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Minutes of the PPG Meeting held on Thursday 17th March 2016

The minutes of the meeting held on 19th March 2015 were approved by those present.
Electronic Prescribing

Work has been ongoing to improve the performance of this system and the practice is trying to set up a meeting with local pharmacists to foster collaborative working. The introduction of on-line prescription requests had at times been problematic and the practice continued to work to improve this.

Patient Charter

Work on this had been completed and the charter added to the practice website. Mandy to check that there are enough copies prominently displayed within the surgery.

Extending membership of the PPG.

Unfortunately during the year two members of the group had withdrawn from active PPG membership, one for health reasons and the other because of increasing commitments in other matters. Mandy and Bob welcomed Andrea Clark to the group and looked forward to her contribution in the future. Another patient, Mr Shah, has kindly agreed to join the group but had been unable to attend on this occasion.

Staff Satisfaction Survey

This had gone ahead during the Summer of 2015 and the results discussed in staff team meetings. Although no significant issues had been identified, staff had been gratified that the PPG supported the team and recognised the challenges of their roles. In line with priorities set for 2015-16, favourable feedback from patients had been circulated widely to staff to counter the effects of occasional negative responses and complaints.


Mandy gave feedback from the mandatory Friends & Families Test survey responses over the last year. The survey comprises one question “How Likely are you to recommend our GP practice to friends and family if they needed similar care or treatment?” Patients are able to give responses on paper (with forms and collection boxes at both surveys) or via Survey Monkey. Overall responses had been low in number (a total of 156 for the whole year) although of these 89% of patients would be extremely likely or likely to recommend the surgery. 11 patients during the year had indicated they would be unlikely or very unlikely to recommend the practice, however, of those respondents who had given this response, none had volunteered names so that their comments could be investigated further.

A large number of very favourable comments had been made and these were shared within the practice team in line with priority for staff engagement and morale from 2014-15.


Gade Publications - Susan Lynch noted that, for some patients who are unable to access the practice website, it would be worthwhile to compile a printed list of patient information sheets so that printed copies could be requested from a “catalogue” of health related documents. She kindly agreed to work with Mandy in compiling the list and a further meeting will be set up to start this project. She also asked when the Gade Gazette might be updated, the last copy dating from 2006.

Internal communications - Andrea Clark also commented on the organisation of the practice noticeboards as, again, these are the main source of information for many patients unable to access electronic resources. She suggested that subject specific noticeboards (eg for Diabetes, COPD, etc) should be considered and Mandy will look into this further. Andrea also noted the age and condition of some of the magazines and felt that this might be an area where responsibility for updating could be delegated so that magazines are current and in good clean condition.


During 2015-16 the practice had been an active member of the Watford Care Alliance providing additional out of hours sessions on some evenings and weekends. Dr Sangar explained that some but not all sessions are held at Gade House; on other occasions patients would be seen at the nearby Bridgwater House. These appointments are available for pre-booking as well as on the day. The group felt that the availability of these sessions should be more widely publicised.

The practice had continued to maintain high standards of patient access due to a combination of factors.

The practice had resumed its role as a training practice under the mentorship of Dr Sudarshi. Dr Sangar explained the processes involved in the training of GP Doctors and highlighted the benefits to patients and others in the practice team. One doctor had already spent a 3 month period working under the mentorship of Dr Sudarshi (and with supervision from other partners) and a second placement is due to start on 8th April. Dr Sangar stressed that these are all qualified doctors who are required to complete a “rotation” in general practice before completing their hospital training or who intend to become a GP.

The practice has yet to receive an inspection from the Care Quality Commission although preparations for this visit have been underway for some time.

In response to a question from Mr Ross, Dr Sudarshi outlined the practice policy on prescribing of antibiotics. Whilst patient care and concerns about over-prescribing of antibiotics remain foremost in doctor’s minds, this does create difficult discussions where patients believe that antibiotics should be the first line of treatment for minor ailments. The group felt that brief presentations could be developed to support patient information (eg on prescribing of antibiotics, treatments for hay fever, etc)

  1. Environmental/Communications – to review and improve patient communications through good presentation of literature and other reading materials in the waiting areas
  2. On line services/Patient Access. Resolve issues relating to on-line patient services and embed systems to benefit the patient population
  3. Engage minority groups (eg carers) with the work of the PPG. Dr Sangar noted the role of the Carers Champion within the practice and the group was asked to suggest other groups who might be invited to take part in PPG activities.
Group members felt that, at this particular time, they did not feel in a position to assume formal roles and that they were happy, at least until the group has strengthened in size, to continue to allow Mandy and Dr Sangar to facilitate group activities. Mandy urged group members to feel free to make suggestions for further action throughout the year.
The next meeting will be held on Thursday 16th June. Mandy will call for agenda items two weeks before this date

Patient Participation Group Annual Report for 2014-15

The group had met in in February 2014 and again in February and March 2015.

The situation regarding the inequality in demographics within the group and the clear under-representation of both younger patients and those in ethnic minorities remains unchanged although new members have been invited to replace those who have, for reasons of relocation, left the membership. Group members have been asked to identify minority groups so that the surgery can actively encourage involvement with PPG activities. That aside, the existing group remains cohesive and committed and remains supportive of the practice as a whole, with a good understanding of the needs of the whole practice population

Breakdown of group membership by age/gender is as follows:

Count 56
Female 30
Male 26

Ethnicity is only recorded for 5 of the 56 members of the PPG (8.9%) against 14% of the practice population so that further analysis of the group profile would not be meaningful

Earlier objectives set by the group have been realistic and achievable and as a result of their suggestions a number of positive initiatives have been pursued within the practice to achieve the action plan set for 2013/14. Based on the responses to the 2014 survey, the group retained its proposals for activities in 2014/15
  • Improvements to telephony
  • Enhancing staff/patient engagement
  • Addressing environmental aspects affecting patient confidentiality
  • Increasing accessibility by fully engaging IT solutions
  • Increasing PPG representation
  • Reviewing the Patient Charter to address behavioural concerns
  • Addressing parking problems

Key activities have been undertaken by the practice during the last year and a number of valuable initiatives have been taken to improve patient experience:

  • June 2014 – the practice moved to off-site storage of patient records in a secure archive. This enabled the remodelling of a small consulting room proposed by the PPG during 2013-14 and this provides additional space with can be utilised where necessary to provide a confidential area patient/staff discussions where necessary.
  • August 2014 – in a bid to improve speed issues affecting the clinical system, the practice implements a “hosted” system whereby records are stored remotely. This goes some way to improving speeds and resolves concerns about security in the event of a major incident affecting surgery premises.
  • August 2014 – as a result of suggestions from the PPG, the practice installs a cloud based telephone system to include call queuing and improved system features. Patient response to date has largely been favourable although it is recognised that system efficiency has resulted in a heavier workload for practice staff due to increased system capacity.
  • September 2014 – the practice joined the Watford Care Alliance with the aim of providing additional appointments outside of normal surgery hours. Patients benefit from additional pre-bookable appointments on some evenings and weekends, albeit this is not always at the practice’ own premises.
  • October 2014 – change of partnership. There was recognition of the difficulties experienced by many practices in recruiting new GPs and the practice is fortunate in recruiting and retaining a dedicated and committed staff team which the PPG is anxious to support fully.
  • January 2015 – introduction of Electronic prescribing (see agenda item). The PPG has expressed its concerns on the impact on some patients and has offered to engage locally to support improvements to the process.
  • February 2015 – the PPG approves a further update of the Patient Charter intended to support staff and to acknowledge the significance of patient behaviour on staff morale. The charter will be incorporated in registration packs for new patients.
  • March 2015 – the Practice engages with local residents to consider ways of improving parking and reducing traffic congestion associated with increased surgery usage and limited parking facilities.
  • March 2015 – the PPG approves a Staff Satisfaction Survey to look further into the factors affecting staff morale, including patient behaviour.

The meeting held on 25th March identified key priorities for the coming year:

  1. Staff Engagement & Morale – depending on the results of the staff satisfaction survey to be carried out in Spring 2015, to consider further ways of supporting practice staff and engaging them directly with the PPG
  2. Environmental/Communications – to review and improve patient communications through good presentation of literature and other reading materials in the waiting areas
  3. Engage minority groups (eg carers) with the work of the PPG to ensure broader representation and understanding of the needs of smaller groups.
  4. Online services/Patient Access. Resolve issues relating to on-line patient services and work to embed systems to benefit the patient population.

Patient Participation Group Annual Report for 2013-14

The group had met in March and September 2013 and again in February 2014

There has been recognition of the inequality in demographics within the group and the clear under-representation of both younger patients and those in ethnic minorities. Group members have been asked to encourage younger patients to engage with the group and there has been consistent advertising throughout the surgery with the aim of attracting new members from more diverse patient groups. That said, group members have remained committed to the PPG and in meetings have made strenuous efforts to ensure that the needs of those not represented are taken fully into account in any plans proposed take account of the needs of all patient groups.

The practice has recognised that, whilst representation of practice population is not universal, the quality of decision making and commitment of the group has added value to the practice as a whole.

Breakdown of group membership by age/gender is as follows:

Count 54
Female 29
Male 25
Under 40 4
Female 2
Male 2
41-50 2
Female 2
50-60 7
Female 4
Male 3
60-70 14
Female 7
Male 7
70+ 27
Female 13
Male 14
Responses to the 2013 survey had been low in number in spite of extensive advertising within the surgery, on the website and providing survey forms throughout the surgery. Extending the survey for a further 2 week period had minimal effect so that the group had to base its action plan on a small sample. However the plan proposed took account of issues relevant to primary care supported by the specific experiences of group members. At the meeting on 28th February 2013, the following areas to be addressed were agreed:
  • Improvements to telephony
  • Enhancing staff/patient engagement
  • Addressing environmental aspects affecting patient confidentiality
  • Enhancing the existing website
  • Increasing accessibility by fully engaging IT solutions
  • Increasing PPG representation
  • Reviewing the Patient Charter to address behavioural concerns
  • Addressing parking problems
Specific action points were noted within each area (as reported in the PPG Minutes) and work continued throughout the summer months to bring about the required improvements.
Progress was initially reviewed at the PPG Meeting on 13th September 2013.

Whilst some headway had been made, cost and other restraints meant that work remained to be done in most areas. Notably, the practice had invested in the telephone booking system but progress had been slow, at least in part because of the limitations of the telephone system underpinning it. System reports available indicate that, at best, usage was consistent but not increasing significantly; the facility to cancel and rebook appointments had helped reduce the number of wasted appointments and overall it was felt that further action should be taken to encourage use of telephone bookings.

In September the practice also initiated a trial of appointment reminders via text and this has proved popular, albeit there are limitations with the system which need to be highlighted to users (ie appointments cancelled on the day are often not captured giving the appearance that the patient has DNAd an appointment). Similarly, the facility to recall patients via text message has been well received and generally has a good response with associated cost savings over postal recalls.

Finally the practice engaged with the clinical system supplier and has introduced on-line appointment bookings and prescription requests which have been operational throughout the winter months. Consent forms used for the flu campaign were used to encourage registration for online services however, although around 1000 accounts have been created, only 588 are currently active, accounting for just 5% of the practice population. Again limitations have been identified with the software solution which has restricted use of prescription requests and prevents many users accessing the system effectively. This has been raised with the system provider and a system enhancement is anticipated in the first quarter of 2014/15. Once this is functioning fully the practice will undertake a further campaign to encourage new registrations.

The PPG met again in February 2014 and again reviewed progress on the 2013/14 action plan (reported fully in the minutes of the meeting). At this meeting the members also approved the Patient Survey for February 2014, focussing on gathering patient views on recent technological developments and availability of appointment times to meet patient needs. Patients with mobile telephones were sent a link to access the on-line survey and this certainly appears to have increased participation. At this point the PPG have not met to review the results although these have been circulated via email and are available on the practice website.

PPG Members were pleased to note that their proposals had been adopted by staff agreement to wearing of ID badges to support patient interaction; similarly, photographs of all clinicians had been added to the practice website to engage directly with site users in line with PPG suggestions.

The group noted that plans were in hand to provide a further consulting room which would double up as a patient facility for confidential discussions in line with a further key action point. Financial constraints would limit what might be achieved but the practice had already invested in off-site records storage to free up much needed surgery space.

Overall the group had recognised that the action plan remains a “work in progress” requiring ongoing investment and commitment.

Finally the group approved a revised “Patient Charter” which, it was hoped would help to establish common ground for patient/staff relationships and behaviour.


The next meeting of the group is proposed for May 2014. At this meeting the group will review the results of the survey, identify actions required and propose areas to be considered in future surveys.

It is also hoped that group will be sufficiently established that its constitution may be reviewed and opportunities identified to increase group membership and patient engagement.


Patient Partner monthly usage reports on telephone bookings Vision Online Service reports (appointment usage and repeat request orders)

Patient Participation Group Annual Report for 2012-13


Note Taker

PPG Members:


Dr Sanjeev Sangar

Mandy Carr, Practice Manager

Mr Vijendra Gajparia; Mrs Susan Lynch; Mr Augustine Odita; Mr William Steel; Mr Colin Thomas; Mrs Sheila Whitehead; Mrs Vera Youngs


  1. 1.       



At their meeting on 31st January, the group reviewed progress in the year to date. Key action points from the previous survey had been reviewed and progress in each area identified:

Action 1Improvements to Telephony. It was noted that during 2012/13 there had been significant financial investment to increase the number of incoming telephone lines and to improve handling of incoming telephone calls. It had been hoped that this enhancement to the system would also increase useability of the telephone booking system but, in the event, the telephone system was failing to live up to expectations. The Practice has called a meeting with the system providers to give account for the significant shortcomings being reported by patients and other system users.

Action 2 – Professionalism. It had been suggested that communications might be improved by the introduction of staff name badges. In discussions with the staff there had been reluctance on the part of some team members to wear identity badges. Several reasons had been identified for this and, whilst the practice remained keen to enhance communications, it had been felt important to maintain staff morale during a particularly difficult year by avoiding conflict. The group felt that this subject should be broached again with the suggestion that ID badges would initially be worn on a trial basis to reassure staff that their views would be taken into account.

Action 3 – General ambience of the surgery. There had been decoration of main patient areas during the year which it was felt had improved the areas to some extent. However, other issues had not been addressed, largely because of significant staffing issues which had affected the practice team for the whole of the year. It was hoped that greater stability would allow staff time to focus on improving the working environment, noticeboards, etc.  Although Signage generally had been improved, it was acknowledged that more work needed to be done particularly in relation to check-in systems.

Action 4 – improvements to the website. The group felt that the site remains heavily text based but that it held a good volume of relevant information. This will be raised again with the practice IT lead for further development in 2013.

Action 5 – Accessibility. As a result of the previous survey the Practice had ordered on-line booking software early in 2012, however, as a result of ongoing technical problems identified by the system provider, this had not been implemented. However, during January the system providers had been able to carry out final commissioning and a plan for implementation would be proposed as soon as system training had been completed. A go-lie date of April/May was considered feasible and early response from patients had been positive who had completed application forms to access the service

Action 6 – Representation. Little progress had been made during 2012-13 to increase patient involvement in the core group so that this will remain an ongoing focus for the coming year. Group members were encouraged to share information about the group with their peers in order to improve engagement locally and the practice would renew its efforts to raise the profile of the PPG among the patient population generally.

  1. 2.       



At their meeting in January the group had reviewed the content and responses of the previous survey and modified the content to target areas for the coming year. Over previous surveys it had become increasingly difficult to secure levels of response from patients It was felt that the survey should again be kept short in the hope of maximising response from patients albeit it was acknowledged that the on-line survey media allowed respondents to skip questions, potentially detracting from the value of the responses reported.

The survey was held as planned, however, response levels remained very low with only 51 respondents completing the survey within the specified period. At their meeting to review the survey the group had agreed to extend the survey period into mid April before drawing final conclusions and agreeing further actions.


  1. 3.       



The group had discussed various aspects of practice operations and including telephone consultations and availability of appointments and remains keen to seek the views of staff within the practice to contribute to planned future developments. The group acknowledged staffing difficulties in the previous 12 months and there had been discussion on the impact this had had on patient services. Notably the group felt they could work to develop a new “Patient Charter” to set out expectations and obligations for patients and this will be revisited during 2013 as a key action point.


  1. 4.       




The current group although still relatively small has now established excellent working relationships and has a clearer understanding of practice operations and the factors which affect it most directly, enabling them to move on to provide valuable patient input to practice developments.

A further meeting in early Summer will re-examine the final results of the extended survey and proposals for a new Patient Charter. It is anticipated that this meeting will take place in May.

At that point, the full results will be circulated to members of the wider Patient Representation Group for their input.

Gade Surgery Patient Participation Take Survey 2013

This questionnaire has been produced again in conjunction with Gade Surgery Patient Participation Group.

The Patient Participation Group would like to review the service changes patients received from us and hopefully with this feedback improve services. Please take a few minutes to complete this online survey by ticking the relevant box(s) and adding your comments.

Please contribute to the collective patient view by clicking here to take the survey.

Gade Surgery Patient Participation Group Patient Survey 2012

Gade Surgery is pleased to announce the results of its first survey the results of which can be seen by following this link.

Gade Surgery Patient Participation Group - Patient Survey 2012

This questionnaire has been produced in conjunction with Gade Surgery Patient Participation Group which has been formed to represent the views of all our patients. The group is currently small but welcomes new members to attend occasional meetings at which we hope to discuss patient concerns and ways of improving the service we provide.

Under the direction of the Patient Participation Group we are undertaking an initial survey to review the service patients receive from us and hopefully to find areas we can improve. Please take a few minutes to complete this online survey by ticking the relevant box(s) and adding your comments.

Please contribute to the collective patient view by clicking here to take survey.

Patient participation group at Gade Surgery

Gade Surgery would like to set up a patient participation group (PPG) if there is enough interest in our patients. The group would set its own agenda but its initial terms of reference would be as follows:

  1. To facilitate good relations between the Practice and patients by communicating patients' experience, interests and concerns and by providing feedback to the Practice on current procedures and proposed new developments.
  2. To help maintain good relations and communication between the Practice, the local community and other bodies.
  3. To explore ideas identified from patients including from a survey and propose relevant actions.
  4. To be a forum for ideas on health promotion and self-care.
  5. To evaluate and review the effectiveness of the PPG not less than once a year.

The main function of the patient participation group is meeting to discuss matters relevant to the practice and group and to propose and carry out consequent actions if possible. The group would consider issues that it feels important and also act as representatives of the wider patient audience whose views would be equally as important in formulating any proposals. The views of this wider audience would be sought by way of an internet discussion group, a suggestion box and by way of a practice survey.

The likely initial cycle would be:
  • Advertise for members of the PPG through notices, the website etc. Applicants would be chosen to reflect the widest possible diversity in interests.
  • Set up the virtual internet group to start the process of obtaining views from a wider audience.
  • PPG to meet to set up constitution and plan practice survey. Minutes to be taken at each meeting.
  • Implement survey
  • PPG to meet to review results and plan possible actions
  • Survey results published on the website with proposed actions.
  • Actions taken
  • Plan next cycle

If you would be interested in being a member of this group please click here for the application form or get one from the practice reception. Applications will be considered by the end of October and successful applicants would be notified shortly after. The first meeting date of the PPG is proposed to be in mid November in the early evening.

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