Teldoc-Oakengates 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

At this assessment we found that the practice did not always organise and deliver services to meet patients’ needs, patients could not always access appointments in a timely way and complaints were not used to drive continuous improvement. We found some people had difficulties with accessing the practice and expressed difficulties in having to complete the online form required before an appointment would be allocated. The call centre system had a limit to the number of calls that would be able to get through, which raised concerns about patient safety and access. Overall, we found that systems and processes needed strengthening to ensure these were consistent to enable patients to access care in a timely way.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Negative feedback had been received through comments at the CQC and online feedback concerning access and being able to speak or see a clinician to discuss health needs. Results of the National GP Patient Survey demonstrated 86% of people said they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment, this was slightly lower than the local and national average of 91%.
We spoke with people on the day of the onsite assessment and received mixed responses to appointment availability and the Health Co-Pilot the practice used to obtain an appointment, with people telling us that they had completed the form, but were unable to secure an appointment and had to redo the form again.
The care plans we viewed reflected physical, mental, emotional, and social needs of people including those related to protected characteristics under the Equality Act.
 

We saw the practice worked in partnership with other services to meet the needs of its patient population. As the organisation had 3 registered locations and 3 branch practices, regular meetings were held with the teams across all sites to ensure continuity of care. We were provided with evidence to demonstrate that practice nurse meetings were in place and clinical meetings were also held on a regular basis. Multi-disciplinary team meetings were held to ensure people received continuity of care within the community.
Teldoc had social prescribers available to support people with signposting to local support within the community, this included people who were suffering with loneliness, caring responsibilities and other non-clinical issues. An inhouse staff survey had been carried out to gain an understanding of staff awareness of social prescribing service and the criteria. The survey highlighted some areas of improvement was required to ensure staff were fully aware of the service. Following the survey the social prescribing team put together information for all staff to support them in referring people who needed help and this had been added to the organisation online information centre for staff to be able to access when they required further guidance.
The organisation provided extended access from 6.30pm to 8pm Monday to Friday and 9am to 5pm on Saturdays to support people who worked and were able to attend a practice during core hours. People were able to access appointments at the 6 practices within the Teldoc organisation.
 

There were systems in place to support patients who face communication barriers to access treatment and patient records were held in line with guidance and requirements.
We found the practice complied with the Accessible Information Standard and that information about people that collected and shared was in line with data protection legislation requirements.

The organisation had a patient experience lead who logged all complaints for the practices and we were told these were acknowledged within 3 days. Any complaints submitted through the website would receive an automatic acknowledgement. All complaints were investigated by the appropriate person and patients were responded too with the outcome of the investigations and any further action that would be taken. Learning from complaints was shared with staff through various meetings within each practice.

Feedback from the patient survey results demonstrated that 76% of patients say the healthcare professional they saw or spoke to was good at listening to them during their last general practice appointment and 86% were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. The practice told us they collated feedback via the Friends and Family test (FFT) to make improvements to the service. Evidence provided for the FFT was from 2023/24 which showed an average of 90% satisfaction scores. In addition, there were regular meetings with the patient participation group (PPG) on ways to improve the service.

The practice had a complaints policy in place and complaints were reviewed further and were responded to improve the quality of care. There were regular practice meetings where complaints and significant events were discussed to share learning to make improvements. Information about how to complain was readily available and patients could make a complaint in person, or via the practice website.
 

Results from the National GP Patient Survey showed negative responses in relation to access. 18% of people said they found it easy to get through to the practice by phone. This was significantly lower than the local average of 48% and the national average of 50%. Further results showed that 21% of people found it easy to contact the practice using their website. This was lower than the local average of 42% and national average of 48%. Feedback provided by people using the service, both online as well as to CQC, was negative.
In 2024 Teldoc introduced the Health Co-pilot as a clinical triage model to reduce the number of calls to the practice and improve access for people. People that required an appointment had to complete the online form which was then triaged by a member of the clinical team and allocated to the appropriate person. Feedback from people on the day of the on-site assessment, through comments received at the CQC and through online feedback showed there was difficulty in accessing the service. People told us that they could not always get access to a GP and at times could be on the telephone for some time, to then be told there were no more appointments left. People told us this was a very stressful experience. On the day of the onsite assessment, we witnessed people becoming very upset as they had been unable to access an appointment and were very concerned about their health. People told the practice staff they had continually completed the form over several days but had not heard anything about an appointment. We also found this had occurred at other sites during the onsite assessment with people reporting the same difficulties.
On the second day of the onsite assessment, we reviewed the call centre and the system currently in place. We found at 10.30 am, the call centre dashboard showed 50 calls waiting, with the longest waiting time at 1 hour 37 minutes. In the afternoon at 2.35pm there were 37 calls waiting, with the longest waiting time at 58 minutes. The waiting times included people who had requested a call back. Information provided showed the call centre capped the waiting queue when it reached 50 calls, which meant additional calls could not join the queue once the threshold was met.
The leadership team told us they had continued to see a rush at 8am for appointments. They had implemented a range of initiatives to encourage people to use the online system. These included patient engagement, website messages and time embargoed appointments to ensure there were enough appointments available throughout the day. We listened to a random sample of calls at the call centre and found people who had been triaged were advised by the call centre staff that they needed to be seen today, however there was nothing available and they were told they had to call back the next day to try and get an appointment. If no appointment was available the following day, this would continue until the 3 day cut off period when their request would be closed and a new online form would have to be completed to commence the process again. We discussed this with the leadership team who told us that urgent cases would be passed to the GP on duty for advice and review.
We found from what staff told us that there were problems with access arrangements in place for people to access a GP. The complaints they had received, and the difficulties being experienced identified the process needed to be improved. Staff were facing issues daily with people struggling to access a GP and the pressure this had put on staff when dealing with people was impacting on their wellbeing. We saw first hand the impact this had had on a member of the reception staff who had to deal with complaints. It was clear the leaders understood access was a concern and continually monitored the Health Co-pilot model and call centre statistics and had made numerous adjustments based on their findings.
Home visit requests were triaged by clinicians before being allocated to the a clinician to complete. We reviewed a random sample of home visit triage cases which showed appropriate clinical judgement. However, on reviewing the home visit policy we found a list of conditions that did not require a routine home visit. These included transport issues and older people with poor mobility or joint pain, this also included care home residents. This posed a potential risk to elderly patients who lived alone without access to transport or mobility limitations that may need a clinical assessment.
 

We found staff treated people equally and without discrimination. The provider had processes to ensure people could register at the practice, including those in vulnerable circumstances such as homeless people and travellers. 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 provider 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, including meeting the Accessible Information Standard. We saw examples where the practice had met the needs of vulnerable patient groups and removed barriers for improved patient experience. For example, the practice premises had a hearing loop in place and access to interpreters was available. People with learning disabilities and poor mental health experienced additional care through annual reviews. People with dementia were referred to appropriate services where required.
The practice had an active PPG, which met with key staff members at the practice, quarterly. Areas discussed included feedback from people who used the service and online access.
 

Leaders understood the requirements of legislation when considering consent and decision making and had access to policies to support them. We were told that the practice held multidisciplinary meetings with other agencies to share and discuss information relating to care and treatment, for example, those on the practice palliative care register.
There were systems in place to ensure staff kept up to date in training relating to the Mental Capacity Act and Deprivation of Liberty Safeguards. We found that all staff had completed the required training.