Askern 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 requires improvement. At this assessment, the rating remains the same.

The service was in breach of the legal regulation in relation receiving and acting on complaints.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We found 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. Our review of clinical records showed patients were supported to understand their condition and were involved in planning for their care needs. They were also involved in decisions about their care.

We found that 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 provider told us how they provided services utilising specialist trained staff bringing specialist care into the community, some of which had helped reduce referrals to secondary care and waiting times for patients. We received positive feedback from patients and members of the patient participation group (PPG) regarding these services. Examples included: a suspected cancer clinic, testosterone monitoring and carpal tunnel surgery.

The suspect cancer clinic was started in response to post Covid secondary care delays. It is reported that the clinic saw between approximately 50 - 70 patients a week assessed as urgent for testicular and breast lumps, suspicious moles, skin cancers, rectal or vaginal bleeding and prostatic symptoms. The operating theatre for any minor surgery performed was based in Mexborough Medical Practice. The provider reported to us that since the clinic was set up, they had seen just under 2,500 patients.

We found that the service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. We were informed that amongst the staff group, staff could communicate in up to 12 different languages and use Makaton. Makaton is a language programme that combines signs, symbols, and spoken language to help people with communication and learning difficulties express themselves.

Information to promote the take up of screening and immunisation programmes was available in a range of languages.

Information provided by the service met the Accessible Information Standard.

Patients were informed as to how to access their care records.

At the previous assessment we scored this quality statement as 1. This was because the provider could not demonstrate that all complaints received were recorded, investigated or responded to and the practice was not following their complaints policy. There was no identification of patterns or trends to the complaints.

At the previous assessment we scored this quality statement as 1. This was because the provider could not demonstrate that all complaints received were recorded, investigated or responded to and the practice was not following their complaints policy. There was no identification of patterns or trends to the complaints.

At this assessment we found the same concerns. There was a lack of effective process for complaints to be investigated, a mechanism for lessons learnt to be identified and shared, and a robust way for improvements to be made. The service did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

We reviewed 3 complaints in detail and found concerns with all of them. These concerns included (but were not limited to) there being no evidence of investigation on file, inconsistent discussion of complaints at multi-disciplinary meetings, issues with written responses, and a lack of lessons learned. All 3 failed to mention the right to escalate their concerns to NHSE/PHSO.

The provider had a complaints policy and procedure in place. This was available on the practice website along with details of how to make a complaint. A laminated summary was available at reception on request. However, within the practice (both at Askern and Mexborough), the complaints policy was not ‘conspicuous’ (easily seen) as per best practice. There was no signage at either site, no posters highlighting the right to complain and no leaflets to give to patients who might request them.

A review of the procedure and a sample of letters confirmed that the provider did not make clear the right to refer unresolved matters to NHS England in line with the complaint regulations. People were signposted only to the Parliamentary and Health Service Ombudsman (PHSO).

There was no identification of patterns or trends to the complaints that were made available during the assessment. An Annual Complaints Review and Learning Log’ was submitted by the provider during the CQC factual accuracy process. Verbal complaints were not consistently recorded. A book was held in reception that monitored self-described ‘grumbles and compliments’. These matters were not collated or classified as complaints, despite requirements to do so.

Feedback we received via the electronic CQC questionnaire we sent to staff was positive about the recent changes made following complaints from patients and suggestions for improvement from staff.

The practice had a Patient Participation Group (PPG). Feedback was positive about the way the practice engaged with them and how they promoted and responded to feedback.

At the previous assessment, this quality statement was scored as 1. This was due to continued concerns around low appointment availability and poor patient experience.

At this assessment, improvements were evident. We saw evidence the service was improving access. However, the National GP patient survey data indicated that patient satisfaction with access was low. At the time of this assessment these systems were newly implemented and so not able to demonstrate/evidence improvement or impact on patients accessing services.

The provider shared a summary statement to demonstrate what changes they had introduced following the last assessment and from their own feedback. The statement stated that a range of performance metrics were reviewed on a regular basis. We saw improved data in terms of call waiting times.

People who used the service were given the opportunity to provide feedback to CQC as part of the assessment. All but 1 response was positive about the prompt and responsive services from the practice. We received negative feedback in relation to booked appointments being moved frequently and often at short notice. We were also informed by staff that pre-booked appointments for medication reviews were often changed as they were booked ahead of the due date and often had to be changed to fit in other appointments.

A new non-clinical leadership team was in place; they told us about changes implemented and oversight arrangements. Non-clinical vacancies had largely been filled, with some staff in post and others awaiting start dates. Non-clinical leaders were observed supporting operational pressures, including covering telephone lines during the day of the assessment.

We were informed by the provider that GP capacity had increased since the last assessment. This was supported by feedback from non-clinical staff who reported there were now more appointments available to book patients in to.

We received positive feedback from the PPG regarding the significant improvement in access via the telephone.

Treatment rooms were available and accessible to patients.

Whilst positive steps had been taken to deliver on improving access, scores from the most recent National GP Patient Survey continued to be significantly below the national average. For example:

• the percentage of respondents who responded positively to how easy it was to contact their GP practice on the phone was 21%, compared to the national average of 53% and
• the percentage of respondents who responded positively to the overall experience of contacting their GP practice was 46.5%, compared to the national average of 69.6%.

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. For example, carers were offered Saturday morning and 7.30am appointments to better suit their needs.

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 experiences and outcomes. For example:

• The service was ‘safe surgery accredited’ which meant they were taking steps to tackle the barriers faced by migrants in accessing healthcare.
• The service was Veteran Friendly accredited and had signed up to the Ministry of Defence’s Armed Forces Covenant.

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.

The practice and treatment rooms were accessible to all patients, for example via ramped entrance and ground floor treatment rooms.

People who used the service were given the opportunity to provide feedback to CQC as part of the assessment. All but 1 response was positive about the prompt and responsive services from the practice.

We found that 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.