Primary Care Centre

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 Requires Improvement. At this assessment, the rating has changed to Good.

At the last inspection we found that the practice had not considered patient feedback concerning being unable to access services and there was no evidence to demonstrate that the provider had reviewed patient feedback to improve services.

At this inspection we found that the practice had taken action to respond to patient needs. Improvements had been made so people could access services when they needed to, without physical or digital barriers, including out of normal hours and in an emergency. The practice website had been improved and people could submit an online request for non-urgent medical queries or administration requests. Leaders understood the challenges to patient access and services were being designed to make them accessible and timely for people who were most likely to have difficulty accessing care. The provider prioritised, allocated resources and opportunities as needed to tackle inequalities and achieve equity of access. At the time of our inspection a callback facility had been implemented to reduce people’s waiting time on the telephone and to improve access further and complaints were used to drive continuous improvements.

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 made 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 practice told us that they regularly involved patients in planning and making shared decisions about their care and treatment that meets their needs. Staff had been trained in equality and diversity, consent, deprivation of liberty safeguarding and mental capacity.

The service made 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. Care plans reflected physical, mental, emotional, and social needs of patients including those related to protected characteristics under the Equality Act. Peoples overall experience of contacting the GP service was generally positive as demonstrated in the National GP Patient survey, where the practice had achieved 66%, which was in line with the local average of 68%, but lower than the national average of 74%.

Patient satisfaction scores in the GP National Patient Survey were in line with local and national averages, particularly in areas relating to patient-centred care. For example, 76% of respondents found the reception and administrative team helpful, in comparison to the local average of 76% and the national average of 83%.

A review of clinical records confirmed that patients were supported in understanding their conditions and were actively involved in planning and making decisions about their care.

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.

The practice understood the needs of its local population and were taking action to develop services in response to those needs. Through the Primary Care Network (PCN), the practice staff were able to offer patients access to other services such as social prescribing, physiotherapy and mental health nurse to support their overall health and wellbeing. We saw the practice worked in partnership with other services to meet the needs of its patient population.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The practice website included useful information on health awareness and promotion. Information and resources were available for patients to support them to understand how to access services. For example, there were arrangements in place for people who needed translation services or who may be digitally excluded.

There were systems in place to support patients who face communication barriers to access treatment and patient records were held in line with guidance and requirements. We found the practice complied with the Accessible Information Standard (AIS) and that information about people that collected and shared was in line with data protection legislation requirements. Patients were informed as to how to access their care records.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. 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 the practice’s policy. There were regular practice meetings where complaints and significant events were discussed to share learning to make improvements. Information about how to complain was readily available and patients could make a complaint in person, or via the practice website.

Feedback from the GP national patient survey demonstrated that 78% of patients say the healthcare professional they saw or spoke to was good at listening to them during their last general practice appointment. This was in lower than the local average of 83% and the national average of 87%.

The practice had an active patient participation group (PPG) and regular meetings were in place to discuss improvements and plans to improve the service.

The service made sure that people could access the care, support and treatment they needed when they needed it.

The practice was responding to the needs of their population and were developing services in response to those needs. The practice told us they obtained feedback from various sources such as the GP patient survey, complaints and via informal feedback from patients. The practice undertook ongoing audits to determine demand and capacity regarding their appointment system and continued to monitor the availability of appointments and staff on a daily basis. The GP national patient survey showed 57% of respondents found it easy to get through to the provider by phone. This was higher than the local average of 44% and the national average of 50%. The practice had a new telephone system which had a call back system to reduce the waiting times for people on the telephone. Information from the telephone audit showed that in April 2025, 99 people requested a call back and 94 people had received a call. Further evidence showed that the average waiting time for a call to be answered was under 5 minutes.

Patients could access appointments by phone and by visiting the practice. The practice used a sign-posting triage system where reception staff would ask the patient for enough information to make a decision regarding which clinician was appropriate for them to see. Patients were given the option of a face to face or telephone appointment. Patients who had a request for an emergency appointment were seen the same day. People who had a non-urgent medical or administration request could submit a form online. The practice website provided information for patients regarding how to book an appointment. Feedback from staff demonstrated people in vulnerable circumstances were able to register with the practice, including those with no fixed abode.

Appointments with a GP were available throughout the week. Extended access was available every Wednesday from 6.30pm to 8pm. When the practice was closed patients were able to contact 111. The practice offered appointments from a variety of additional clinical staff for example nurses, health care assistant and pharmacist. Pre-booked appointments were available on weekday evenings and at the weekend through an arrangement with other local GP practices.

The practice had arrangements in place for prioritising patients. Staff were trained to book appointments with members of the practice clinical team or signpost patients to other appropriate services and were supported by a duty doctor.

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.

The practice had promoted and responded to feedback by people who used the service within the last 12 months. People could leave feedback via NHS UK, the practice website and via the Friends and Family test (FFT). At the time of the on-site assessment, the provider was preparing an inhouse survey to gather patient feedback. This was due to be launched in June 2025.

The provider complied with legal equality and human rights requirements, including avoiding discrimination, having regard to the needs of people with different protected characteristics and making reasonable adjustments to support equity in experience and outcomes, including meeting the Accessible Information Standard (AIS). We saw examples where the practice had removed barriers for improved patient experience. For example, the practice premises had a hearing loop in place and access to interpreters was available. The provider had processes to ensure people could register at the practice, including those in vulnerable circumstances such as homeless people. 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 with learning disabilities and poor mental health experienced additional care through annual reviews. People with dementia were referred to appropriate services where required.

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.

Leaders understood the requirements of legislation when considering consent and decision making and had access to policies to support them. We were told that the practice held multidisciplinary meetings to share and discuss information relating to patient care and treatment, for example, those on the practice palliative care register.

There were systems in place to ensure staff kept up to date in training relating to the Mental Capacity Act and Deprivation of Liberty. We found that staff had completed the required training.

There were registers held for those patients who were vulnerable who were on the palliative care register or at the end of their life. We found that clinicians understood the requirements of legislation and guidance when considering consent and decision making and saw that consent was documented.

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.