Local Patient Participation Report...Local Patient Participation Report 2012 – 2013 Lead - Dr...

Local Patient Participation Report

2012 – 2013

Lead - Dr Mewar Assistant: Sue Lawrence / Practice Manager

A copy of the action plan can also be found on our website:

www.hilltopmedicalcentre.co.uk

Practice Demographics and PRG recruitment

The practice profile was looked at in detail and a list made to ensure that the PRG fully represents

our registered patients. At the time of reporting (20.6.2012), the list size was 10222, the age / sex

breakdown of patients as at 1st June 11 was as follows

Sex 0-4 5-14 15-44 45-64 65-74 75+

Female 4% 7% 22% 12% 4% 4%

Male 4% 7% 20% 11% 3% 2%

Total 7% 14% 42% 23% 7% 6%

The following points were considered:

White British accounts for 79% of the practice population

14% of our practice under the age of 65 are in a clinical risk group

13% of our patients are over 65 yrs

42% of our patients are in the 15 – 44 age group

The practice has a high birth rate

2% of our patients are carers. This has increased by 23% in the last year.

In 2011 / 12 a PRG recruitment drive was commenced. Posters were displayed in all waiting areas,

a notice was posted on the website and a message was displayed an the Clinical television screen in

both buildings. Appendix A and recruitment questionnaires were given to patients. Appendix B

Pro Forma Survey

A short pro-forma survey was carried out to establish what the general practice population required

our full survey to focus on. 250 questionnaires were sent out with routine letters randomly (May

2012) for patients to complete. (Appendix C)

The results were as follows:

Employed:

Those who would like the following to be addressed – 76 returned surveys

A Clinical care received from GPs and Nurses 40%

B Surgery cleanliness and safety 45%

C Other 11%

D No issues 4%

http://www.hilltopmedicalcentre.co.uk/

Retired 60+:

Those who would like the following to be addressed – 116 returned surveys



C Other 21%

D No issues 4%

Under 60 – 143 returned surveys



C Other 18%

D No issues 2%

Total results – 192 completed surveys



C Other 17%

D No issues 3%

It was clear from the results of the pro forma survey that we should focus on improving cleanliness

and safety in the surgery.

Other areas considered

Our complaints from 2011/12 were also analysed.

Registering for CQC put even more emphasis on the importance of the surgery being at an excellent

standard.

PRG Group

In order to fully represent the practice population, the new recruited PRG Group is represented by

the following:

Ethnic Minority representation – 2

Under 15 – Female - 1

Carer’s Group 13

Clinical risk groups / 6

Young mother / 2

15 – 44 representative / workers – 2 / unemployed – 1

45 – 64 representative / workers – 3 / unemployed -1

House bound / 1

Elderly 65+ Retired Male – 2 Female – 3

A letter with all results (Appendix D) and suggested action template to complete (Appendix E) was sent to

members of the PRG group, together with an invitation to attend the meeting with clinical and admin staff on

Monday March 4th

at 12.30 pm

The meeting on Monday March 4th was attended by all the clinicians, an admin representation and comments

from all members of the patient group. Actions were proposed and a copy was sent to members of the

patient reference group (Appendix F)

100% of the PRG group who were either at the meeting or who returned their completed proposed action

plans agreed with the changes. Our intention is to publish on our website, display notices in the surgery,

and publish in the practice news letter.

Now that we have approval, we will begin the implementation of the changes.

APPENDIX A

HILL TOP MEDICAL CENTRE PATIENT REFERENCE GROUP

THE PRACTICE WISHES TO ESTABLISH A GROUP OF PATIENTS WHO ARE WILLING TO CONTRIBUTE SOME OF THEIR TIME TO THE DEVELOPMENT OF THE PRACTICE AND

ITS HEALTH SERVICES.

We are especially keen to make sure that the group is fully representative of our

patients and therefore invite anyone with an interest to enquire about joining.

This will not necessarily mean attending meetings at the surgery, but may include

giving your opinion on the development of the practice and the services we offer, by

telephone or email.

If you are interested please contact Sue Lawrence – Practice Manager

0121 506 6858 [email protected]

mailto:[email protected]

Appendix B HILL TOP MEDICAL CENTRE

15 HILL TOP ROAD OLDBURY

WEST MIDLANDS B68 9DU

If you are happy for us to contact you periodically by email to answer a short survey, which will help us to

make changes to the service we offer (Maximum of twice per year) please leave your details below and hand

this form back to reception.

Name:

……………………………………………………………………………………………………………………….….

Email address: …………………………………………………………………………………………………………….

Postcode: …………………………………………………………………………………………………………………….

This additional information will help to make sure we try to speak to a representative sample of the patients

that are registered at this practice.

Are you? Male Female

Age: Group Under 16 17 – 24

25 – 34 35 – 44

45 – 54 55 – 64

65 – 74 75 – 84

Over 84

To help us ensure our contact list is representative of our local community please indicate which of the

following ethnic background you would most closely identify with?

White British Group Irish

Mixed White & Black Caribbean White & Black African White & Asian

Asian or Asian British Indian Pakistani Bangladeshi

Black or Black British Caribbean African

Chinese or other ethnic Group Chinese Any Other

How would you describe how often you come to the practice?

Regularly

Occasionally

Very rarely

Thank you.

The information you supply to us will be used lawfully, in accordance with the Data Protection Act

1998.

The Data Protection Act 1998 gives you the right to know what information is held about you, and

sets out rules to make sure that this information is handled properly

Q Will my doctor see this information?

A This information is purely to contact patients to ask them questions about the surgery, how well we are doing and ensure changes that are being made are patient focused. If your doctor is responsible for making some of the changes in the surgery they might see general feedback from patients.

Q Will the questions you ask me be medical or personal? A We will only ask general questions about the practice, such as short questionnaires. Q Who else will be able to access my contact details? A Your contact details will be kept safely and securely and will only

be used for this purpose and will not be shared with anyone else. Q How often will you contact me? A Maximum twice per year Q What is a patient group/patient participation group?

A This is a group of volunteer patients who are involved in making sure the surgery provides the services its patients need. Q What if I no longer wish to be on the contact list or I leave the surgery? A Just let us know by email / telephone or at reception if you do not wish for any further messages.

Appendix C

Please complete the following: Male Female Age

Employed Unemployed

We are planning our next annual survey and to ensure that we ask the right questions, we would like to know what you think should be our key priorities when it comes to looking at the services we provide to you and others in the practice. What do you think are the most important issues on which we should consult our patients? For example, which of the following do you think we should focus on: Care received from Doctors & Nurses Infection Control: Patient safety / Cleanliness of the surgery Other: ______________________________ ______________________________

Appendix D

HILL TO MEDICAL CENTRE

Improving the Practice Questionnaire

INTRODUCTION

This questionnaire is designed for issue to patients to assess the service provided.

QUESTIONNAIRE

You can help the practice to improve its service.

The doctors and staff welcome your feedback

Please do not write your name on this survey

Please read and complete this survey while waiting for your appointment

PLEASE RATE EACH OF THE FOLLOWING AREAS BY TICKING ONCE ON EACH

LINE

GENERAL CLEANLINESS No

experience

Poor Fair Good Very

Good

Excellent

MAIN RECEPTION AREA

UPSTAIRS WAITING

AREA

TOILETS DOWNSTAIRS

TOILETS UPSTAIRS

CONSULTING ROOMS

DOWNSTAIRS

CONSULTING ROOMS

UPSTAIRS

Any further comments

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

__________________________________________

The following questions provide us only with general information about the range of people who

have responded to this survey. It will not be used to identify you, and will remain confidential

How old are you?

Are you male or female

Appendix E

Improving the Practice Questionnaire

Carers Meeting – 31 January 2013

13 Carers attended this meeting and discussion was held regarding the questionnaire.

Summary of answers given below:

General Cleanliness:

Main Reception Area Fair

Upstairs Waiting Area Fair

Toilets Downstairs Good

Toilets Upstairs No experience

Consulting Rooms Downstairs Good

Consulting Rooms Upstairs Good

Any Further Comments:

When sitting in upstairs waiting area, can clearly hear what is being said in consulting

rooms – would soundproofing help?

Difficulties in hearing what is said over the existing tannoy system. ?consider visual display

of appointments.

Cleanliness of old building not as good as annexe – décor looks tired.

Car parking is major problem – especially during recent snowy period.

Would appreciate a drink/water machine to be available for patients in reception.

Blood test results – one carer was told by reception their blood tests were normal, but when

seeing GP a couple of weeks later was told they were actually abnormal ?training issue.

Reception staff generally do an excellent job.

Appendix F

Hill Top Medical Centre – Cleanliness and Safety Survey Results

Patients who have no experience of a service have been excluded from this

survey

Questions Poor Fair Good Very

Good

Excellent

GENERAL CLEANLINESS &

PATIENT SAFETY

Main reception area

1 0% 4% 31% 42% 23%

Upstairs waiting area

2 8% 3% 31% 37% 21%

Toilets downstairs

3 22% 2% 24% 31% 21%

Toilets upstairs

4 33% 2% 21% 24% 20%

Consulting rooms downstairs 5

5% 3% 29% 39% 24%

Consulting rooms upstairs 6

9% 2% 28% 38% 23%

Appendix G

Hill Top Medical Centre / Cleanliness & Safety Survey – Patient Comments

Staff very good always helpful

Many thanks to the receptionists, always bright, cheerful and welcoming

Still confused about the appointment system. Not being a regular, when I need to see a doctor, the

appointment is always a few days or a week. The Doctor you want to see is on holiday. How many holidays

do they have?

Please give an appointment when we need on, because sometimes when we phone, you say you are fully

booked

The receptionists and their service are very good

Its always very clean

Difficulty getting an appointment

If you need same day appointment, almost impossible to get through on the phone

Need to do something about the phone when trying to get through for appointments

Main pride of service are the receptionists. Helpful on the phone, pleasant and helpful in surgery

Always found alright

The staff at this surgery are very helpful most of the time

Service received very helpful and professional

Car parking is very poor

The receptionists are brill. Friendly and helpful. I feel confident in confiding in them. The car park is a

nightmare and dangerous for the elderly. Other than that love the place

Appointments difficult to get. Need to wait at 8.30 am which isn’t always possible

Staff always friendly and helpful

It would be better if it was easier to get an appointment

Very well run practice with good hygiene standards

Booking an appointment is hard for people working, most people are unable to get to a phone at 8.30 am, so

have to do without seeing a doctor

Too hard to get an appointment if you work

The staff are friendly, from the nurses to the receptionists, you are doing a sterling job

Good service

Waiting times for appointments are too long, sometimes up to a fortnight

Doctors and staff are helpful

Please use the air con in the summer months and warm weather

Receptionists always friendly and helpful

Good surgery, good receptionists and nurses

Would like to email or text appointment request

The microphone calls are not clear when your name is called

Excellent service from staff, all pleasant

Everything excellent. If its not broken don’t fix it

Lovely girls

Very nice surgery, staff very nice and helpful

Staff are always very friendly and polite, always willing to sort out any problems. Doctors also willing to

explain any illness

Very understanding reception staff, always willing to help

All excellent

The best doctors and reception staff ever

Everyone is wonderful, the doctors will sit and listen and not just push issues to one side

Staff always helpful

Excellent clinic with all round friendly helpful staff and excellent doctors

Always clean and very welcoming

Staff are polite, friendly and helpful

Acceptable and satisfactory

Care/Nursing Home Quality Assessment Tool February 2012 13

Appendix H

Dr H S Hanna

Dr K Singh

Dr R Mewar

Jane Evitts ANP

HILL TOP MEDICAL CENTRE

15 Hill Top Road

Oldbury

West Midlands

B68 9 DU

Tel: 0121 506 6858

Fax: 0121 422 9235

«SYSTEM_Date»

«PATIENT_Forename1» «PATIENT_Surname»

«PATIENT_House» «PATIENT_Road»

«PATIENT_Town»

«PATIENT_County»

«PATIENT_Postcode»

Dear «PATIENT_Title» «PATIENT_Surname»,

We have completed our annual patient survey, which was focused on cleanliness, infection control and

patient safety in the surgery. This was an area of importance decided by patients in the priority pro-

forma survey carried out last year. This is particularly relevant this year as from 1st April 2013 we will

be regulated by the Care Quality Commission (CQC).

The CQC makes sure that essential standards of quality and safety are being met where care is provided,

from hospitals to private care homes. It has a wide range of enforcement powers to take action on behalf

of people who use services, if services are unacceptably poor. The CQC’s aim is to make sure better

care is provided for everyone, whether that’s in hospital, in care homes, in people’s own homes or GP

surgeries. The CQC has been given a range of legal powers and duties. It will take action if providers

don’t meet essential standards of quality and safety, or if there is reason to think that people’s basic

rights or safety are at risk.

500 copies of the survey were given out randomly during flu clinic week, to a cross section of patients.

The survey was also sent out with routine letters to patients and discussed at our carers’ meeting. Our aim

was to receive 250 completed surveys, but we actually received 359, an excellent response, which proves

that patients do care about the service they receive and want their voices to be heard to help shape the way

the practice moves forward.

We have analysed the results and are now looking for comments and suggestions as to how we can

improve our surgery. To help you with this process, I have enclosed the following documents to refer to:

A copy of the analysed results

Carers meeting comments

Copy of the questionnaire

A report of the comments made on the questionnaires

Template to complete

We would like you to consider how we would be able to make changes to improve cleanliness and safety

for all patients. Firstly, please complete the template attached with any suggestions, and return by Friday

1st March. These comments will be discussed at a practice meeting to be held at the surgery on Monday


4th

March at 12.00 pm with the doctors, nurses and other staff members. You are welcome to attend, but

please do not be concerned if you are unable to. Your comments will be discussed at this meeting and an

action plan will be proposed. For those of you who are unable to attend the meeting, I will send a copy of

the proposed action plan to seek your agreement.

I would be grateful if you would return the completed template by Friday 1st March. I have enclosed a

stamped addressed envelope for your reply, or if you prefer please reply to me at [email protected].

I would also be happy to receive your comments by telephone on 0121 506 6858.

Yours sincerely

Sue Lawrence

Practice Manager



Appendix I

Please complete the template below, paying particular attention to improving cleanliness and

patient safety when completing the template. Please continue on a separate sheet if necessary &

return by Friday 1st March 2013

General cleanliness & patient safety Suggested change

Main ground floor reception area.

96% of those who completed the survey said this

area was good / very good or excellent

Do you agree?

Do you think anything could be in place to make it a

better more comfortable environment for patients?

Upstairs waiting area



Do you agree?

Do you think anything could be in place to make it

a better more comfortable environment for

patients?

Toilets downstairs



Do you agree?

Are there any other changes we can make?

Toilets upstairs



Do you agree?

Are there any other changes we can make?

Consulting rooms downstairs



Do you agree?

Do you think anything could be in place to improve

the environment for patients?


Consulting rooms upstairs



Do you agree?

Do you think anything could be in place to improve

the environment for patients?

Car Park

Following a patient comment regarding the safety of

patients on the car park, how do you think this could

be improved?

Please note we are unable to extend the car park area


Appendix J

Dr H S Hanna

Dr K Singh

Dr R Mewar

Jane Evitts ANP

HILL TOP MEDICAL CENTRE

15 Hill Top Road

Oldbury

West Midlands

B68 9 DU

Tel: 0121 422 2146

Fax: 0121 422 9235

«SYSTEM_Date»

«PATIENT_Forename1» «PATIENT_Surname»

«PATIENT_House» «PATIENT_Road»

«PATIENT_Town»

«PATIENT_County»

«PATIENT_Postcode»

Dear «PATIENT_Title» «PATIENT_Surname»,

As you are probably aware we have now completed the patient survey. This was focused on cleanliness an

safety for patients in the surgery, as decided by patients in the priority pro-forma survey.

Copies of the results were sent to our patient reference group. We received many valuable

contributions, so thank all of you who responded. We then held a practice meeting to discuss these

options, which was attended by all of the clinical staff, admin representatives and patients. I have

attached a copy of the proposed action plan for your approval.

Please read it carefully and complete the section at the bottom to either approve or give reasons for not

approving. I would be grateful if you would return the completed form by Friday 16th

March, either in

the S.A.E. provided, by fax – 0121 422 9235, e.mail – [email protected] or alternatively call me on

the above number 8.00 am – 5.30 pm Monday to Thursday.

Thank you for your help with this process.

Yours sincerely

Sue Lawrence

Practice Manager



Hill Top Medical Centre / 15 Hill Top Road Oldbury West Midlands B68 9DU - M88645 Section 1.1

Management of Infection Prevention and Control – General Management Question

Action By when

By who

Completion/Comments

2 Does the job description of the names lead person outline responsibilities in respect of infection prevention and control?

A job description to be given to the lead person.

5/11/12 SL Approved

2 Is there a policy on staff exclusion from work with regards to infection prevention?

Policy in place.

5/11/12 SL Approved

1 Are up to date infection prevention and control policies and guidelines available and accessible by staff?

Most policies have been reviewed or are in the process of being reviewed. The policies are being discussed during in house training in infection control with plans to cover all of them A copy of these policies will then be available on key PCs around the practice for all staff to access

31/3/12 SL LB

2 Are systems in place to ensure infection prevention input is sought prior to purchase of equipment?

Policy to be written. 5/11/12 SL Completed & Approved

3 Is furniture made of impermeable and washable materials?

16 chairs for replacement.

31/3/12 SL

19 Is there information displayed for parents on how to clean the changing area after use?

Notice to be written and discussed in meeting 5/11/12

5/11/12 SL LB

Wipes ordered / Notice Completed

22 Is there a foot operated pedal bin designated for the disposal of nappies?

New bins / not foot operated/ monies secured

31/3/12 SL

13 Are elbow/sensor taps available? 3 rooms do not have elbow taps 31/3/12 SL


14 If no elbow or sensor taps, are staff aware of how to turn off the taps with a paper towel?

For discussion 5/11/12 SL LB

To be re addressed in clinical meeting

27 Is the foot pedal of the domestic waste bin in good working order?

Foot operated bins not in all rooms

31/3/12 SL

9 Is the floor covering washable and impervious to moisture?

The store room and one consulting room has carpet

31/3/12 SL

31 Are detachable mop bucket wringers removed and cleaned daily?

Added to cleaners instruction list 22/10/12 SL Completed

1 Is staff food in the fridge labelled with their name and date when it should be consumed by?

Procedure in place 22/10/12 SL Completed

3 Fridge temperature recorded? No facility

31/3/12 SL

2 Is an audit completed at least annually? In place 17/10/12 SL Completed

3 Is there a named individual who is responsible for receiving and storing vaccines?

Lynn Buckley 22/10/12 SL Completed

4 Is there a named deputy who is responsible for receiving and storing vaccines?

Lianne White & Jeanette Ramsorrun 22/10/12 SL Completed

2 Does the refrigerator have an uninterrupted electrical supply?

No 31/3/12 SL

3 During transport, are vaccines wrapped in bubble wrap (or similar insulation material) and stored in a suitable approved cool box with a maximum and minimum thermometer?

Vaccine cool bag used with ice packs/ No thermometer

31/3/12 SL

7 Is there a designated specimen fridge available when required?

No 31/3/12 SL

8 Are specimens sorted in a dedicated refrigerator which is separate to food,

See above Stored in cool bag

31/3/12 SL


medicines and vaccines?

10 Are there automatic door closure? Not on all rooms


Infection Prevention and Control Quality Assessment Tool/Check List

Hill Top Oldbury

Name of Assessor Anna Pronyszyn Date…3 January 2013………………………

Observation Action Required

Action Undertaken Date Signature

Inappropriate and additional items require removing from theatre

All areas are tidy & free from clutter (the environment is free from inappropriate items clutter and can be easily cleaned)

Tops of doors, lamps, pictures, apron dispenser require cleaning

Ensure fixtures/fittings are intact, visibly clean and free from dust (check furniture and fixtures and fittings for damage or wear)

Material chairs in consulting rooms

Material chairs require to be replaced to facilitate cleaning.

Stair wells and inside radiators dusty To keep all areas clean and free from dust and to be added to cleaning schedule

Top of toilet systems, corners of room and sani-bin dusty

Toilets require thorough cleaning

Signed cleaning schedules do not reflect cleanliness of building

Cleaning schedules only to be signed following cleaning




BP holders dusty.

Equipment cleaning schedule is in place and complied with.

Multi use urine pots in Room4 Removal of urine pots

Toys cannot be cleaned

Toys if used should be wipeable and cleaned between use

Couch frames dusty

Couches identified on cleaning schedule should be clean and free from dust and signed once cleaned

HTM64 clinical procedure hand wash basins unavailable in treatment rooms

Replacement of inappropriate sinks in treatment and consulting rooms

If store cupboard to be utilised as cleaner’s cupboard, HTM64 clinical procedure hand wash basin unavailable

Use of room to be agreed and appropriate action taken. HTM64 clinical procedure hand wash basins to be installed if room to be used as cleaner’s cupboard

Top of dispensers require cleaning

Towel dispensers clean & full

Inappropriate items disposed of in clinical waste

Correct segregation of waste i.e. aprons, gloves, couch roll, paper towels

Waste bins are clean, lidded & in good working order

Clinical waste bin lids to be cleaned and added to cleaning schedule



Belfast sink in store room Use of room to be decided either for cleaner’s cupboard or storage of clinical items. If clinical cupboard removal of sink required. Ensure all items are stored off the floor to prevent contamination and to facilitate cleaning.

Uterine sounds to be stored to prevent damage to packaging to maintain sterility and out-of-date

Sterile goods in date( check dates of several items) A system required to check and dispose of out-of-date items in Room 9

Stores and sterile goods stored on floor. Areas identified during audit: Couch roll on the floor

Ensure all items are stored off the floor to prevent contamination and to facilitate cleaning.

Cupboards not clean and contain clutter ( Clutter from cupboards in Room 9 requiring removing


check inside) (shoes etc stored with medical items)

and cleaning

Ensure all single-use items are disposed of immediately following use. Single –use items observed: Room 1 Auroscope speculae Room 9 Scissors/forceps)

Single use equipment not reused

(single patient use symbol

http://www.mhra.gov.uk/home/groups/comms-con/documents/websiteresources/con2015673.gif

http://www.mhra.gov.uk/home/groups/comms-con/documents/websiteresources/con2015673.gif


PROPOSED ACTION PLAN

Problem Proposed Action

Although most agreed that the practice was

reasonably clean, there was also room for

improvement in the waiting areas and toilets

This task has been allocated to Lynn Buckley

who is our Health Care Assistant. Lynn is

attending all external Infection Control

meetings and then filtering the information

back to the rest of the practice team. Lynn

has also given training to cleaners on their

responsibility. A third cleaner has been

employed to assist.

There is now a form in each room that has a

list of duties to be completed daily. This has

to be signed daily by the cleaner responsible.

Spot checks are carried out by Lynn to ensure

a good standard is maintained

The general outlook of the waiting area when you

arrive tends to look a little unclean due to the

paintwork / several comments

It was agreed that the waiting area and stairs

were in need of painting and carpet replacing.

A quote to be obtained for this work.

It gets very stuffy and far too hot in both waiting

areas

The thermostat needs to be checked during

the day with temperature kept at 18 – 20

degrees. When it gets too hot, the central

heating is to be turned down before windows

are opened or air con switched on.

The waiting area has an untidy feel to it

The main leaflet stand, which is changed

weekly will remain. All other leaflets will be

removed. In place of this, there will be a

notice board promoting a single topic. This

will be changed each month. e.g. Diabetes

awareness / Travel immunisations / Smoking

cessation.

The notice board with patient comments will

remain

Notices on windows and doors will be kept to

a minimum

Toilets need to be checked more regularly

Receptionists will check the toilets a

lunchtime for any problems or replace toilet

rolls

Pull cord alarm to be fitted in disabled toilets


Leaflets on sex / periods etc should be on a higher

shelf away from younger children

These will be moved

Books / Magazines for patients whilst waiting

We will not be having books and magazines

due to infection control purposes

Outside path between the annexe and the chemist

is very uneven

Mandy Rollinson will check this and address

Car parking:

It was agreed that car parking is a problem.

Dangerous for people with children. – several

comments

Obtain quote to extend the car park onto the

grassed area by 2 – 3 feet. This will give

more room to reverse.

Too many cars trying to get on when there are no

spaces

Large cars / vans parking too close to the door to

restrict entrance

Message on TV screen / news letter regarding

parking responsibly.

As above. When noticed ask patients to

move cars

Allocated parking for cars with young children

The size of the car park is not large enough to

offer this.

In the snow and ice the slope into the car park

proved dangerous to walk on, particularly for the

elderly.

Ensure the car park is well gritted /

responsibility of the Practice and Pharmacy

There is a problem with over hearing patients

consultations in the waiting area upstairs and

outside in the street when the windows are open

There is a radio in the waiting area upstairs,

which needs to always be on and turned up

slightly to mask conversation.

Air con to be used instead of opening

windows

As it gets so hot – would it be possible to have a

drinks machine

We do not have the space for a drinks

machine.

Name ………………………………………………………………………………….

I agree with the above action plan

I do not agree with the above action plan and give my reasons below

Reasons

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