Alston Medical Practice

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

We looked for evidence that the service met people’s needs, and that staff treated people equally and without discrimination.

At our last assessment, we rated this key question as Outstanding. At this assessment, the rating has changed to Good. At this assessment we found that some of those areas previously regarded as outstanding practice were now embedded throughout the majority of GP practices. While the provider had maintained this good practice, the threshold to achieve an outstanding rating had not been reached. The practice is therefore now rated good for providing responsive services.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service was exceptional at making sure 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 service understood the needs of different people and groups of people and delivered care and support in a way that met these needs and promoted equality and equity. For example, the practice is located in a rural community, many of their patients are farmers whose livelihood and wellbeing could be impacted at different times in the year. Support services were co-ordinated by the practice during these times, looking particularly at mental health needs.

Similarly, the practice staff understand that the rural nature of their practice area can make hospital attendance difficult. The practice tried to do blood tests in the surgery that would otherwise be done at hospital and will communicate directly with hospital consultants re the needs of patients. This results in appointments being expedited when needed and avoided when not needed. This represents a considered approach by practice staff as the nearest secondary care settings are between 18 to 20 miles away. It also takes into consideration that between 20-25% of their registered patients are over the age of 65.

Care plans reflected physical, mental, emotional, and social needs of patients including those related to protected characteristics under the Equality Act. Our review of clinical records showed patients were supported to understand their condition and were involved in planning for their care needs.

The most recent National GP Patient Survey showed that 96% of respondents felt positive about the practice meeting their needs, compared with 90% nationally and 91% in the local ICS area.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

We saw the practice worked in partnership with other services to meet the needs of its patient population. The practice had tailored its services to meet the diverse needs of its community, for example, building relationships with community groups to promote the take up of screening programmes. There were established mechanisms for engaging with the local care home.

We received feedback from the district nursing team which emphasised the importance of joint working with the practice, the rapid arrangement of joint visits for palliative patients. They also praised a named practice nurse who had received additional training for leg ulcers and compression bandage care; which the practice was utilising for the benefit of patients.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Individual communication needs were noted on the patients’ records.

Information to promote the take up of screening and immunisation programmes was available in a range of languages. The practice had access to interpreter services, including British Sign Language. Information provided by the service met the Accessible Information Standard. Patients were informed as to how to access their care records.

Leaflets were available in the reception area and posters were displayed to provide patients with information on the practice and the different services available to them.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. This included providing clear links to provide feedback or concerns on the practice website or on a practice leaflet for those who didn’t use digital media. This was in response to patient feedback regarding digital literacy and rural communities. They involved people in decisions about their care and told them what had changed as a result.

We saw complaints were managed in line with policy. Learning from complaints was evident and staff were able to identify changes made as a result of patient feedback, including complaints. Examples of this included the rewording of patient result letters to improve clarity and external clinical involvement in concerns regarding a phone call with staff.

The service was considerate at ensuring people could access the care, support and treatment they needed when they needed it.

In response to the National GP Patient Survey data and from feedback from members of the community, the provider delivered easyaccess to the service. 97% of respondents to the National GP Patient Survey felt they had good experience when contacting the practice compared to 70% nationally or 73% in the Integrated Care System (ICS). In addition, 98% of respondents said they felt happy with their next steps having contacted the practice.

The practice policy was for 15-minute appointments, and they could offer extended appointments for people when needed, for example for patients with a learning disability. People could access the service to suit their needs for example online, in person and by telephone.

Treatment rooms were all on one floor, and a ramp and automatic door had been fitted to the entrance for ease of access.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Feedback provided by people using the service, both to the provider as well as to CQC, was positive. Staff treated people equally and without discrimination. Leaders proactively sought ways to address any barriers to improving people’s experience and worked with local organisations, including within the voluntary sector, to address any local health inequalities. An example of this was the provision of the Social Day Unit. Other examples we heard about include a special winter after-work (out of hours) clinic and extended clinics for people with a learning disability.

Staff understood the importance of providing an inclusive approach to care and made adjustments to support equity in people’s experience and outcomes.

The provider had processes to ensure people could register at the practice, including those in vulnerable circumstances such as loneliness and isolation. Staff used appropriate systems to capture and review feedback from people using the service, including those who did not speak English or have access to the internet.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

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 when necessary.

The practice used NHS health checks, ICAT visits, care planning including DNACPR work to actively review patients and their current state of health but also proactively developing plans and coming up with solutions to problems moving forward. Examples of developing local solutions include the development with hospitals and ICB commissioning teams to set up different cancer pathways for patients; having bloods done in the practice. They learnt from experience from this when setting up a pathway for some patients with cancer of unknown origin; forward planning for the benefit of patients.