Ripple Road Medical 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 looked for evidence that the service met people’s needs, and that staff treated people equally and without discrimination.

At our previous assessment on 14 December 2023, we rated this key question as Requires Improvement. At this assessment, we assessed all seven quality statements from this key question, and the rating has changed to Good.We found staff treated people equally and without discrimination. The provider complied with legal equality and human rights requirements.

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.

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.

Staff used structured, condition‑specific templates to support personalised and holistic care, including for long-term conditions such as Chronic Obstructive Pulmonary Disease (COPD), asthma, diabetes (including insulin initiation and patients of child-bearing age), learning disability, dementia, and Hormone Replacement Therapy (HRT).

Care plans reflected patients’ physical, mental, emotional, and social needs including those related to protected characteristics under the Equality Act. Patients were supported to understand their clinical condition and related considerations such as co-morbidities and long-term conditions and were involved in planning for their care needs and decisions about their care. People’s cultural needs were considered. This included targeted support for patients with diabetes, such as younger patients and those requiring guidance during Ramadan. Advocacy services were promoted within the practice to support patients in making informed decisions about their care.

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.

Patients with specific vulnerabilities were flagged on the practice system to ensure person-centred support, including those with frailty and individuals with learning disabilities or dementia. Staff engaged with allied health and social care professionals to ensure patients’ care was centred around them, with multidisciplinary team (MDT) involvement supporting safe and personalised care. This enabled shared clinical input and coordinated management across services, including for patients with diabetes and weekly MDT meetings for older adults.

Staff worked jointly with community respiratory services, and shared care arrangements were in place, including monitoring for patients prescribed Disease-Modifying Antirheumatic Drugs (DMARDs).The practice had appropriate processes for managing patients’ referrals, correspondence, and follow-up. A daily duty doctor system supported triage, urgent assessments, and home visits, including for housebound patients to help address patients’ needs promptly.

Patients had named clinicians where appropriate and effective workflow management processes were in place. These included two-week wait referral pathways with tracking to ensure follow-up in line with urgency, routine referral processes, and clear patient DNA (“Did Not Attend”) and child not brought procedures, with appropriate escalation. Safeguarding concerns were monitored through regular reviews, with named leads overseeing this work. This approach was promoted by clinical leadership, with one of the practice partners presenting a child not brought to appointment policy at a Royal College of General Practitioners (RCGP) conference.The practice also signposted families with children under six years of age with autism, providing supporting information and appropriate referral pathways.

The service made sure patients were given clear, understandable information to help them take part in decisions about their care and treatment.

Patients’ communication needs were identified, supported, and recorded in their clinical notes. Interpreter or sign language support was available, and the practice’s website included translation functionality so information could be viewed in different languages.

The service provided information in accessible written formats, in line with the NHS Accessible Information Standard (AIS). Large print versions of registration and online access forms were available for people with visual impairments, and easy-read materials supported people with learning disabilities or lower literacy. Appropriate information and signage were shared and displayed throughout the practice, and a hearing loop was available for patients who were deaf or hard of hearing.

The practice also provided support for patients who needed assistance to access online services and their clinical records. Patients were given guidance on how to access their medical records and how to use the NHS App.These arrangements helped patients remain informed, involved, and supported in managing their health and to receive information in a way they could access and understand.

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.

The service gathered feedback through a range of methods, including the national GP Patient Survey, the Friends and Family Test, practice surveys, and regular Patient Participation Group (PPG) meetings.GP Patient Survey feedback reflected that the service had listened to people’s views and experiences to improve services. For example, at the previous inspection in 2023, 41.4% of respondents reported that it was easy to get through to someone at the practice by telephone. In response, the practice improved its telephony systems. At this assessment, the GP Patient Survey showed that 56% of patients found it easy to get through to the practice by phone, which was higher than both the local average of 51% and the national average of 53%, reflecting an increase in patient satisfaction.

Staff also engaged with people who may be less likely to use traditional feedback routes. This included holding a “drop-in” clinic in a local church, which helped engage socially isolated patients and provided an opportunity for people to raise concerns in a community setting.

The service had clear processes for patients to raise concerns and complaints, which were managed compassionately and in a timely way. Learning from complaints was evident; the practice apologised where appropriate, and feedback was shared with staff and used to make improvements. For example, actions had been taken to keep patients updated in the event of appointment delays. Patients were informed about how to escalate concerns if they remained dissatisfied.

These arrangements demonstrated that the service listened to people, involved them in decisions, and used feedback to make improvements to how care was provided.

The service made sure that people could access the care, support, and treatment they needed when they needed it.

Staff used appointment data and a triage system, aligned with NHS guidance, to prioritise care and improve patients’ equity in access according to clinical urgency and patient need. This supported appropriate access and reflected a multidisciplinary approach, including physiotherapy, pharmacy, mental health, and social prescribing services.

A range of appointment types was available, including face-to-face, telephone, online consultations, and home visits. Appointment lengths were adjusted where needed, for example, for patients with learning disabilities, those requiring interpreters, and postnatal or baby checks.

Staff were trained in care navigation and triage to support timely access and appropriate signposting to other services. Home visit requests were reviewed promptly by the duty doctor, with visits provided for housebound and palliative care patients.

The practice made reasonable adjustments to support equitable access, including step-free access, disabled parking, hearing loss support, a quiet room, and baby changing and breastfeeding facilities. A “drop-in” clinic in a local church provided an opportunity for patients to access care or monitoring such as a blood pressure check in a community setting.

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.

The practice monitored and improved equity in experience and outcomes by using data and audits and participating in research. This included demographic data and audits on cancer, Hormone Replacement Therapy (HRT), and hypercholesterolaemia (high LDL or "bad" cholesterol). Higher-risk or harder to reach groups were identified, including patients living in areas of deprivation, those from Pakistani and Bangladeshi backgrounds, and people with long-term conditions. The service had acted to improve its slightly below target breast and cervical screening uptake and its below target bowel screening uptake.

Findings were used to inform targeted action, including improving communication, supporting non-responders to bowel screening with multilingual information, and strengthening cervical screening processes through named leads and failsafe systems. Patients with long-term conditions were supported through recall systems, including structured follow-up for those missing elements of the diabetes care processes.

The practice participated in the Genes and Health study to improve understanding of health outcomes in Pakistani and Bangladeshi communities. Learning from audits and research was used to improve follow-up, communication, and safe care.

Staff collaborated with partners, including the local authority, to increase uptake of childhood immunisations and deliver community-based initiatives. This included the pop-up clinic in a local church with GP, nursing, care coordinator, health visitor, talking therapy services, fitness classes, and social prescriber staff in attendance, enabling engagement with and care for patients, ensuring access to a range of health and wellbeing services.

Staff received training appropriate to their roles, including equality, diversity and inclusion (EDI), learning disability and autism, mental capacity, and care navigation. The practice implemented guidance to support patients with gender dysphoria and provided targeted support for families of children with autism through signposting and collaboration with specialist leads.

Staff treated people equally and without discrimination and feedback from patients was positive. These arrangements demonstrated that the service understood its population and took proportionate action to reduce inequalities in patients’ experiences and outcomes.

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.

Staff identified patients who may benefit from early future care planning and supported personalised discussions about preferences, priorities and wishes including DNACPR and treatment‑escalation decisions. This information was appropriately shared with other services via an electronic shared care plan.

Patients with palliative care needs were identified through a structured system and reviewed regularly. These patients were discussed in multidisciplinary and practice meetings, supporting a shared understanding of care priorities and ensuring continuity and coordination across the team.

Records showed that advance planning was clearly documented where appropriate, including decisions about preferred place of care and place of death. Evidence was seen of patients expressing a wish to remain comfortable at home or be supported in a hospice setting. Documentation also included lasting power of attorney and carer contingency planning where relevant. These arrangements demonstrated that the service planned with patients and families and supported care that was aligned with individual wishes and needs.