St Andrews Medical Practice

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• 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. The service did not always make sure that people could access the care, support and treatment they needed when they needed it, however we did note that there had been a sustained effort by the provider to improve access and that patient experience

At our last assessment, we rated this key question as requires improvement.At this assessment, the rating has changed to good.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people were at the centre of their care and treatment. Evidence we viewed showed that care delivered was person-centred and considered people’s physical health, mental health and social needs.

Since our last inspection of this provider in 2023, it had refined its internal governance to ensure people were at the centre of their care and treatment choices. Patients had access to appointments provided by a range of clinicians. These appointments contained a mix of face-to- face, telephone and home visits. The provider informed us that patient feedback was used to identify areas for improvement and made necessary adjustments to ensure the care provided was addressing relevant patient needs.

The provider operated a total triage system for appointments. The provider used an online platform where patients can request appointments. Once a request is received at the service, it was triaged by experienced GPs to allocate resources based on clinical urgency and guide patients to the most suitable services. There was a duty doctor available during opening hours to manage on the day clinical priorities. The provider informed the assessment team that the use of the triaging system provided appropriate appointments for patients according to their reported health concerns.

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 practice had tailored its services to meet the diverse needs of its community, for example, building relationships with community groups to promote the take up of screening programmes. There were established mechanisms for engaging with the community healthcare provider.

The provider worked in partnership with other services to meet the needs of its patient population. We saw evidence of provider engagement with group organisations in relation to dementia care and support for specific ethnic minorities, support provided to local nursing and care homes and working closely with local pharmacies to support the Pharmacy First Scheme. Home visits were undertaken for housebound patients, and patients who were unable to come to the service (following triaging by GP).

The provider had been nationally recognised for its collaborative work within the local borough on a specialised asthma nurse-led service focusing on enhancing safety and care for high-risk children in Barnet.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information to promote the take up of screening and immunisation programmes was available in a range of languages. The provider had access to interpreter services, including British Sign Language. The provider’s website was able to be translated into over 90 languages. The website included information on how patients could access their care records, what services were available at the service and latest news about the provider and the wider community services.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

We viewed the provider’s complaints log for the past 12 months and identified that the provider addressed concerns raised. The provider fed back to patients the outcome of concerns/complaints raised with them. Learning from complaints was discussed at team meetings. This was evidenced by the provider from service meeting minutes we viewed as part of this assessment.

The provider’s website had a ‘You Said We Did’ section, in which the provider spotlighted changes made within the service based on patient feedback as well as answering broad questions received from patients.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

The most recent published National GP Survey results for this provider showed that people did not always feel that they could easily access services. 38% of respondents to the survey said that it was easy to contact the provider by phone, in comparison to local and national averages of 55% and 53% respectively. Similarly, 26% of respondents said that it was easy to contact the provider using their website, in comparison to local and national averages of 50% and 51% respectively.

People could access the service to suit their needs for example online, in person and by telephone. There were treatment rooms available on the ground floor, and a ramp and automatic door had been fitted at the entrance.

The service informed us that the refinements regarding patient access they had implemented since our last inspection continued to be embedded. Patients were able to make appointments in person, and via the telephone, practice website and an online consultation tool. Both urgent/same day and pre-bookable appointments were available. The service offered early morning appointments and (working with their Primary Care Network) were able to offer patients evening and weekend appointments.

The service told us that reasonable adjustments were in place to enable support patient choice, which included access to interpreter services, longer appointments when needed, and tailored communication approaches.

Staff treated people equally and without discrimination. The provider sought ways to address any barriers to improving people’s experience and worked with local services, to address any local health inequalities. This provider worked with local dementia care agencies, the collaborative work on the specialised nurse-led asthma clinics, and engagement with local residents’ associations.

Staff were able to support those with additional needs, this included those with language and communication needs via access to translation and interpretation services. Longer appointments were available where required, especially for patients with more complex needs. In addition, we saw that the provider delivered services to the elderly or more vulnerable within the community. The provider supported patients who resided in two local care homes. Services offered to these patients included regular site visits, ad hoc call outs, and structured communication with care home managers to ensure services were appropriate, or if changes to care and treatment was required. We received positive feedback from both care homes, regarding the care and treatment residents received.

The service’s GP’s, nurses collaborated with patients to enable shared decision-making about their care. The provider’s social prescriber worked with patients and looked at a variety of factors (including social, emotional and practical) that might impact on patient health, enabling patients to co-produce personalised social care plans.

The provider undertook targeted outreach work to support engagement with vulnerable patients and families who may otherwise struggle to access care.

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.

The provider told the assessment team that urgent care plans (UCPs) were completed and actively reviewed to ensure patient preferences, escalation decisions and treatment limits are clearly documented and shared with relevant services. This supports safe, coordinated care across settings, including out-of-hours services.

Named GP lists were used to ensure continuity of care for all patients approaching end of life, with clear communication between clinicians and community partners. Working with patients, family and multidisciplinary partners, the provider told us their focus was to provide compassionate, coordinated end-of-life care. As this assessment focused on the key question of Responsive, we did not review any patient records as part of this assessment.