Dr Lalit Gurnani Also known as Nantwich Health 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 assessed all quality statements under this key question. At our last inspection we rated this key question as good. At this assessment the rating remains the same.

Staff worked to reduce health and care inequalities. Continuity of care was consistently offered to patients, with GPs maintaining specific patient lists, and longer appointments were available when necessary. The practice worked within the PCN and supported local service developments as part of this. Indicators around access, when benchmarked against other local practices, was within expectation and had recently been reviewed to make improvements. Information about how to raise a complaint was provided and the sample of complaints we looked at had been investigated and responded to. However verbal complaints were not documented to inform themes and trends. Information from complaints was discussed with required individuals but was not routinely shared with the entire team for the benefit of learning and improvement. The premises were purpose built and fully accessible for people with disabilities including quiet areas where patients could have 1-1 discussions with staff or be alone with relatives.

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.

Staff said they ensured people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any changes in their needs. The provider attended multi-disciplinary meetings with relevant professionals and services to discuss and plan patient care and treatment so that people’s needs could be met holistically. Staff demonstrated a person-centred approach to their work, and we observed staff who were supportive of patients during our assessment. Results from the National GP Patient Survey showed that 74% of people said they had enough support from local services or organisations in the last 12 months to help manage their condition or illness compared to 71% locally and 69% nationally. A total of 81% of people who responded to the National GP Patient Survey said the healthcare professional they saw or spoke to was good at treating them with care and concern compared to the local result of 88% and national result of 86%.

The practice worked in partnership with other services to meet the needs of its patient population. There were 6 part time GPs with their own patient lists. However, this amounted to 2.9 whole time equivalent GPs to provide continuity of care, and the practice was awaiting the onboarding of 2 additional GPs to improve equitability for the existing clinicians. Staff worked with multi-disciplinary professionals to meet the needs of patients. Staff told us that, where appropriate, patients were able to request and see the same healthcare professional. However, this was not supported by the National GP Patient Survey results, in which 25% of respondents confirmed this was their experience compared with 39% locally and 40% nationally. Referrals to other services were made promptly and information shared by other services was managed effectively and timely to support good outcomes for people. We saw that all practice staff encouraged patients to attend for follow up appointments, screening programmes and child immunisation uptake, and results in these areas were better than average. The provider worked closely with the PCN to plan, develop and deliver services across the locality. Patients from within the locality could attend the practice for outreach clinics for the providence of ultra-sound scanning, epilepsy, neurology, and audiology. NHS consultant led vasectomy clinics were also held at the practice negating long waiting times for patients who would otherwise only be managed in secondary care services.

Staff communicated and provided information in a way that helped people to understand their care. People received information about their health and treatment options to enable them to make an informed decision and the practice website contained NHS information about health conditions and support services. The provider used systems to share information about patients effectively across services. Safety netting advice was provided when patients were at risk of deteriorating. Feedback from people who responded to the National GP Patient Survey showed that 79%knew what the next step would be within 2 days of contacting their GP practice, compared to the local and national results of 83%. Staff had access to interpreter services and used these to support people whose first language was not English. They could make information available in a patient’s preferred choice when required. We noted the practice website provided a language translation feature covering a broad range of languages.

Information was available at the service and online so that people knew how to give feedback about their experiences of care and support, including how to raise any concerns, complaints or issues. People were encouraged to write in to the practice if they wished to complain about their care, treatment and support, and those complaints we reviewed were responded to appropriately with an acknowledgement and an apology. Reception staff told us how they dealt with people’s concerns and addressed concerns before they escalated. Feedback was collected through the NHS Friends and Family Test and from formal complaints, but feedback from verbal complaints was not analysed to inform improvement. We discussed these missed opportunities during the assessment with staff and leaders who were receptive to our feedback with plans in place to rectify this.

The provider was aware of the requirements to meet the Accessible Information Standard. The patient record system was used to alert staff to any specific communication or health related needs. Longer appointments were booked for patients who required the services of an interpreter and for those with a learning disability or complex long-term conditions. The provider tried to ensure that people could access the service easily and quickly so that they got the support and treatment they needed when they needed it. Staff said that most patients who requested it could see a GP on the day of request or were signposted to a more appropriate person or service to meet their needs that day. An on-call GP was available to triage and arrange for patients to be given an urgent appointment. Staff were trained to direct people to the most appropriate clinician or service to meet their needs. The provider monitored patient access effectively and made changes in response to ensure patient satisfaction.

Staff and leaders actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. The practice had engaged in The Better Care Fund (BCF) a government initiative to identify frequent attenders of accident and emergency (AE) services with a view to providing a holistic case management approach in the hope of addressing unmet needs and reducing the demand at AE. We saw that staff treated people equally and without discrimination and understood the importance of providing an inclusive approach to care which was adjusted to support people’s individualities. There were processes to ensure people could register at the practice, and people in vulnerable circumstances such as homeless people and Travellers were treated equally. Staff used appropriate systems to capture and review feedback from people using the service.

People who used the service were provided with information to make informed decisions about their current and future care and treatment and supported to plan for these. 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 as necessary. Multi-disciplinary meetings were held on a regular basis to discuss the needs of people receiving end of life care.