Bitterne 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 that staff treated people equally and without discrimination. We found leaders used people’s feedback and other evidence to actively seek to improve access for people. The practice was designed to be accessible and timely for people who were most likely to have difficulty accessing care. The practice prioritised and allocated resources and opportunities as needed to tackle inequalities and achieve equity of access. At our last inspection, we rated this key question as Good. At this inspection, the rating remains the same.

This service scored 86 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service.

Staff told us there was a person-centred approach to delivering care and the service provided care in a way that was inclusive to improve accessibility to vulnerable patient groups. We saw evidence of patient feedback being collated and reviewed monthly with improvements to service provision implemented where needed. For example, the practice had implemented a ‘questions and answers’ newsletter for the wider patient community. This had enabled the practice to review themes in queries and feedback, leading to positive changes including amendments to appointment availability and services offered within community settings.

Patients had a named GP to support continuity of care, although they could choose to see a GP of their choice where possible. Where referrals were made to external services, these were monitored and followed up appropriately. There was an integrated approach to patient care, and services worked well together. Patients at the practice who lived in a care home benefited from access to a frailty nurse and GP via the local primary care network (PCN), a group of GP practices working closely together, aligned to other health and social care staff and organisations, providing integrated services to their local population.

The practice complied with the Accessible Information Standard. Staff told us translation services were available for patients who required them. They also told us patients could request information in more accessible ways, such as in large print or braille. Individual communication needs were noted on the patient’s record for all staff to be aware of. Staff told us they supported patients with using online services. Staff completed training on data protection to ensure information collected and shared by staff met data protection legislation requirements.

The practice website contained accessible information, for example, opening times, patient registration, clinics and services, complaints, and prescription ordering. Reasonable adjustments were made at the practice to support communication, including the use of interpreters. 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. Patients were also provided with information on how to access their medical records.

There was a complaints process in place, including a complaints lead, and a policy. Information was also available on the practice website on how to complain to the practice. We reviewed a number of complaints and found they were actioned in an appropriate and timely manner, discussed in meetings, and learning shared with staff. Where appropriate, patients were provided with an apology and signposted to the Parliamentary and Health Service Ombudsman. There was also an annual review of complaints which looked at themes, learning points, changes made and other planned actions.

The practice manager chaired meetings with the practice’s Patient Participation Group and ensured that the group were provided with clinical input from a GP. They organised regular education sessions for both the PPG and wider community.

Results from the National Patient GP Survey were positive. However, the practice noted some patients had difficulty using the website, which led to changing the website provider and seeking patient feedback to improve usability. The practice had received positive comments from patients following this change.

Patient appointments were available either online, face to face, via telephone, or as a home visit. Patients could book appointments by telephone, online, walking-in and could also submit medical or admin requests online via the practice website. Patients could book routine appointments up to 2 weeks in advance and same-day appointments were available each morning. Staff confirmed both emergency and routine appointments were available during the week of the assessment. The practice offered appointments with a variety of clinical staff, for example GPs, health care assistants, pharmacists and practice nurses. The practice had remote access sessions (medical appointments that take place virtually) twice per week via the local PCN.

Staff took a proactive approach to supporting patients identified with a learning disability. The practice had actively engaged with the local residential homes for adults with a learning disability. They had co-produced systems to ensure patients with a learning disability were confident in visiting the practice. For example, they had implemented introductory visits to the practice and Saturday clinics as a ‘quiet time’ for these patients as requested. This had led to particularly high rates of learning disability health checks, with no ‘Did not Attend’ markers. The learning disability health checks took a ‘one stop shop’ approach, incorporating vaccines, blood tests and health promotion advice in one visit.

The practice had offered a routine proactive care review to people who were cared for at home and could not access the practice. This was undertaken by a GP or advanced care practitioners via the local PCN. The practice also had systems in place to prioritise patients based on need, including those receiving palliative care.

Staff had completed care navigation training, and the practice had designed and implemented a triage process for staff to follow, outlining what constituted an urgent priority and how to respond appropriately.

The practice had met the Accessible Information Standard to ensure all people, including those with communication needs, could receive effective care and treatment. The practice was able to demonstrate reasonable adjustments under the Equality Act 2010. For example, the premises had a portable hearing loop in place for patients with a hearing impairment.

The practice worked with the local PCN social prescribing team to identify unregistered carers and had sought their feedback to understand what support carers would like to receive. The practice was registered as a Veteran Friendly Practice. This accreditation, run by the Royal College of General Practitioners (RCGP) and NHS England, recognises and supports practices in delivering the best possible care and treatment to patients who have served in the armed forces.

The local PCN’s social prescribing team, together with a GP partner of the practice, held outreach clinics at a local church once a month to support patients facing issues such as debt and social isolation. The practice shared many positive stories demonstrating how this project had helped patients. For example, social prescribers assisted a patient in obtaining financial support to cover the cost of prescriptions.

Additionally, the practice was actively involved in health innovation programmes and had recently been selected by NHS England to promote a community-based cardiovascular disease case finding.

Staff were trained and had guidance available to ensure specific care plans were completed for people to ensure their resuscitation and emergency treatment wishes were known. The provider had access to annual training for staff in relation to the Mental Capacity Act, understanding learning disabilities, and consent.

Staff supported patients to make informed decisions about their future, including at the end of their life. The practice employed a specialist palliative care nurse who held the caseload for patients with palliative care needs. They worked closely with the local hospice and secondary care settings to ensure effective, joined-up care. The specialist palliative care nurse worked closely with patients’ families to provide support after death, utilising the local PCN’s social prescribing team for signposting to local wellbeing services.

Patients on the practice’s palliative care register were reviewed in monthly multi-disciplinary meetings. Staff told us how they worked with patients and their carers, to support them to understand their options regarding Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions.

Processes were in place to support patients to make informed decisions about their future, and to review patients at the end of their lives.