Island Health

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• 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 assessed all 7 of the quality statements from this key question – Person-centred care, care provision, integration and continuity, providing information, listening to and involving people, equity in access, equity in experience and outcomes and planning for the future. We rated this key question as good. People’s care, treatment and support promoted equality, removed barriers or delays and protected their rights. Leaders and staff proactively sought ways to address barriers to improve people’s experience, acted on information about people's experiences and outcomes and allocated resources and opportunities to achieve equity. The service 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.

There was partnership working to make sure that care and treatment meets the diverse needs of communities. People were encouraged to give feedback, which was acted on and used to deliver improvements. For example, in response to some poor feedback about the practice website, the service redesigned the practice website to improve accessibility and information for patients. There were systems and processes for planning for the future. Patient feedback was mixed about accessing the service.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The national GP patient survey carried out from January to March 2024 had 127 responses. This found 75% of patients stated the healthcare professional was good at treating the patient with care and concern, and 75% of patients stated the healthcare professional was fairly or very good at listening to them. In addition, 86% stated to some extent or definitely they had confidence and trust in the health care professional they saw or spoke to.

Leaders told us assessments of the needs of the local population have been carried out by the service and gave examples of action taken to address these needs. For example, he service told us they had obtained approval from the Integrated Care Board to run a pilot Same Day Access (SDA) hub in the practice area from November 2024 which would bring 44 extra same day appointments to the local area. The leaders explained they worked with multidisciplinary teams and other partners to enable co-ordinated patient care. To better understand their population's needs, the service team attended locality meetings which are held with the neighbouring PCN and cover themes including growing well, ageing well, and child health.

The service formed a health and wellbeing service designed to address social needs while building confidence and skills for better self-management. Better lifestyle groups were run by the service physiotherapist and health coach to support those with chronic pain.

The service had worked with the local primary care network to develop anticipatory care planning for housebound patients. A home health service was developed by one of the service GPs. The home health service was led by an ANP and nurse practitioners who deliver care in people’s homes. Staff told us that 4% of the patient population had been identified as carers.

The service has been involved in work with a local charity called Neighbours in Poplar who provided support to patients who were isolated or vulnerable. The service also included a Christmas Day meal delivery service to patients who were housebound and isolated. The service had held charitable events to support the work this charity does. For example, staff at the service took part in a sponsored walk. Leaders told us that staff had completed customer service training which emphasised patient centred care.

Leaders told us the service used technology to enable them to continually monitor their performance, for the management of health conditions and access to the service. Staff told us the service ran searches to identify their very vulnerable patients who were at high risk from poor health or isolation. The service carried out welfare checks on these patients. The service had social prescribers who had held open days to tell people about services and support available locally.Staff told us the service was taking part in a lung cancer screening pilot to find cancer in patients earlier, to improve the outcome. The service was also taking part in a bowel cancer screening pilot to follow up patients who had not responded to the bowel cancer screening programme.

People’s care and treatment was delivered in a way that met their assessed needs from services that were co-ordinated and responsive. Where services had not been co-ordinated, these were reviewed as an incident, appropriate action taken and shared learning was cascaded to all staff. There were policies to ensure people received care and treatment from services that understand the diverse health and social care needs of their local communities. Continuity in people’s care and treatment was delivered in a way that met their assessed needs.

The staff from the local integrated care system stated they did not have any concerns about the service. The service was actively involved in their local primary network, where they worked with other services to improve local health inequalities.

The service reviewed long-term condition monitoring at their GP partners meetings and in clinical team meetings and PCN meetings.The service attended both anticipatory and current multidisciplinary meetings regularly to review and improve patient care. Patients could book appointments online, in person or by telephone, longer appointments were offered to those with more complex needs. People in vulnerable circumstances were easily able to register with the service, including those with no fixed abode such as homeless people and Travellers. Patients could be referred to the PCN appointed community mental health nurse, who worked one day a week at the service.

The national GP patient survey carried out from January to March 2024 had 127 responses. This found 85% of patients stated the health care professional to some extent or definitely had all the information they needed about them, and 75% of patients stated the healthcare professional was fairly or very good at listening to them. CQC did not speak to patients on the days of the assessment.

The leaders and staff explained how they ensured information was available to as wide an audience as possible. Staff told us they understood people’s communication needs and they gave examples of how they provided information in a way that was accessible. People who use the service, their family and carers (where appropriate) were provided with information that was accessible, safe and secure and supported their rights and choices.

There were policies and procedures for staff to follow to ensure people had information that was tailored to individual needs. This included making reasonable adjustments for disabled people, interpreting and translation for people who don’t speak English as a first language and for deaf people who use British Sign Language. We saw information was available in easy read formats and information about interpreter services was visible in the reception area. The service complied with the Accessible Information Standard and staff had completed training. There were arrangements in place for people who needed translation services. Staff had access to the data protection and accessible information policies online.

The national GP patient survey carried out from January to March 2024 had 127 responses. This found 75% of patients stated the healthcare professional was fairly or very good at listening to them during their last general practice appointment. Feedback from people via the NHS website and friends and family test showed people felt that staff listened to them and communicated with them appropriately and in a way they can understand.We were provided with patient feedback from local Healthwatch which they had gathered between January 2024 and October 2024. Healthwatch staff interviewed patients in person at the practice and completed a questionnaire. There were 28 responses. The positive feedback covered the quality of online consultations (filling out an online form about your symptoms) and the quality of treatment and care received. People were also positive about the attitude of staff at the service. There was negative feedback about people’s experience of getting an appointment and the ease of getting through to the GP practice by phone. The negative comments were regarding delays in getting through on the phone and availability of appointments. CQC did not speak to patients on the days of the assessment.

The service had collaborated with the PPG to co-produce informative videos about the ARRS roles. The Additional Roles Reimbursement Scheme (ARRS) is a government scheme which provides funding for Primary Care Networks (PCNs) to enrich their teams with health care professionals, to improve access to care for patients. The videos aimed to help other patients better understand the responsibilities and benefits of the ARRS roles, such as Clinical Pharmacists and Social Prescribers. The service had carried out an independent staff wellbeing survey in September 2024, 11 out of 29 staff responded, 100% felt safe in the workplace and 100% felt supported by their manager in their role, 91% stated they were satisfied with the training and development programmes offered by the service. 81.8% felt valued and recognised for their contributions at work. Leaders told us that people’s complaints were reviewed, responded to and shared with colleagues. Any improvements were made in response to the complaints received.

The service had processes for people to share feedback and ideas or raise complaints about their care and treatment. The practice displayed a ‘you said, we did board' in the reception area detailing changes the practice had made in response to patient feedback. After listening to people’s feedback, the practice introduced prescribing of medication to delay menstruation. Staff recognised that many women requested this medication when they undertook religious pilgrimage. A GP designed an online template and pathway to make prescribing of period delay tablets a safe and positive experience for patients.

The service had an active patient participation group. The service had worked with PPG members to make a video about the ARRS roles. Staff had listened to feedback from patients who said people were confused about the introduction of allied health professionals such as paramedics and ANP's. The PPG interviewed staff and made a short video explaining each ARRS role. Staff told us the videos have been used by other practices in the PCN.

The PPG was also involved in the development of the practice website. There was information on the practice website about how to join the patient participation group. The practice held quarterly meetings with the Patient Participation Group. However, there were no minutes from the patient participation group meetings available to read on the practice website. The service had received 61 complaints in the last 12 months. We examined 3 complaints and found all had been managed satisfactorily and in a timely manner. Information about how to complain was available. However, there was no information about who to contact on the practice website and no online copy of the complaints policy. There was evidence that complaints were used to drive continuous improvement. The service acknowledged complaints within 3 working days.

The national GP patient survey carried out from January to March 2024 had 127 responses. This found 49% of patient had a fairly to very good experience of contacting the service, 68% found the reception and administrative staff fairly to very helpful.. 76% of patients know what the next step would be after contacting the service, this increased to 97% within two days. However, 21% found contact through the website fairly to very easy. Only 22% of patients found it fairly easy to very easy to contact the service by phone. This was lower than the National average of 50% and local average of 48%. Satisfaction with phone access at the service had been below the national average for a number of years. The service was aware of this and had introduced a new cloud-based telephone system in December 2023 with new functions, such as a callback option. The service increased the number of staff answering phones at peak times and introduced an online patient consultation form, with the aim of reducing the number of patients calling to book appointments. The leaders told us that in October 2024, the service offered an average of 83 appointments per 1,000 patients per week, which was above the recommended minimum of providing 70 appointments per week per 1000 patient.In response to patient feedback, the service switched from using “econsult” to accurx online consultations (as patients felt this was easier to use). Patients were able to book appointments in advance and the service actively promoted the use of the NHS app. The service had a team of 12 trained patient navigators to ensure patients were booked with the most appropriate healthcare professional. The service had a duty doctor hub and triage protocol to allow for patient navigators to be better supported in care navigation. The physical premises and equipment were accessible. People were given support to overcome barriers to ensure equal access. Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of people in accessing care, treatment and support (whether this was from wider society, within organisational processes and culture or from individuals).

The service had a team of patient navigators who triaged and signposted all requests for support at the first point of contact. A duty doctor hub supported patient navigators and staff had access to a clinical and non-clinical triage protocol. The provider explained this had enhanced patient access and maintained service quality. Leaders told us they monitored appointment data. Prior to the introduction of the online patient consultation form, the service told us they had held patient engagement meetings.

The staff provided examples of how they had engaged with patients and their families who were unable to use the phone or digital platforms to offer them care or treatment. Staff told us the service had participated in a borough wide disability awareness project and had listened to feedback about access from service users and local disability charities.

The service was open from 8am to 6.30pm Monday to Friday and extended hours appointments were available in the evenings and weekends. Patients could book appointments using a new online tool. The online appointment booking was open from 8.00am Monday to Friday. Patients could also call the service and responses were monitored through a dashboard system. The service had a quality improvement plan which included reviewing any barriers to accessing appointments.

The service had a ‘duty doctor hub’ every morning where the duty triage doctor was physically based in the reception area to enable patient navigators to ask questions and offer appropriate appointments.

Appointments could be booked on the same day and in advance through the online appointment system. The service had introduced a triage protocol to help staff identify patients who needed to be seen urgently or face to face. All requests for home visits were reviewed and responded to by the duty triage GP. The service was located in an area of high deprivation and staff we spoke with understood the challenges some people experienced in accessing care.

The service had signed up to receive monthly telephony data collection management reports from Surgery Connect to support a better understanding of demand.

We asked the provider to share details of our Give Feedback on Care process on their website and although we received 10 pieces of feedback, none were specific to this area. The national GP patient survey carried out from January to March 2024 had 127 responses. This found 49% of patient had a fairly to very good experience of contacting the service, 68% found the reception and administrative staff fairly to very helpful and 21% found contact through the website fairly to very easy. 76% of patients know what the next step would be after contacting the service, this increased to 97% within two days. 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. 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 service, including those in vulnerable circumstances such as homeless people and Travellers. We were provided with patient feedback from local Healthwatch which they had gathered between January 2024 and October 2024. Healthwatch staff interviewed patients in person at the practice and completed a questionnaire. There were 28 responses. The positive feedback included the quality of online consultations (filling out an online form about your symptoms) and the quality of treatment and care received. People were also positive about the attitude of staff at the service. There was negative feedback about people’s experience of getting an appointment and the ease of getting through to the GP practice by phone. The negative comments were regarding delays in getting through on the phone and availability of appointments. CQC did not speak to patients on the days of the assessment. CQC did not speak to patients on the days of the assessment.

The service worked closely with local stakeholders and reviewed local health inequalities. The service worked with external partners to implement measures to reduce health inequality within the local population. Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of people using the services. The service had identified the need to offer additional support to patients from the Bangladeshi community and had arranged an advocacy service for Bengali speaking people who came into the service. The staff told us that if patients who wished to register with the service, had no fixed abode, they provided the service address and registered the patient.

The service 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. The service had systems in place to obtain and review patient feedback. This information was used to review the patient experience and address any instances of discrimination. The service had information available in alternative formats and equipment in place to support patients who had a hearing impairment. The service had taken steps to promote patient confidentiality.

The service had recruited staff from the local communities to enable equity of access. The service had a health and wellbeing coach and social prescribers supported by a team of volunteer co-ordinators. The service had formed a health and wellbeing service designed to address social needs while building confidence and skills for better self-management.

The national GP patient survey carried out from January to March 2024 had 127 responses. This found 87% of patients stated they were to some extent or definitely involved as much as they wanted to be in decisions about their care and treatment. People had the opportunity to express their wishes around DNACPR and were supported to plan their future care while they have the capacity to do so. People’s decisions and what matters to them were delivered through personalised care plans that were shared with others who may need to be informed. CQC did not speak to patients on the days of the assessment.

The leaders explained how they had planned for patients care, through the multidisciplinary team meetings. 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. Staff told us about examples where they had supported people to fulfil their goals and aspirations. For example, if a patient wished to improve their independence and rely less on staff care and support.

We reviewed five patients Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions and found they were made in line with relevant legislation and were appropriate. DNACPR records were clearly documented, accessible and evidenced people’s involvement in the original decision. The service held a monthly palliative care meeting to review patients’ needs and had a system in place to ensure their needs were met.