BURY CIRCUMCISION CLINIC

Walmersley Road Medical Practice, 
Bury: BL9 6DX
Tel: 07811 125404

    Dr. AFZALHUSSAIN
    (MBBS, FRCS, FCPS)
    GMC: 4352392

					
	
5th November 2011

Date: 21 / 01 / 2020

Audit on Parents Satisfaction Survey following Religious male baby Circumcision :

Introduction: 			

The Circumcision Service was initially set up at Woodbank surgery in Bury in 2009. It is currently provided at Walmersley Road Medical Practice, Bury: BL9 6DX on every Wednesday PM and Saturday AM sessions. It was introduced as a result of an approach made by The Bury Council for Mosques to meet the cultural and religious needs of the local population. The service is of special benefit to the Muslim, Jewish and Afro-Caribbean population as every male baby must be circumcised on religious/cultural grounds.  Circumcision is only provided under the NHS for medical reasons, religious circumcisions are not, therefore a charge for the cost of the procedure is made and this is currently £120. It is a Doctor led service with a dedicated nurse. The doctor has been supervised and approved by a Consultant Urologist to undertake the procedure. An independent Quality Assurance (QA) assessment and certificate is issued on the yearly basis by Manchester Public Health. A peer review meeting is conducted at the Greater Manchester level on a yearly basis.

This service is provided on 1st come, 1st serve basis, to the babies of all communities between the ages of 1-week to 12-months of age. Babies outside this age bracket will be accepted only in exceptional circumstances. A dedicated direct public access phone number and an information leaflet is available. The procedure is carried out only in surgery using standard "Plastibell" (ring) technique under local anaesthetic using pre-sterilized single use equipment in a simply clean environment.

On arrival at the clinic the baby is first assessed by a doctor/Nurse.  A history form is completed by the parents with the baby’s birth details, together with his current health and wellbeing.  Family’s medical history is also noted, with specific references to any bleeding disorders or allergies.  The procedure is explained to the family along with information leaflet. The information covers different aspects of the actual procedure, risks involved, as well as the after care of the baby once he has gone home. 

The baby is observed in clinic for up to ½ hour following the procedure for any signs of bleeding.  If a baby bleeds and continues to do so for more than the half hour, steps are taken according to the situation, as needed. 

All high risk families/babies receive a telephone call the following day to enquire whether there have been any complications or problems overnight.  Further follow-up is arranged according to the need. Parents are encouraged to ring back after 10-days to let us know if the ring has come off or not.  A small number of babies may need to be brought back to the clinic to have the ring removed.

BURY CIRCUMCISION CLINIC

Walmersley Road Medical Practice,
Bury: BL9 6DX
Tel: 07811 125404

					

    Dr. AFZAL HUSSAIN
    (MBBS, FRCS, FCPS)
    GMC: 4352392

Aims and Objectives

The objective of the audit is to assess on-going parental satisfaction with the service during this emotionally draining and physically exhausting period of carrying out religious circumcision of their beloved newly born babies. It was also intended to provide an opportunity to the parents for their feedback, advice and suggestions to further improve the provision of this service to the community on the national level. By carrying out this audit, we would ensure that we were practicing in line with the Quality Assurance protocol run by Greater Manchester department of Public Health, CQC and the GMC Guidelines.

Method

A “Parents Satisfaction Survey” questionnaire (attached) was handed over to all 176- parent of babies operated for circumcision from 15th Novevember-2019 to 15th January-2020.

All parents were requested to fill in the questionnaire and return it either on the same day after the procedure or by mail / email at a later date. The majority of parents filled in the feedback back form but some parents apologised for not being able to fill up the form due to language barrier but were very delighted to leave a verbal +ve feedback after the procedure. 
All parents were contacted again by their phone numbers provided within 2-weeks after carrying out the circumcision for the parental comments and feedback. However the comments included at the end of this audit report are taken only from the written feedback provided by the parents after the procedure.

						Walmersley Road Medical Practice,						Bury: BL9 6DX
						Tel: 07811 125404								
BURY CIRCUMCISION CLINIC

Parents Satisfaction Survey:	 

Baby’s Name …………………………………………………..DOB: ...……………………………

Address: …………………………..........................................................................................

Date of Procedure ……………………………….Telephone No ……………………………..

1. Parental satisfaction: (1= minimum, 5= Maximum)

                        1                2                 3                   4                    5

2. Are parents happy with over all experience:                		Yes / No
	
3. Are you going to recommend this service to others:              	Yes / No

4. Post Op complications:	Bleeding		Infection		Ring Related

Please write your comments: ……………………………………………………………

………………………………………………………………………………………………

………………………………………………………………………………………………

………………………………………………………………………………………………

Date: …………………… Name: …………………………. …..  Signature ………………….

Thanks

BURY CIRCUMCISION CLINIC

Walmersley Road Medical Practice,
Bury: BL9 6DX
Tel: 07811 125404

 Dr. AFZAL HUSSAIN
    (MBBS, FRCS, FCPS)
    GMC: 4352392

	

Results and analysis:

A total of 176- consecutive parents were requested to fill in a Parents Satisfaction Survey form and to hand over or post it back as soon as possible. Some of them required a reminder for these forms to be sent back. 149-parents left the written feedback on the same day.   Number of parents expressed their high level of satisfaction but could not fill up the form due to the severe anxiety at the time or due to the language barrier. However all parents were contacted by phone once again between 2-weeks after the procedure to get their final feedback about the procedure. Total feedback received were 149 (84.6%). 27-parents (15.3%) remained not contactable either due to no contact number provided or due to wrong number on the notes. 

Out of 149-parents given feedback, 141 (94.6%) parents scored “Excellent”, 6-parents (4.02%) scored “Very Good” and 2-parents (1.34%) scored “Good”. 3-parents (2.01%) expressed some degree of unhappiness with the final outcome of the procedure even though they were satisfied with the procedure on the day of surgery.

Two babies (1.13%) had slight post-operative bleeding. One baby had a bleeding on the same day and the 2nd baby had slight bleeding on the 2nd post-op day. Both of these bleedings were attributed to fastening tight nappies despite given clear instructions to use 1-2 size bigger nappies throughout the post-op week. Both of these bleedings were stopped after taking their nappies off altogether and just by observing them at home. 4-babies (2.27%) developed signs of suspected local infection and were treated with topical antibiotics.  In 5-babies (2.84%), ring was removed electively in the clinic on 7th post op day. Ring can take up to 2-weeks to fall off by itself but these parents travelling from far away were not able to return for review at a later date. All these were considered to be minor complications of this procedure.

Out of all 149-parents given the feedback, all parents (100%) expressed high level of initial satisfaction with the service. At the 2-weeks follow up, 3-parents (2.01%) expressed some degree of unhappiness with the final outcome of the procedure even though they were satisfied with the procedure on the day of surgery. All (100%) but 3 (2.17%) parents expressed their happiness in recommending this service to their family & friends. 

Feed back

All circumcision clinical staff has been informed about the outcome of this audit. 
A further yearly review audit will be conducted next year in Jan-2021.

Dr. A. Hussain,  GP Principal at Warmersley Road practice, Bury:  BL9 6DX

Walmersley Road Medical Practice, 
Bury: BL9 6DX
Tel: 07811 125404

BURY CIRCUMCISION CLINIC

    Dr. AFZAL HUSSAIN
    (MBBS, FRCS, FCPS)
     GMC: 4352392

Some of the written comments passed by Parents:

•	All staff is very kind and helpful, doctor nicely handled the baby, it was worth an experience
•	Amazing service, doctor handled things brilliantly, we are very happy.
•	Doctor has been so gentle with our baby that he did not cry at all. Aftercare instructions were well explained especially about nappy changing.
•	Really pleased about how doctor handled everything, will recommend to other family members and friends. 
•	Doctor & nurse is very polite and communication with parents was clear.
•	Very personal service given. Both Dr & nurse were brilliant & highly recommended.
•	Good service provided, thank you Dr. Afzal Hussain
•	Fantastic experience, very well informed procedure, will recommend to F&Fs.
•	Very professional, educational and quick, Dr in particular was very knowledgeable and empathetic to parental concerns and answered all Qs.
•	Fantastic experience, this is our 3rd child, been done. We were made to feel welcome and comfortable. All relatives and family use the same doctor, thanks for everything.
•	Great experience, doctor was in full control of the procedure and takes parents wellbeing in to consideration, he is highly recommended.
•	The service is brilliant; doctor and nurse explained everything really well. Im happy.
•	Aftercare explained parents reassured, happy with service.
•	The service is brilliant, the doctor & nurse explained everything really well, 
•	Very easy looking procedure, no issues occurred during the procedure, all were great.
•	Dr was very nice, informative, made the experience easy for us all, religious in his ways, will definitely recommend to others.
•	Very nice & kind staff, Dr explained everything step by step, thanks very much. 
•	I am very happy with how the doctor handled everything and with the outcome of the procedure after a week.
•	Excellent professional service, calm atmosphere, Surgery staff is very helpful, thanks
•	The procedure was carried out really well and very professional.
•	Masha-Allah very good behaviour and very kind staff.
•	Procedure was well done & explained. Dr made us feel at ease, comfortable to contact him anytime.
•	Very helpful & friendly service, we were well informed of each step.
•	Very friendly and professional service, all information provided accurately.
•	We visited for the 1st time and are very happy with the service.
•	Procedure explained well, we were made comfortable, child was also comfortable.
•	Helpful staff, given good/very good written information about aftercare prospectively.
•	Brilliant service, very well explained, 100% satisfaction.
•	Excellent service, well done, place was clean, will definitely recommend to others.
•	Friendly service, all good Alhamdulillah, thanks to the Almighty.
•	Very friendly and great service, we have been seeing Dr. Hussain since 2006, JZA.
•	Very kind humble doctor, explained everything well before procedure, the staff is also very helpful. God bless you all.
•	This is 7th baby from the family getting procedure done here, we are all very happy.
•	Dr. Hussain did my 1st son as well, procedure done really well, very polite and calm.
•	Thank you very much doctor, we have been back many times and will be back with another family member soon.