Patient Participation Group Meeting. All patients registered at the  Surgery  are invited to join the Patient Group. Please leave your contact information at the reception if you want to have an active involvement in your surgery.

Recent Surveys and documents

AYLESHAM  MEDICAL  PRACTICE  & WINGHAM  SURGERY

PATIENT  SATISFACTION  SURVEY  REPORT

RESULTS APRIL 2014- MARCH 2015

   We currently have 12 patients who attend regularly. Our Practice population is 6158 which consists of 3012 males and 3146 females.  We had several meetings with the group members where we reviewed last year’s survey results and practice complaints and issues. We asked the group to come up with ideas of what sort of questions they would like to include in the Patient Survey. Please see below a copy of the results of the survey along with the action plan  and details of any changes made.

The questionnaire agreed by the patient group and staff at Aylesham Medical Practice and Wingham Surgery was offered to every patient who attended the surgery between 1st December and 12th December 2014.

Dr-Ariyaratnam-pie-charts-Jan-2015 Dr-Collyer-pie-charts-Jan-2015 Dr-Mahadevaiah-pie-charts-Jan-2015 General-Questions-pie-charts-Jan-2015-1 Nurses-pie-charts-Jan-2015

Patient Satisfaction Survey comments

  • I am new to the surgery and from my old village. As I work full time away from the village and around Kent it would be helpful on occasions to be able to book a specific appointment. I can schedule work around it, sometimes unknown waiting times does not work with my schedule and I have to choose not to see the doctor.
  • Thank you to all the staff for their hard work and help.
  • You have always offered my family a fantastic service and we are very grateful for this. Thank you.
  • Satisfied.
  • It would be nice to have caring doctors, I feel like I am a number, not a human on most appointments. Now I will only see one doctor at the surgery as I don’t have faith in the others.
  • It is a problem for elderly people to attend appointments who need to use the bus. We cannot get to the surgery before 10 am using a bus pass. The alternative is an appointment at the earliest at 3.50pm, in winter it is dark and not safe to be out, especially walking in country lanes with no pavements.
  • I feel the clinic is very busy and when you feel poorly it’s not nice sitting amongst so many people and you cannot see your doctor, also, when you phone at 8 am you can never get through or get an evening appointment.
  • If you do not feel well the last thing you want to do is wait.
  • Deaf people need a louder call.
  • Lots of patients would like a louder call system, if they are deaf or hard of hearing, can’t hear when being called. Some patients can’t understand Dr Ari calling their names.       Needs more than 2 doctors in the morning surgery.
  • The service provided by the locum doctor on one of the 2 weeks in October 2014 was not good.
  • Everything taken into consideration in my personal opinion the Wingham practice deals with all aspects very efficiently where nothing is too much trouble to render a positive end result.
  • Certain recent initiatives, such as the new appointment arrangements, have not been well explained. Ways to communicate with patients who are not frequent visitors to the surgery.
  • I have no comments at present as I have always found the practice very good.
  • 20/12/2014 The receptionist who was on duty this morning was extremely helpful, so often it is difficult to get an appt, but although she couldn’t give me one straightaway she was very helpful. At 8.00 am it is not easy to get through by phone but then a bit later it is easier to get through gut the appointments for the day have usually gone. I just wanted to particularly mention the receptionist for her helpfulness and consideration. So often you can feel a bit of a nuisance but she didn’t make you feel like that. Thank you.
  • I came in to have a blood test. Being needle phobic, I was dreading coming in. Gill Hudson the nurse who took my blood was amazing, caring and so understanding. In the end it was a surprisingly pleasant experience. Thank you Gill.
  •   Pre-bookable appointments.       Later surgery for people who work.
  • Morning appointments doesn’t suit – maybe till 12.30 due to bus arriving.
  • A&E attendances at weekend only – once.
  • A walk-in surgery would be a great idea and if there was one in the afternoon as well that would be something for the future.
  • Very good advice from Nurse Annie Cryer.

Action Plan arising from Aylesham Medical Practice and Wingham Surgery 2015 Patient Satisfaction Survey

 Overall the survey reflected that patients were generally happy with the surgery and the care they received although there are still issues regarding appointments.

The main issues that have been raised from the questionnaire and comments are:

  • Availability of appointments

Following last year’s survey we started writing to patients that Do Not Attend their appointments and although this has improved slightly we are still having issues with patients not being able to get an appointment on the day and having to ring day after day to try and get one. We discussed the options with the PPG and the Doctors and decided to alter the appointment system. We are now going to change the appointments system from bookable appointments all day to a walk-in morning clinic and bookable appointments in the afternoon. The walk-in clinic will start at 8.30am and patients must book in at reception before 10.00am they will then be seen by the doctor on duty that day. This will mean that patients will no longer have to telephone at 8am to get an appointment for the morning they can attend the surgery and be guaranteed to see a GP. Patients will be informed of the change via the website and notices put up around the surgery. We will monitor the success by adding a question to the FFT asking patients to give us their views on the new walk-in clinic.

  • Publicising changes within the surgery.

After reading the comments from both the survey and the suggestions box it was suggested by the PPG that changes made within the surgery are publicised in the local community magazine to ensure those who rarely attend the surgery and do not have access to the internet are kept informed of any changes. The Practice manager will approach the editor to take this plan forward

  •   Afternoon appointments

The afternoon appointments are currently bookable with a selection available to be pre-booked and the remainder available on the day. These appointments are currently released at 8.00am when the surgery opens. The PPG thought it would be a good idea to consider releasing these later on in the day after the walk-in clinic has finished. The purpose of this is to relieve the pressure on the reception at 8.00am, to reduce the number of patients queuing outside before the surgery opens and to accommodate working people who may only be able to telephone the surgery during their lunch break.  It was decided that before we make any changes we would put this suggestion on the next FFT to see what the general consensus is from the patients. If it reveals that the patients do not want to consider changing them then we will leave them as they are but if they are interested in changing the time they are released we will hold another meeting with the PPG and discuss what time we think would be reasonable. This change will then be advertised on the website, notices within the surgery and in the local community magazine prior to making the changes.

  • A Tannoy system

There have been some comments from patients that they have been unable to hear/understand when the doctor has called them in for their consultation. We discussed the option of a tannoy system but came to the conclusion that because of the security door between the consulting rooms and the waiting area this would not be viable as patients cannot gain access to the corridor without the clinician letting them through. As this is not a viable proposition the practice manager will discuss the comments made from the patients at the next clinical meeting and ensure the clinicians go further into the waiting area before calling the patient to ensure they can be heard.

Below is a copy of the Standard Reporting Template completed by the Surgery and signed off by the Patient Group.

 

 

Annex D: Standard Reporting Template

 

Kent and Medway Area Team

2014/15 Patient Participation Enhanced Service – Reporting Template

 

Practice Name: Aylesham Medical Practice

 

Practice Code: G82211

 

Signed on behalf of practice:                                                                                                          Date:

 

Signed on behalf of PPG:                                                                                                                          Date:

 

  1. Prerequisite of Enhanced Service – Develop/Maintain a Patient Participation Group (PPG)

 

Does the Practice have a PPG? YES  
Method of engagement with PPG: Face to face, Email, Other (please specify) Face to Face
Number of members of PPG: 12
Detail the gender mix of practice population and PPG:

% Male Female
Practice 49 51
PRG 16.7 83.3

 

 

 

Detail of age mix of practice population and PPG:

% <16 17-24 25-34 35-44 45-54 55-64 65-74 > 75
Practice 19.4 12 11.6 11.4 15.3 11.6 10.7 8
PRG 0 0 0 8.3 0 25 50 16.7
Detail the ethnic background of your practice population and PRG:

White Mixed/ multiple ethnic groups
British Irish Gypsy or Irish traveller Other white White &black Caribbean White &black African White &Asian Other mixed
Practice 1187 1 5 35 4 2 7 0
PRG 12 0 0 0 0 0 0 0

 

 

Asian/Asian British Black/African/Caribbean/Black British Other
Indian Pakistani Bangladeshi Chinese OtherAsian African Caribbean Other Black Arab Any other
Practice 6 0 0 4 17 4 0 0 0 24
PRG 0 0 0 0 0 0 0 0 0 0
Describe steps taken to ensure that the PPG is representative of the practice population in terms of gender, age and ethnic background and other members of the practice population: We have a notice in our reception, highlighted on yellow paper, informing  patients of the PPG and inviting them  to join.  We also advertise our PPG on our surgery website and include it in our annual Patient Survey.  

 

 

 

 

Are there any specific characteristics of your practice population which means that other groups should be included in the PPG? e.g. a large student population, significant number of jobseekers, large numbers of nursing homes, or a LGBT community? NOIf you have answered yes, please outline measures taken to include those specific groups and whether those measures were successful:All of our patients are given the chance to join the PPG group; we have found that it is mainly the elderly and retired population who are interested.

 

 

 

 

 

  1. Review of patient feedback

 

Outline the sources of feedback that were reviewed during the year: We have used our patient survey, the new Friends and Family test, any comments or suggestions received via the suggestion box in the reception and also the surgery website. We also review complaints if they are regarding appointment systems etc. 

 

 

How frequently were these reviewed with the PRG? They were reviewed regularly at each meeting which are held 4 times a year.

 

 

  1. Action plan priority areas and implementation

 

Priority area 1
Description of priority area: Appointment system   
What actions were taken to address the priority? We have now changed the appointments system from bookable appointments all day to a walk-in morning clinic and bookable appointments in the afternoon. 

 

 

Result of actions and impact on patients and carers (including how publicised): Patients no longer have to telephone at 8am to get an appointment for the morning they can attend the surgery and be guaranteed to see a GP. Patients were informed of the change via the website and notices put up around the surgery. Feedback from the FFT regarding this change has been positive. 

 

 

 

 

 

Priority area 2
Description of priority area: Publicising changes within the surgery.  
What actions were taken to address the priority? It was suggested by the PPG that changes made within the surgery are publicised in the local community magazine to ensure those who rarely attend the surgery and do not have access to the internet are kept informed of changes.  

 

Result of actions and impact on patients and carers (including how publicised): We have now approached the editor and are moving forward with this plan. 

 

 

 

 

 

 

 

Priority area 3
Description of priority area: Afternoon appointments and Tannoy system. 
What actions were taken to address the priority? We felt both of the above needed to be addressed. The afternoon appointments are presently bookable with a selection available to be pre-booked and the remainder available on the day. These appointments are currently released at 8.00am when the surgery opens. The PPG thought it would be a good idea to consider releasing these later on in the day after the walk-in clinic. The purpose of this is to relieve the pressure on the reception at 8.00am, to reduce the number of patients queuing outside before the surgery opens and to accommodate working people who may only be able to telephone the surgery during their lunch break.  It was decided we would put this suggestion on the next FFT to see what the general consensus is from the patients. There have been some comments from patients that they have been unable to hear/understand when the doctor has called them in for their consultation. We discussed the option of a tannoy system but came to the conclusion that because of the security door between the consulting rooms and the waiting area this would not be viable as patients cannot gain access to the corridor without the clinician letting them through.  
Result of actions and impact on patients and carers (including how publicised): Regarding afternoon appointments it was decided we would put this suggestion on the next FFT to see what the general consensus is from the patients before implementing any changes. Tannoy system – as this was not a viable proposition the clinicians have agreed to go further into the waiting area before calling the patient to ensure they can be heard.  

 

 

 

 

 

 

Progress on previous years

 

If you have participated in this scheme for more than one year, outline progress made on issues raised in the previous year(s):

 

 

  1. PPG Sign Off

 

Report signed off by PPG: YESDate of sign off: 
How has the practice engaged with the PPG: We have held 4 meeting throughout the year with the PPG.How has the practice made efforts to engage with seldom heard groups in the practice population? We make all information available on our website to try and engage every patient. Has the practice received patient and carer feedback from a variety of sources? We have had feedback via the survey, the website and the Friends and Family Test.

 

Was the PPG involved in the agreement of priority areas and the resulting action plan? Yes the results of the survey were discussed with the patient group and appropriate action plans were decided.

 

How has the service offered to patients and carers improved as a result of the implementation of the action plan? We have altered the appointment system to a walk-in clinic in the morning to accommodate the demand for appointments and to give the patients the option to be seen on the same day.

 

Do you have any other comments about the PPG or practice in relation to this area of work? No we are fully satisfied with relationship we have with our PPG.

 

 

 

 

 

 

 

Aylesham Medical Practice Further Information

The average pay for delivering NHS services to patients for GP’s working in Aylesham Medical Practice & Wingham Surgery in the last financial year was £58,103 before tax and NI.  This is for three full time Doctors who have worked in the practice for more than six months.

Medical Reports and Sickness Certificates

 On occasions insurance companies and employers and some other organisations

may ask your doctor to write a report regarding your medical history for insurance purposes and fitness for employment.  The provision of medical reports is governed by The Access to Medical Reports Act, 1988.

The Act covers the following points.

  • A report cannot be provided without your consent
  • You are entitled to see the report before any third party and you have a right to ask the doctor to make amendments if you feel it is incorrect or misleading.  Should the doctor not agree to this you may write a note and attach it to the report before it is sent.
  • You have a 21 day period to view the report before it is sent off to the third party.  A report can be sent off after 21 days without your viewing provided you consented to the preparation of the report for the third party.
  • A doctor must hold a copy of your report for at least six months.  You can request to view the report during this time by arrangement with the doctor. A fee will be charged to cover the cost supplying a copy.
  • A doctor can decline to reveal elements of the report to you if he/she feels it would be severely detrimental to your physical or mental health

Sickness Certificates

If you are absent from work for less than 7 days a self certificate is required, these can be obtained from your employer.

It is not a statutory right for your employer to ask for a Medical Certificate if you have been absent from work for less than 7 days, if they insist, they can pay for the cost of a Private Certificate which your doctor can provide.

If you are sick for more than 7 days you will need to see your doctor before a Medical Certificate is issued, he/she will need to see you again each time a further certificate is required.

Medical Certificates for absence from school, college or any other place can only be issued as a Private Certificate for which there will be a charge.

FEES FOR NON-NHS SERVICES

PRIVATE SICK NOTE                                                                                                                                              £20.00

VACCINATION CERTIFICATE                                                                                                                              £10.00

HOLIDAY CANCELLATION CERTIFICATE                                                                                                         £20.00

FITNESS TO TRAVEL CERTIFICATE                                                                                                                    £20.00

CLAIM FORMS (BUPA/PPA ETC)                                                                                                                      £15.00-£20.00

SICKNESS/ACCIDENT BENEFIT CLAIM FORMS                                                                                             £15.00-£20.00

HGV/PSB PRE-EMPLOYMENT MEDICAL                                                                                                        £80.00

ENG1 MEDICAL                                                                                                                                                      £80.00

OFFSHORE OPERATORS MEDICAL/UKOOA                                                                                                 £80.00

FOSTERING MEDICAL                                                                                                                                          £80.00

 

Any letters required to provide information or to support applications                                          £10

 

Common Ailments in Children and Adults

Please click on the following link for information regarding Common Ailments

Health Centre – Childhood Illnesses and Common Ailments

We have a zero tolerance policy towards violent threatening and abusive behaviour or aggression in any form at this surgery. Violent threatening and abusive behaviour or aggression may lead to police involvement and removal from the surgery register.

Patients are entitled to see their notes at a small fee, If you need more information please telephone the surgery and ask to speak to the secretary.

 The following web site will give you all the information you will need to know on how to access your medical records.

 If you have any further questions please telephone your surgery and ask to speak to the secretary.

 http://www.bbc.co.uk/dna/actionnetwork/A1181657

Medical examinations such as insurance, employment and driving medicals etc. are undertaken at the surgery. A fee will be payable and our secretary will be happy to answer any questions you may have.

Please Print off this Well Person Questionnaire and bring it with you to the surgery

Click here for form

When you register with the surgery you will be asked to complete a questionnaire regarding your personal history. This gives us some knowledge prior to your notes arriving from your previous doctor.  You will also be asked to make an appointment for a health check.  Please bring any medication that you are taking with you.

All prescriptions are computer generated for safety and clarity.

We are not a dispensing Practice so you will need to take your prescription to the pharmacist; there is no charge for prescriptions if you are exempt.  If you require many medicines on a monthly basis it may be cheaper to purchase a pre-payment certificate for a twelve month period.  Your pharmacist will be able to answer any questions you have regarding this.

Repeat Prescriptions

Repeat prescriptions are given for medicines you need to take on a long term basis, sometimes for life.  On the right hand side of the prescription is a list of your current medications, please tick the ones you need and return the slip to the surgery giving 48 hours notice (not including weekends). Also on the right hand side of the slip you may find a message from the doctor.  We do not accept orders for prescriptions over the telephone as this can lead to mistakes.

Medication Reviews

Once or twice a year the doctor/nurse will need to see you for a medication review, through this review the doctor will be able to see if your medication needs to be increased, decreased, changed or maybe stopped as well as monitoring you condition.

If you need a doctor out of hours (evenings, weekends and bank holidays), please call 111 where you will receive medical advice/assistance. This service is for problems that cannot wait until the surgery re-opens.

If you need a doctor out of hours (evenings, weekends and bank holidays), please call 01304 840415 where you will be diverted to Stourcare.   Stourcare provide a service to deal with problems that cannot wait until the surgery re-opens.   You will need to provide full information about your problem to the specially trained nurse who takes your call and if she feels you need to speak/see a doctor she will ask him to call you as soon as possible.

If you are too ill to come to the surgery, terminally ill, very sick or are housebound, please telephone the surgery as soon as possible in the morning, before 11.00am, to arrange a home visit. When you telephone the surgery the receptionist will need to ask you some questions regarding the visit so the doctor can judge its urgency and prioritise accordingly.

The Practice endures that all healthcare professionals who are employed by the Practice are currently registered with the relevant professional body on the appropriate part(s) of its register(s) and any employed general practitioner is a member of a recognised medical defence organisation and registered on a care performance list.

 

  • All professions working at the practice are covered by appropriate insurance
  • All doctors have an annual appraisal
  •  Batch numbers are recorded for all vaccines administered
  • The premises, equipment and arrangements for infection control and decontamination meet the national standards.

Soluble Aspirin

Aspirin is good for headaches, colds, sore throats and general aches and pains.

Aspirin should not be given to children under 16 years of age

Paracetamol or Ibuprofen

For pain relief and fever in young children

Sedative cough linctus

For dry painful coughs

Vapour Rub

For steam inhalers, good for children with stuffy noses and dry coughs, rub on chest.

Antiseptic Solution

Diluted (1 teaspoonful) in warm water for cuts and grazes

Antiseptic cream

For treating septic spots and grazes

Antihistamine Tablets

For Hay fever

Calamine Lotion

For dabbing on sunburn, stings and bites.

Bandages (different Sizes)

To support strains and keep dressings in place

Cotton wool

For cleaning cuts and grazes

Thermometer

For taking temperature,

Tweezers

For removing splinters

Plasters

For minor cuts

Click on the following link for all information regarding emergency contraception

Click Here For More Information

You can either use this form to drop your new details in at the surgery

Change of details form

or fill in this online form

Please notify us of any changes to your address or contact numbers.  It is also important to register new born babies as soon as possible.

Change Of Patient Details

Please Fill in only the details that need changing

You can either fill in this form or print off a copy and drop it in the suggestions box in the surgery

Click here for suggestions form

Suggestion

We would love to hear from you! Please make your suggestion below

We endeavour to offer high standards of medical care within the Practice. Patients should expect, and be given, a courteous and prompt response at all times and be offered contact with a doctor within 24 hours.  Patients have the choice to see any doctor they wish, although we recommend they try to stay with the same doctor if there is an ongoing problem.  Patient’s can expect complete confidentiality and involvement with the treatment they are undergoing.

It is the patient’s responsibility to keep appointments and arrive on time, if for any reason an appointment cannot be kept, the surgery should be informed as soon as possible by telephone so it can be offered to somebody else.  We actively monitor patients who do not attend or arrive late for appointments.

The surgery does not tolerate abusive or threatening behaviour to any member of our staff and reserve the right to remove patients from the register who behave in this manner.

The Health Service has decided that that the following holiday vaccines can no longer be supplied under the National Health Service.  The charges payable in advance will be as follows:
 
Vaccine Northern Europe, Australia & New Zealand All other areas
Hepatitis A Adults £59.70 free
Hepatitis A Children £51.10 Free
Hepatitis A & B £116.55 Free
Hepatitis A + typhoid £124.50 Free
Hepatitis B course & blood test £131.25 £131.25
Booster & Blood Test £65.00 £65.00
Japanese B Encephalitis Not Needed £104.90
Meningitis ACWY £30.85 £30.85
Rabies £103.72 £103.72
Tick bourne Encephalitis £86.90 £86.90

Net Doctor

The following links will provide you with lots of information should you need to administer first aid.

 

St Johns Ambulance First Aid

Aylesham Medical Practice and Wingham Surgery are registered with the Data Protection Registry.  All patient information is obtained and processed within the law and all information is confidential. No information will be disclosed by doctors, nurses or administration staff without prior consent from the patient, this includes patients under the age of 16.

 

In extreme circumstances where the doctor feels the patent is at great risk of harm he/she may need to disclose information to a third party.

All patient information held at the practice is confidential.  It may sometimes be necessary to share information with other healthcare individuals involved in your case.  No information shall be disclosed without a patient’s permission unless there is a very exceptional case where the patient is at grave risk of harm.

Written consent is required preferably from a parent or guardian.

The injections are given in the thigh for babies and an arm for older children unless stated nasal. Please tell the nurse if your child has had any reaction to previous vaccines.

The current programme is:

Immunisations Given and When
 Birth  2 Months  3 Months  4 Months  12- 13Months  2,3 & 4 years plus school year one & two
Targeted Hepatitis B and BCG Diphtheria Diphtheria Diphtheria  Hib/Men C booster Nasal flu (annual)
Tetanus Tetanus Tetanus Measles
Whooping Cough Whooping Cough Whooping Cough  Mumps

Rubella

Polio  Polio Polio
Hib  Hib Hib
 rotavirus   rotavirus Men C
Pneumococcal Conjugate Pneumococcal Conjugate  Pneumoccocal
 Men B  Men C  Men B  Men B
 

Girls aged 12 – 13 years – HPV

Age 13-18 years Diphtheria, Tetanus and polio booster – Men ACWY vaccine

 

 

Side effects are few, occasionally there is soreness and redness at the injection site. A cool pad will reduce swelling. Some children develop a raised temperature a few hours later in which case we recommend a dose of Calpol be given.

You will be asked to wait for 10 minutes on the premises after the immunisations to make sure your child has no immediate ill effects. Side effects are very rare.

It is very important that children are protected as early as possible, so please do keep appointments. If on the day, your child has a raised temperature or is feeling unwell the vaccination should be postponed until they are better. If you are unsure please check with the practice nurse or duty doctor, and make sure you cancel your appointment.

Please bring your child health record book along with you, as the nurse will need to complete it for you.

How we deal with Complaints

 

  • A sign in the reception area indicates that anyone wishing to make comments, suggestions or complaints should ask to speak to the Practice Manager. The Receptionist shall contact the Practice Manager (or a designated deputy where the Practice Manager is absent.)

IN-HOUSE PROCEDURE

  • The Practice Manager shall interview the patient/complainant in a private area.
  • Listen to what the complainant has to say without interruption. Take notes and before responding make an assessment as to whether this is an informal complaint or a formal complaint. In either circumstance complete a Complaint Form and at the end of the interview invite the patient/complainant to check and sign it.
  • An informal complaint will be something that can be resolved there and then or that the Practice Manager can undertake to resolve quickly. Such matters can be dealt with by telephone or by sending a follow-up letter.
  • If it is considered to be a formal complaint, advise the complainant that there will be an investigation as part of the NHS Complaints Procedure and provide a copy of the complaints leaflet as well as a leaflet about the Mediation Service and a consent form if the complainant is not the patient.

The following points should be included during the discussion:

  • the investigation will be started immediately
  • an acknowledgement will be sent within 2 working days
  • a formal response will be provided within 10 days working
  • an opportunity to meet those involved may be offered
  • the Complainant can request an Independent Review if the outcome is not satisfactory.

 

If you have a complaint or concern about the service you have received from the doctors or any of the staff at our surgery, please let us know.  We have a procedure as part of a NHS system for dealing with complaints.

Our fist action will be to try to resolve the complaint quickly and easily at the time it arises.  If you would like to take it further we would ask you to put your complaint into writing and send it to the Practice Manager who will deal with the matter very promptly.

We will acknowledge your complaint within two working days.  Within two weeks you will either receive a letter of explanation or an invite to attend a meeting at the surgery with the people involved where it will be discussed and hopefully resolved.

 

Primary Care Trust contact

Mrs Ann Cook (complaints manager)

Protea House,

Newbridge,

Marine Parade,

Dover,

Kent CT17 9HQ

Tel: 01304 222312

Fax: 01304 225775

Email: Ann.cook@ekpct.nhs.uk

The surgery will always welcome any suggestion you may have that will improve our services, you may write in or use the suggestion box at the reception.