Bousfield Surgery

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last assessment we rated this question as requires improvement. At this assessment the rating has changed to good. We assessed all quality statements within this key question.

Staff worked to reduce health and care inequalities. Continuity of care was offered to patients where required or when requested and longer appointments were available if necessary. The practice worked within the Primary Care Network (PCN) to provide extended access for patients.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff said they ensured people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs. The provider attended multi-disciplinary meetings with relevant professionals and services to discuss and plan patient care and treatment so that people’s needs could be met holistically. Staff demonstrated a person-centred approach to their work, and we observed staff who were supportive of patients during our assessment. Results from the patient GP survey showed 73% of people said they had enough support from local services or organisations in the last 12 months to help manage their long-term condition or illness, compared to 71% locally and 69% nationally. Additionally, 91% of people said they found the reception and administration team helpful, compared to 85% locally and 40% nationally. Whilst on site 2 patients sought out inspectors to provide positive feedback particularly about staff and the improvements that had been achieved since the previous CQC visit.

The practice worked in partnership with other services and all staff we spoke to were familiar with and understood the needs of the patient population. The clinical staff team was small and were able to provide continuity of care. Staff worked with multi-disciplinary professionals to meet the needs of patients. Staff told us that, where appropriate, patients were able to request and see the same healthcare professional. This was supported by the National GP Patient Survey results, in which 76% of respondents confirmed this was their experience, compared to 39% locally and 40% nationally. Referrals to other services were made promptly and information shared by other services was managed effectively and timely to support good outcomes for people. The practice staff said they tried to encourage patients to attend for follow up appointments, screening programmes and child immunisation uptake, although results in these areas remained lower than average.

Staff communicated and provided information in a way that helped people to understand their care. People received information about their health and treatment options to enable them to make an informed decision and the practice website contained NHS information about health conditions and support services. However, there were areas where information on the practice website could be improved to support people by adding for example, minutes from Patient Participation Group (PPG) meetings, updated information on carers and links for the Friends and Family test. The provider was responsive to these improvements. Interpreters and a language tool were used to assist people whose first language was not English but information on the website could not be changed to a different language by patients. Social media sites with practice information were also available for patients.

The provider used systems to share information about patients effectively across services. Safety netting advice was provided when patients were at risk of deteriorating. Feedback from the National GP Patient survey was positive and showed that 89%of people who responded, compared to 83% locally and nationally, knew what the next step would be within 2 days of contacting their GP practice.

Information was available at the service and online so that people knew how to give feedback about their experiences of care and support, including how to raise any concerns, complaints or issues. Reception staff told us how they dealt with people’s concerns daily and addressed concerns before they were escalated to the relevant leads. However, we saw that compliments and complaints were not always analysed in a way that could monitor trends although it was evident that learning was disseminated and improvements made when required. Complaints training had been undertaken by the practice manager and supervisor but not by all other staff who would benefit from formal training around the complaints process to encourage uptake and review. Feedback was also collected through the NHS Friends and Family Test, and inhouse patient surveys, but the feedback was not analysed in a way to inform improvement. In addition, results and access to the Friends and Family test on the website were not current. We discussed these missed opportunities during the assessment with staff and leaders who were receptive to our feedback with plans already in place to rectify this. We saw evidence of positive feedback and compliments from patients.

The provider was aware of the requirements to meet the accessible information standards. The patient record system was used to alert staff to any communication or health related needs. A hearing loop was in place for people with hearing difficulties, though staff were not trained in its use. Longer appointments were booked for patients who required the services of an interpreter and for those with complex long-term conditions. A member of staff held the role of Learning Disability Champion, attended meetings and brought recommendations for improvement to support patients back to the practice. The provider tried to ensure that people could access the service easily and quickly so that they got the support and treatment they needed when they needed it. However, appointments were generally offered on a first come first served basis rather than triaged by need. This had been recognised by the practice as ineffective, and some improvement had been achieved by arranging for staff to be trained in care navigation. However, we did not see this fully embedded at the time of the assessment. The provider had also added 1 emergency appointment per day. The provider monitored patient access and made changes in response to ensure patient satisfaction. People who responded to the GP patient survey were positive about their access to appointments with 76%, compared to 39% locally and 40% nationally, stating they usually got to see or speak to their preferred healthcare professional when they would like to. Of the people who completed the survey 59% found it easy to get through to the practice by phone, compared to 52% locally and 53% nationally. In addition, 84% described their overall experience as good compared to 78% locally and 69% nationally.

We saw good examples where staff and leaders actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this, specifically in relation to the reduction of addictive medicines. Staff treated people equally and without discrimination and understood the importance of providing an inclusive approach to care which was adjusted to support people’s individualities. There were processes to ensure people could register at the practice, and people in vulnerable circumstances such as homeless people and Travellers were treated equally.

People who used the service were provided with information to make informed decisions about their current and future care and treatment and supported to plan for these. Our records review showed people were supported to consider their wishes for their end-of-life care, including cardiopulmonary resuscitation. This information was shared with other services as necessary. Multi-disciplinary team meetings were held on a regular basis to discuss the needs of people receiving end of life care.