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Tamar valley health survey results
Tamar Valley Health – Patient and Carer Satisfaction Survey 2013.
527 responses from patients and carers. Please see separate document for the practice response. 1) Which Health Centre do you usually attend?
2) On average, do you visit or contact the practice:
3) Clinical care. When you last had an appointment at the practice:
a) Did you feel that your queries and concerns were listened to?
b) Were your problems or any treatment fully explained?
c) Were you involved in decisions about your care?
d) Were your problems dealt with to your satisfaction?
e) If you are on long-term medication or have a chronic illness, you will be
recalled for an annual review for all such problems. Do you find our system:
a) Are you able to get an appointment when you need one?
b) When the practice is very busy and all pre-bookable and on-the-day GP
appointments have been booked, your details will be taken and you will then be called back, sometimes by a doctor. Do you find this system is:
c) If you have not been able to get an appointment at the time of your choice,
did you feel that the waiting time for an appointment was:
d) The practice offers some appointments as telephone consultations? Do you
e) We send text message reminders for appointments if you have chosen to
a) Do you generally fine the receptionists:
b) Do you have to queue at the reception desk?
c) Do you use the automatic check-in computer screen?
d) Have you found the automatic check-in computer system to:
e) Are you kept waiting in the waiting room?
a) Do these opening hours meet your needs? (91.85%)
b) Have you ever used extended opening hours?
7) Getting the results of tests and investigations
a) Have you had a blood test or other investigation at the practice in the last 12
b) If you did, how did you find out about the result?
c)Were you satisfied with how you received this information?
White British/Cornish – 462 (94.29%) Any other white background – 20 Mixed white and black African – 0 Any other mixed background – 2 Asian or Asian British Pakistani – 0 Any other Asian background – 0 Black or Black British African – 1 Chinese – 0 White Irish – 5 Mixed white and black Caribbean – 0 Mixed white and Asian – 0 Asian or Asian British Indian – 0 Asian or Asian British Bangladeshi – 0 Black or Black British Caribbean – 0 Any other Black background – 0 Any other ethnic group – 0 Didn’t answer – 65
10) Are you satisfied that you are kept informed of changes at the practice, as and
Yes – 301 (89.05%) No – 37 No opinion – 93 Didn’t answer – 96
11) Are there any improvements or changes that you would like to suggest to the
healthcare offered by the practice or any other comments?
11-1 – Don’t like explaining to reception medical problems to see if we deserve an appointment (That’s how it feels) What does urgent mean? On day appointments are always booked for days-week ahead already and on the day are ‘urgent’, I can’t always predict if I will be ill or need a doctor. Blood tests take a long time to do. 2 weeks wait last time. Thank you to all the staff thought most are very pleasant and helpful and do their best. (C) 11-2 – I don’t really like when you have to wait until they put your appointment on the screen and wait until the doctor phones you back. I can’t see why you can’t have one right away. Sorry but this is the only thing that I don’t like. (C) 11-3 – I would prefer that I didn’t have to tell the receptionist what is wrong as I feel that they are not trained as doctors/nurses and I’m not always sure of their confidentiality. (C) 11- 4 – Appointments are very hard to make ringing 3 weeks in advance for an appointment whilst I was on holiday (off work) and there being no appointment available. Very difficult to get through to reception in the mornings and up until lunch time. (G)
11-5 – Nice to be able to get appointment when worried about things. (C) 11- 6 – Receptionists seem to be the first line of defence, trying to avoid you seeing doctor, they want to know what it’s about, when in fact it’s your own personal business. Not all receptionists are like this, but you do feel you are asking too much to see a doctor when we’ve all contributed to the health service in our working life. Just a bit more respect, especially as you get older, we’re still young in our hearts. (C) 11-7 – Do not agree with telling a receptionist an outline of medical problem, this should be confidential between doctor and patient (G) 11-8 – I would like my GP to be available more than two days a week. I want to keep him as my GP but it makes it difficult to get an appointment. Although other GP’s are offered I prefer to see the one who knows me. (G) 11-9 – I find the intervention? of the Gunnislake appointment system unhelpful, and makes an extra layer of officialdom? (C) 11-10 – As a diabetic it is frustrating to make an appointment for test one week then find I have to make another appointment the following week for bloods. If working this takes up a lot of my “holiday entitlement”. (C) 11-11 – More receptionists on and to see only my GP instead of many different ones. (G) 11-12 – The system of non urgent appointment seem to be out of proportion i.e. much to long a wait. People in general do no like to make a fuss and will nearly always say there appointment requirements are non urgent, even if they are urgent and for this they are penalised. (C) 11-13 – I would like the receptionists to be trained to be more pleasant, caring, kind and helpful especially to older people, who wouldn’t be at the surgery unless they were sick. The attitude of receptionists didn’t use to be so casual and at times rude. (C) 11-14 – For receptionist to give out the right information although this is not there fault I was told by one I would be phoned in the morning, no phone call had until I phoned up to be told I was given the wrong information and that I would be called after 2 and was phone at 3:15. If the wrong information wasn’t given then you wouldn’t get irritated patients. (C) 11-15 – I think when in appointment, I feel that the doctors don’t listen to what you’re trying to explain what is wrong with you; it feels like it goes in one ear and comes out the other. Also when calling up for an appointment it takes ages to get through and if the doctor is supposed to ring you back it take forever for them to actually get back. (G) 11-16 – Some receptionist are far more approachable than other – standard treatment would allow patients to understand procedures. (C)
11-17 – More than one receptionist. Quicker answering of phones. (C) 11-18 – Only one receptionist is rude!! All the other staff are fantastic. (G) 11-19 – Some of the receptionists are very friendly and helpful, but the odd one could be not so grumpy. (C) 11-20 – If possible it would be helpful to be able to book appointments from 8am-6pm without an automated machine looking in! Being able to order more that 1 months medication at a time for some repeat prescription patients may decrease appointment load. A drop-in clinic for injection would be lovely. (C) 11-21 – Why do we explain at the appointment desk and ask me what the problem is sorry that is between me and my doctor. (G) 11-22 – Over the last 10 years I believe the practice has slowly deteriorated but that this has been a generic problem with the NHS emphasis on business efficiency not patient service. I dread phoning for an appointment there seems to be no middle ground the receptionists are either exceptionally helpful or have a mission to prevent you from seeing a GP. I have just been informed that I can request to see a GP for my annual medication review this has never previously been offered to me and I haven’t seen a GP from the practice for 18 months. I don’t mind seeing the pharmacist at the 6 month review but would prefer to see GP once a year. Overall I suspect this is more negative than I intend. On a one to one basis most folk are doing their best but times have been moved on and priorities have changed. This may be a ‘box ticking’ exercise but at least I have had the opportunity to ‘ventilate’. (C) 11-23- Better communication needed between reception/pharmacy/GPs messages do not get delivered. Blood test results seem to get lost, meaning repeat prescriptions can’t be authorised. I have heard good reports about customer care at Gunnislake – better follow up service than Callington!! (C) 11-24 – Having open appointments in morning and booked appointments in afternoon. This would offer more emergency appointments to phone up at 8am for that day's appointments. Much better system. Also every time I have used the practice I have been waiting up to 50 minutes past the appointment time. System of on the day booking worked in other practices that I have attended. (C) 11-25 – I seldom wish to make appointments but when I do it would be good to be able to get one when the problem is acute – like same day. (C) 11-26 – Your time is precious, we know but so is ours, and it is slightly annoying to have to phone several times before we can get through, thus wasting time. To all that ‘chit-chat’ from the receptionist/surgery about how to order medication (when we already know) really necessary. Sometimes I think a cup of coffee (even if from a vending machine) might be welcome especially if around 11am. Otherwise you all do a grand job! (G) 11-27 – It would be nice if you didn’t have to give to much information when you make an appointment to the receptionist bad experience from the past. (G)
11-28 – Immediate communication when very unwell either by call out or a no waiting service for an immediate appointment. (C) 11-29 – Appointment slots should of longer to avoid keeping customer waiting by GPs running late (C) 11-30 – Organise patient appointment time as usually/never on time. Don’t get patients to waste time on stupid forms! (G) 11-31 – Maybe to make a charge for all those who do not keep appointments and cannot be bothered to cancel. (C) 11-32 – I am liking the email reminders for my appointments times I find this very helpful, it is a shame that the auto booking system still is not working. (C) 11-33 – getting annual diabetic check due October 12’ done Jan 13’ this system does not work. (G) 11-34 – Being able to phone and then get a call back is really difficult. I work and am in a lot of meetings. It’s not always easy to take calls I don’t want to be discussing medical appointment when I am in a meeting. I don’t mind waiting a week for an appointment so long as I can make it on the phone. When I get here, the practice is excellent, it’s arranging the appointments that are challenging. Internet appointment service would help for non urgent cases like me. Text confirmation of the appointment is a superb idea. (G) 11-35 – Weekends are easier for appointments perhaps shorten week day opening hours can lengthen weekend opening times. (C) 11-36 – I do think services should be available on Saturdays at both centres. (G) 11-37 – Saturday mornings, practice could be open for emergencies (G) 11-38 – Early surgery 7:30am one or two days week would be helpful (G) 11-39 – Once I was unwell to attend my Saturday morning appointment but was unable to contact the surgery. Is there now an answering service for this now? I felt I had let the doctor down and didn’t want to be thought of as having forgotten the appointment. (G) 11-40 – More evening appointments, more choice with regard as to which doctor you can see. (C) 11-41 – If the evening surgeries are over subscribed please consider extensions – when I worked this was a real issue, 6pm close is still early. Saturday morning surgery should be the norm as a public service and could prevent patients from deterioration. (C)
11-42 – Not sure if this system still applies, but having to phone at 8:30 for an on-the-day appointment penalises people with children, because it is very difficult while getting kids off to school. (G) 11-43 – Answering your phones quicker (G) 11-44 – No especially as the telephone service has improved over the last 12 months. The telephone can be the source of great frustration as in my view it is important to get it right. (C) 11-45- Separate phone lines e.g. for appointments, for information (such a long time wasted to get answers to simple questions) (C) 11-46 – It is sometimes hard to get a line when phoning the surgery – often engaged. More phone lines would help. Thank you (C) 11-47 – Answer phone before 11am! Need to check and listen to careers comments about needs quick turnaround. (C) 11-48 - I generally find the doctors at Callington unhelpful and very quick to pass the buck to others. Having moved from Portsmouth the most densely populated city outside of London to Callington, I would of thought to have received better care but my experience is quite different. On two occasions I don’t believe the doctors have helped me with the two various medical issues I’ve had. (C) 11-49 – Doctors need more time to talk to patient not so much of a rush. (G) 11-50 – I find it hard to get to my doctor some of the doctors have a lovely attitude and are helpful and polite but others really do need to review their ‘bedside manner’ most of us are intelligent people and it really would be helpful if this could be respected. However Dr Farr is my designated doctor and I’ve always found her to be competent, helpful and a very good doctor indeed. I also think it would be helpful to circulate some air in the waiting room – might keep germ population down. (C) 11-51 – Dr Porter should be kept on she has been exceptional! (G) 11-52 – When I come down to see the doctor my systems were not recognised. (G) 11-53 – When a doctor retires his patients should be informed at the time not after several weeks. This applies to my wife and not myself. (C) 11-54 – I live in Gunnislake and come regularly for INR past week I was given an appointment at Callington but was told and only noticed shortly before my appointment – when I checked the time. Also when I have waited shortly before my appointment when it checked the time. Also when I have waited its see the doctor I don’t appreciate him standing with the open to show me out before I have finished telling him what is wrong. (G) 11-55 – I was very sorry to hear Dr S Porter is leaving – I have found her excellent and wish she was staying on. (G)
11-56 – If waiting for doctor to phone back can be difficult as means waiting by telephone most of days. (G) 11-57 – Yes: Dr Simon Chaplin informed us that the car park was going to be resurfaced last May 2012. All that has been done is to make a bad job of patching up the holes. Since when the potholes are now at the stage where they will require urgent attention. Otherwise your patients will be taking their cars to doctors of car suspension at the local garage!! (C) 11-58 – Help older people and listen to their problems and not sweep it under the carpet. (G) 11-59 – Bring Dr Stewart back, things have changed a lot since his retirement (departure) (G) 11-60 – I have recently been re-assigned to Dr Cameron from Dr Chaplin but without any reason given. As Simon has been my Dr since 1982 surprised that there has not been any information. (C) 11-61 – As a long time patient of Dr Chaplin I feel we have been left in limbo with no explanation of his leaving, I now have no elected doctor in the practice and think its only right to know what is happening. I have lost a great doctor and friend! The health centre is not the same without him. He cared! (C) 11-62 – It would be nice to see the doctor when I wished too! Some of the wording in your letters make it look as though you might automatically stop my meds if I don’t come to a requested appointment! ‘check ups and alike’ If feel un-well, like today, don’t seem like I would be able to see my own doctor. (C) 11-63 – Doctors could listen to patients more as sometimes it takes time to explain symptoms which are a concern to the patient. (C) 11-64 – Be able to see someone, especially nurses when you need to. Post op especially when you can not foresee what will happen e.g. infection requiring redressing regularly, lack of parking and appointments. (C) 11-65 – More nurses - surgery seems very understaffed! (C) 11-66- Having type 2 diabetes was a great shock to me when I was told for the first time I didn’t think there was enough information about being a diabetic. I would like to see a diabetic clinic set up so that you could go and see a resident qualified diabetic nurse, I think that might free up sometime for the doctors who could see other patient. (G) 11-67- I have recently had to have my babies inoculated and they are overdue by nearly 2 months due to nursing shortage. Whilst I appreciate nurses being sick etc it would have been nice to maybe have a locum. (G) 11-68 – Waiting up to 25minutes to see nurse (C)
11-69 – Feel there is a lack of professionalism with the whole surgery from making appointments to dealing with samples and results which seem to get lost regularly. (C) 11-70 – Results of tests, e.g. blood tests, urine tests etc should always be given, regardless of if they are positive or negative. (I have had tests lost by this practice in recent times and have had to have the test taken again because initial test results had been completely lost; hardly inspires confidence) Some of the receptionists are fine and fully professional while others on reception are terrible and unprofessional (sorry to say) Recent ‘adventures’ with reception have included being booked in with the wrong doctor. Also recently there was a queue of four patients waiting while the only receptionist was clearly and audibly chatting to her mother on the phone! I have been with this practice for well over a decade and in the last 2 or 3 years the overall standard of reception/receptionists have fallen to a very low standard. (Sorry again to have to write this, but it is time) Some of the receptionists are excellent some are dreadful, surely this reflects on the reception management? (G) 11-71 – More availability for blood test – waiting over 2 weeks for sample is unacceptable when one is feeling really poorly and then another week for the results. (G) 11-72- I believe it would be good if the practice were more proactive in letting patient know the results of tests. (C) 11-73- When I received my blood test results I was told they were normal, when I asked for a print out I was given one, however there were a couple of mildly abnormal results, I would have liked to have been informed as I am looking at the details of my health, due to severe menopausal symptoms so I want as much information as possible so I can inform both husband and accupuncist in order to get all info. (G) 11-74 – Online repeat prescription ordering does not seem to keep details. Have to re-enter every time. (C) 11-75 – I have been unable to log on to your website to update on repeat prescription. (C) 11-76- Shorten waiting times. Prescription ordering on internet does not save patient information most of the time. (G) 11-78 – Free prescriptions (G) 11-79 – Suggest relaxing policy of min prescription drugs for certain cases – An automatic repeat would avoid missing tablets. For patients on a minimal dose surely this would be acceptable. (G) 11-80 – Why do they change heartburn pills from Nexium (which work for me) to Esomeprazole. (C) 11-81 – Better organisation with regard to prescriptions and the collection of items from pharmacy. (C)
11-82 – Use plastic bottles for pill prescriptions, as they are more practical, and surely must cost less (also reusable) (G) 11-83 – Pharmacy open longer Saturday is sometimes useful. For those who have to use taxis a multi appointment for drugs review/asthma check/ exam can surely to save an pension? (C) 11-84- Telephone option for repeat prescriptions, internet is good but I do not always have a connection at home and can’t always get to the practice to put request in! (C) 11-85 – Alter medication update procedure to provide verbal contact with organising office. (G) 11-86 – Particular ‘flagging up’ of the fact that husband and I are full time carers will my elderly/disabled patients living with us. Under extreme stress so need sensitive handling when ring/ask for appointment/help! (C) 11-87 – Automatic doors that does not require any manual contact. (G) 11-88 – Do not think the automatic blood pressure is very accurate, gives all sorts of different readings, prefer it to be taken by the doctor or nurse. (G) 11-89 – Be more patient focused as opposed to CPC and finance. Online appointments not working. (C) 11- 90 – Money is wasted seriously over heating the surgery. There are times when privacy is not respected by staff. A great many minor issues that could be easily be solved with more money – It would help if less were wasted. (C) 11-91 – Would not be listened to (G) 11-92 – Still waiting for the digital display to be put in a more convenient position over door to consulting rooms. More clients will be able to see it without standing up and cricking necks. (G) 11-93 – Service not what it was know a lot more patients and shortage of staff. (C) 11-94 – Needed ultrasound scan had to go all the way to Wadebridge to get appointment. Asked if I could go to Derriford but was told this was out of my area. Seems daft to me. (G) 11-95 – Get rid of check-in machine which is worse then useless when it says ok but isn’t. The moving message display in waiting room is an insult to technology and human common sense. So the tiny mechanical ? But all else is very good thanks. (G) 11-96 – I keep receiving reminders about the annual review although I came in during December to see Dr Warren and have any review, I was contacted twice more about same. Someone isn’t putting the correct information on my records. Also, do not understand why I need to give out personal details to a receptionist who asks ‘what’s wrong’. (G)
11-97 – What could you possibly change. Patients need to look to themselves – a lot more respect and understanding of your problems wouldn’t come amiss. (C) 11-98 – When people are worried, the need help, not a fob off. (C) 11-99 – Car parking, nice greeting when you come to the reception area. TV in waiting area or relaxing music playing, just to put people at ease. (C) 11-100 – Electronic system informing waiting patients that doctor ‘X’ is on time/10 minutes late etc. (C) 11-101 – Parking is a nightmare! Bumper cars in the rain! Staff are mainly very kind and helpful. Seem to be very short of nurses, don’t really like having to go to Gunnislake. (C) 11-102 – Car parking for disabled need more spaces. (G) 11-103 – Longer opening times, free parking, happier staff especially in pharmacy, nicer decor to make you feel more at ease, radio/tv, a door for the childrens area (can be loud), open on a Saturday – at least 8hours. Overall its good better than Callington! (G) 11-104 – Less stuffy waiting area. TV with anything on to pass the time. (G) 11-105 – Some children books and toys would be helpful in the waiting area. (C) 11-106 – Maybe a quiet radio station in the waiting room. Would like to say that the layout of the waiting room is very nice, comfy seats. The electronic notice board works well. (C) 11-107 – More alternative options of treatment. (C) 11-108 – Patients should be notified when doctors etc are running late. Not just left sitting in waiting room especially after checking 20 minutes later at reception. (G) 11-109 – Cut down waiting times. (G) 11-110 – More than happy with service we find that all members of staff are very helpful. (G) 11-111 – No, I use the health centre a lot and am more than satisfied with all my care. (C) 11-112 – Very good service (G) 11-113 – No, we are generally very satisfied with the attention we get. (C) 11-114 – No always happy (G)
11-115 – I am happy with the service overall – don’t mind waiting in waiting room for doctor (I may need 5 extra minutes at sometime!) Reception staff/doctors/pharmacy staff always polite and helpful. (G) 11-116 – Satisfied thank you (G) 11-117 – The care and service at this health centre is outstanding. The doctors, nurses, assistants and pharmacy are brilliant. (C) 11-118 – No, everyone very helpful. (G) 11-119 – I am quite happy with the current system and thank you all for excellent service. (C) 11-120 – None, I am fully satisfied with the service and the longer hours of opening. It suits my working days very well. (G) 11-121 – I have been very satisfied with my treatment at Callington health centre. (C) 11-122 – I am more than happy with the healthcare I get at the Gunnislake health centre. (G) 11-123 – Not that I can think of. (G) 11-124 – I have always found all the staff helpful and welcoming even under pressure which of courses does happen! Great service all round – reception, doctor, nurse and pharmacy. (G) 11-125 – I think the practice is generally efficient and well run. (G) 11-126 – Very satisfied (C) 11-127 –No, all seems to run and work fine. It can’t be helped if you have to wait because someone else has taken longer with their appointment. However, 15 minutes is an acceptable waiting time any longer can be frustrating. (C) 11-128 – I think you are all doing a fantastic job. Thank you (C) 11-129 – No changes – but a “thank you” to all staff at Callington health centre, who go out of their way to be helpful and efficient. (C) 11-130 – Have always been completely satisfied. Thank you (G) 11-131 – All ok (G) 11-132 – Keep up the good work (C) 11-133 – I haven’t been at the practice long but so far I have been very satisfied. (C)
11-134 – We are new so not able to make many comments, but service received so far has been good. (C) 11-135 – I feel the practice to be of a high standard, offering very good service. Our doctors Farr and Early are always receptive, giving clear advice. More importantly understanding of our position and wishes regarding treatment. 11-136 – 1) Cut down waiting time 2) More time with GP 3) Getting an appointment is a problem. Medicine reviews? What are our GPs for, stop wasting NHS cash on office staff pushing paper around, building empires (see 1,2,3).
António H A Emiliano UNIVERSIDADE NOVA DE LISBOA Faculdade de Ciências Sociais e Humanas Departamento de Estudos Linguísticos TRADITION AND INNOVATION IN THE DEVELOPMENT OF ROMANCE WRITING IN MEDIEVAL PORTUGAL AND SPAIN: REMARKS ON THE SPELLING OF LATINATE DOCUMENTS (Oxford, Faculty of Modern Languages, Sub-Faculty of Portuguese, 1. DOCUMENTOS TABELIÓNICOS / NOTARIAL DOC
Original articles: Changes in hepatic tissue water content in EC-, UW-, and HTK-preserved livers tested in a pig liver transplant modelR. Steininger, E. Roth, P. Holzmüller, H. Reckendorfer, M. Sperlich, T. Gruenberger , E. Moser, F. Mühlbacher Transplantation Proceedings 1991; 23(5): 2414 Comparison of HTK- and UW- solution for liver preservation tested in an olt model in the pig R.