Castlegate & Derwent Surgery

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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.

At our last assessment, we rated this key question as requires improvement. At this assessment, the rating has stayed the same. The service was in breach of legal regulation in relation to receiving and acting on complaints.

This service scored 39 (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 make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs. People’s care, treatment and support was sometimes task orientated. Care delivery did not always holistically consider people’s needs when it should. External patient triage removed choice from patients. Some clinicians in the practice refused to carry out telephone appointments, even where this was a patient’s preference.

We were not assured that external triaging was taking into consideration the information and communication needs of people with a disability or sensory loss.

Leaders did not take the opportunity to learn from significant events or complaints where patients may have come to harm.

Patients told us they had issues with nominated pharmacies, they had told the surgery that certain pharmacies did not stock items, but the practice continued to send repeats to the same pharmacy. The practice had not taken the time to explore alternative options for patients.

There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity. People were not always at the centre of treatment choices, especially in relation to appointments.

People’s care, support and treatment sometimes met their assessed needs, but this was not consistent as services were not designed to be co-ordinated and responsive. At the time of our assessment hundreds of patients who had been assessed as needing to be seen were waiting for an appointment. This demonstrated that the practice could not meet patient demand. Leaders did not have a safe way to resolve this backlog. A short clinic was being trialled by one clinician. Other clinicians had not engaged with these as they did not feel they were safe. Furthermore, we reviewed evidence which indicated a lack of continuity of care. For example, one clinician requesting a test, this being carried out, but due to appointment availability a patient would see another clinician.

The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. We noted significant events, and evidence from service users regarding personal data being shared incorrectly. For example, a prescription being provided to the wrong patient.

Information to promote the take up of screening and immunisation programmes was available in a range of languages. The practice had access to interpreter services, including British Sign Language. Information provided by the service met the Accessible Information Standard. Patients were informed as to how to access their care records.

The service did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not involve people in decisions about their care or tell them what had changed as a result. Complaints were actioned, however we were not assured that this was done effectively. Patients told us that complaints were responded to using AI tools. We saw evidence of this. Patients did have the option to speak with a member of management if they were not happy with the outcome of the complaint. We were not assured that appropriate clinical oversight was given to complaints. Patients told us, complaints had been answered with a generic response. Sometimes produced by an AI programme. There was no evidence that clinical leaders reviewed complaints, and developed training or further supervision where required. Leaders were unaware of or dismissive of what people who used the service thought of their care and support. Patient views were not always taken into consideration.

The service did not make sure that people could access the care, support and treatment they needed when they needed it. Services were not accessible and timely for people who are most likely to have difficulty accessing care, for example young people.

In response to the National GP Patient Survey data and from feedback from members of the community, some leaders recognised the difficulties in access, however nothing had been implemented to resolve it. The National GP Patient Survey demonstrated that 57% of patients who responded felt contact with the surgery was good. This compared to a local average of 73% and a national average of 70%.

People were unable to access care, treatment and support in a way that worked for them, which promoted equality, removed barriers or delays and protected their rights. The National GP Patient Survey highlighted that for those patients with a long-term condition, 25% of those who responded got to speak with a preferred health professional, compared with 41% nationally and locally.

People’s care, treatment and support was not always accessible, timely and in line with best practice. We saw numerous examples of patients who should have been triaged to be seen more urgently. Triage was provided by an external company; however clinical leaders had no oversight of this system. There was no scope for reasonable adjustments in the triage process. Patients with no internet access could telephone the practice.

The provider did not use people’s feedback and other information to improve access for people more likely to experience barriers or delays in accessing their care. Leaders had not reviewed the triage process. For example a patient with a learning disability, who may prefer an appointment at a specific time of day was unable to request this.

The practice was accessible for patients who required Motability assistance, there was also a hearing loop avaliable. Disabled parking spaces were avaliable.

Clinical leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this. We did not see evidence that indicated leaders had considered vulnerable groups when implements external triaging. For example patients living in care homes, or those with a learning disability. Patients could complete the triage form with a member of admin staff however the outsourced system was not effective at ensuring this patients were highlighted as vulnerable.

Feedback provided by people using the service, both to the provider as well as to CQC, was positive towards certain members of staff. Leaders had not proactively sought ways to address any barriers to improving people’s experience or worked with local organisations, including within the voluntary sector, to address any local health inequalities. Leaders told us due to staffing issues there were limited resources available and this was challenging. There was nothing in place for specific groups of people who may struggle with online triage.

Senior Clinical Leaders did not understand the importance of providing an inclusive approach to care and adjusting support equity in people’s experience and outcomes. This was demonstrated in the patient triage process. 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.

People were not always 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. At the time of our inspection, it was not clear how palliative care meetings worked and we were not provided minutes. Leaders told us there was a weekly meeting which we will review as part of our next inspection. Patients were discussed at an MDT. Due to staffing challenges, end of life care was not provided in a consistent way. Patients with prostate cancer were not being consistently monitored. It was unclear what the process for patients with a new diagnosis of cancer was.

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 when necessary.