Castlegate & Derwent Surgery

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

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

This service scored 35 (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 did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity.

We received mixed feedback regarding if the service treated people with kindness, empathy and compassion, or respected their privacy and dignity.

Within significant events recorded by the practice, we saw examples in which patient privacy was not always upheld. For example, patient notes being made on the wrong clinical record, or a prescription being issued to the wrong patient.

Staff told us that shorter appointments that were being offered to patients did not give staff the opportunity to offer their preferred level of compassion and communication to patients to provide a holistic approach to care. Staff told us that they tried their best in difficult circumstances to deliver good care. National GP Patient Survey data showed that 64% of respondents would describe their overall experience of this GP practice as good. This was lower than the national average of 75%.

We received 108 submissions of feedback from patients. This was positive toward clinicians, nursing staff and receptionists. We also received numerous examples from patients who told us one clinician was rude and impersonal. Patients report feeling rushed during consultations with this clinician. They also told us where possible they preferred to see another doctor.

The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

National GP Patient Survey data showed that 86% of respondents were involved as much as they wanted to be in decisions about their care and treatment during their last appointment. This was lower than the national average of 91%.

The practice leadership were aware of issues with the patient recall system within the practice. We saw that an example of a missed recall included a patient with a learning disability. Consideration had not been given to this person’s individual needs when arranging for a further appointment to take place. Information from our clinical searches showed that care and treatment such as medication reviews, did not always account for people’s individual needs.

We were not assured that patients individual needs and communication preferences were being considered as part of the patient triage process one the form had been completed.

A representative from the PPG told us that the practice had been keeping its head above water for years, and that this had impacted patient care. Patients were aware that numerous staff members leaving had a negative effect, as the practice could not recruit new doctors with the same experience.

The service did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

People were not supported to have choice and control over their own care. Some clinical staff did not offer telephone appointments where the patient or triaging clinician felt this would best meet the patients’ needs at that time. National GP Patient Survey data showed that 34% of respondents usually get to see their preferred health care professional; this was lower than the national average of 40%. Staff told us they were concerned about continuity of care due to the number of clinical staff leaving the practice.

Feedback from people to CQC indicated that people felt the new patient triage system was ineffective. They were told various things from different clinicians. If a patient wanted a telephone consultation this was not always an option offered, which delayed care in some cases.

The service did not listen to or understand people’s needs, views and wishes. The practice leadership did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

There was a system for appointment triage that did not ensure that all people with immediate needs had access to services, we note palliative patients were prioritised. The practice leadership were aware of these issues but had not taken steps to identify patients who may be within the triage list that had more immediate needs.

Staff told us that they were concerned about the number of patients waiting for an appointment and were worried that the patients being given appointment were not the people who needed them the most. Staff we spoke with raised concerns about the volume of patients that were being signposted to other services such as 111. We saw that whilst people were waiting for an appointment, they were not signposted to other services such as crisis teams and sexual health services.

Staff told us that senior support was not always available and told us examples of incidents in which an immediate response was needed from a senior doctor, where they were unable to reach them by telephone. We saw evidence of incidents where staff were lone working, and there were therefore no staff around to observe patients in the waiting area in the event of an emergency or a deterioration in someone’s health.

The service did not care about or promote the wellbeing of their staff. They did not support or enable staff to deliver person-centred care. This posed a risk to the wellbeing of both staff and patients.

We received information from several whistleblowers, as well as staff questionnaires, and when speaking with staff during our site visit.

There were significant areas of poor working culture. Staff told us they felt discouraged from providing feedback and suggestions about the ways in which to improve the service for people, and some described being afraid to do so. There was little wellbeing support for staff. Staff told us they felt discouraged, and afraid for patient safety. Staff felt an immense amount of responsibility for patients and the care they received. Staff did not get support from practice leadership if they were struggling at work. There was a feeling of low morale within the practice, and staff told us they struggled to think about what the future of the practice looked like.

The practice leadership did not encourage or promote a healthy work-life balance for their staff. In response to concerns about capacity of appointments, the practice leadership had suggested that GPs should work more hours and overrun on clinics where short appointments were offered. Staff told us that they would often complete excess work at home.