The Willow Tree 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

We looked for evidence that the service met people’s needs and staff treated patients without discrimination. At our last assessment in 2018 using the old methodology, we rated this key question as good. At this assessment, the rating has changed to requires improvement because we found issues with equality of access, person- centred care and experience of outcomes.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice did not always ensure people were at the centre of their care and treatment choices and care plans were not always developed with the people in response to their changing needs. The care plans of asthmatic patients seen were not comprehensive and personalised to the patients. The care plans for patients with Chronic Obstructive Pulmonary Disorder (COPD) were equally not personalised to the patients. Our review of the clinical records showed patients were not supported to understand their health conditions to be fully involved in planning for their care and to make informed decisions.

The practice worked in partnership with other services to meet the needs of the patient population. The practice offered flexible appointments to patients and tried to encourage patients to attend medication reviews with the same GP to ensure continuity. The social prescriber from the primary care network workforce worked closely with the practice staff to ensure the patients got the right support they needed.

The practice staff shared information with the patients. The local Primary Care Network (PCN) also shared information with the patient population in preferred language using technology such as Google. The practice liaised with the social prescriber to enable patients to use the NHS App to access their records. However, after the site visit, the practice informed CQC that provision of interpreting services was made for patients who required such services. There was no evidence that the practice staff had completed Accessible Information Standard training, however, some of the staff had completed training on information governance. From patient feedback, there was a lack of sufficient information to help them understand the benefits of health care screenings offered.

The practice responded to complaints from patients, however, action plans and lessons learned were not always clearly defined and recorded in staff meeting minutes to prevent a recurrence. Patients were not always involved in the review of their conditions to monitor improvements or deterioration.

The practice did not always make sure that people could access the care, support and treatment they needed when they needed it. The door to the practice was not accessible for patients in a wheelchair. Following our site visit, the practice shared the risk assessment completed for wheelchair service users and how the practice staff would support patients who needed assistance with the door (2 members of staff will assist the patient in a wheelchair). The patients could access appointments online and via the telephone but the feedback from patients was more face-face appointments were needed. We saw records that showed the patients were in the queue on the telephone for long periods of time before they could speak to anyone at the practice to book appointments or share their concerns. The telephone call‑back system was not always followed by the practice as some patients told us they never received a call‑back despite requesting one. Patients who were visually impaired were able to order their repeat prescription over the phone.

The results of the 2024 National GP patient survey showed the practice as significantly below the national and local averages for responses about access to the practice. The results showed 50% of the respondents had a good overall experience of contacting the practice (national 67% and local 70%), 34% found it easy to contact the practice on the phone (national 50% and local 58%), 23% found it easy to contact thepractice using the website (national 48% and local 52%), 55% found the reception and administrative staff helpful (national 83% and local 81%), 22% found it easy to contact the practice using the NHS App (national 45% and local 49%), 15% usually got to see or speak to their preferred healthcare professional(national 40% and local 41%). Following the site visit, the practice shared the action plan to improve patient experience, but the impact remained to be seen.

Most of the staff at the practice had completed training on equality and diversity. The patients were known to staff. Health check reviews were not always completed for eligible patients including patients with a learning disability. The uptake of cervical screening 75.2% (national target 80%) and child immunisations 82.4% which is significantly below the 90% minimum target (national target 95.0%) was very low among the patient population and was below the national average targets. The only group of child immunisations that met the 90% minimum target was children aged 2 who had one dose of MMR (91.4%). The practice explained that the uptake had remained low because the level of deprivation in the area which was in the 4th lower decile might have possibly impacted on the results. The door knocking exercise embarked on by the Nominated individual to increase the uptake was not measured to monitor the impact on the awareness of the patient population. This did not show an effective measure to improve patient experience and outcomes.

The practice did not have a process to identify patients in last 12 months of life other than GP flagging this on a case-by-case basis and by Care Connection (one of the community services team) highlighting patients. The practice relied on knowing the patient and alerting the Care Connection team of any issues. At the time of our visit, the practice had one patient on palliative care and there were no alerts on the patient record. The principal GP informed us that the code was on a differently named list (problem list) accessible to the staff. There was a patient identified who had a Do not attempt resuscitation (DNCPR) recorded in accordance with relevant legislation. The patient record had an alert for all staff to see.