookies but our tests indicate that an analytic tool is used to track usage of the site and our research has indicated that this should be highlighted to visitors. We consider the website to be an example of best practice for others to follow.
• Just over 84% of the patients we spoke to have not visited the surgery website.
•  Of the patients spoken to during the visit, only 10.5% had an awareness of the Surgery Patient Group.
• The waiting room does not have any background noise and is very quiet.
• There are no activities for children in the waiting room.
• The surgery was easy to find and external signage was good but internal signage could be improved and expanded on.
• The surgery appears clean and tidy but the décor appears tired.
• The majority of feedback about reception staff is positive and positive interactions between staff and patients were observed.
• The surgery has never responded to feedback or reviews on NHS Choices and no Friends and Family Test data is available. Recommendations
• To make all health professionals aware of the resources available in the community to support those with mental health issues - particularly young people.
• The issue of access to appointments is closely linked to the problems with telephone access at the surgery but our evidence also suggests there are issues for patients booking follow up or routine appointments as the surgery only books 2 weeks in advance. We recommend that, in tandem with our recommendations regarding telephone access, the surgery undertakes further work with patients to monitor this element of the service with the aim of improving access.
• The telephone system used by the practice is, in our opinion, not fit for purpose and the staff we spoke to during our visit acknowledged this. The current system is not automated and if not answered in a specific time cuts off without any message. Healthwatch Bracknell Forest recommends that the surgery replaces this system to improve access and the patient experience.

13 recommendations were made.