Glenroyd Medical

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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 practice met people’s needs, and that staff treated people equally and without discrimination.

Complaints were not effectively or consistently managed; there was no clear guidance for staff to follow. People were involved in decisions about their care. The service provided information people could understand. The service was easy to access and worked to eliminate discrimination. People received fair and equal care and treatment. People were involved in planning their care and understood options around choosing to withdraw or not receive care.

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

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice 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.

Care plans reflected physical, mental, emotional, and social needs of people, including those related to protected characteristics under the Equality Act. Our review of clinical records showed people were supported to understand their conditions and were involved in planning for their care needs. They were also involved in decisions about their care. 90% of people who responded to the National GP Patient Survey said they found the reception and administration team helpful. This was above the local and national average. We observed staff who were supportive of people’s needs.

The practice understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. Over 14,000 people were registered with the service, and staff had a good understanding of the demographics of the area to tailor its service to their needs.

We saw the practice worked in partnership with other services to meet the needs of its patient population. It had built relationships with some community groups. The practice worked closely with the Primary Care Network (PCN) to plan, develop and deliver services across the locality.

The practice 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 displayed at the main and branch surgeries, and information could be printed 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. People were informed as to how to access their care records. Feedback from people who responded to the National GP Patient Survey showed that 96% knew what the next step would be within two days of contacting their GP. This was slightly higher than the local and national average.

The practice provided us with their complaints procedure. It mentioned a complaints manager but did not state who this was. The policy did not give enough information to guide staff through the process. It did not state who was responsible for investigating and responding to complaints. We saw different staff were involved in the handling of complaints, and they dealt with them in different ways.

The complaints procedure was not followed. Final responses to complaints did not always include information on how a complainant could take action if they were not satisfied with how the practice managed their complaint. Written notes were not made of all investigations.

The practice manager told us they were the lead for complaints, and they provided us with a folder containing all the information they held about complaints they had received, including responses. The business manager told us they also received complaints by email, to a dedicated email address for complaints, and these were held separately. However, although complaints were received by email, the practice manager told us they collated all complaints, and they provided a spreadsheet detailing complaints that had been received. We saw that not all complaints received by email were recorded on this spreadsheet and we examined one. We received conflicting information about the reason for this. The practice manager, who was the lead for complaints, told us they not been at work at the time it was received and dealt with so could not comment on it. They said it had been dealt with as a verbal complaint, but the complaints’ procedure did not state how verbal complaints should be dealt with. The practice manager and business manager then told us if a complaint was dealt with within 24 hours, they did not need to record it, even if this was a formal written complaint. We saw another manager had dealt with this particular complaint by telephone and recorded this in the person’s records.

We examined some complaints that had been made about salaried and trainee clinicians. In these cases, the clinician provided a statement to be sent to the complainant. We asked about the clinical oversight and records of investigations into these complaints. The practice manager told us they usually copied the GP partners into this type of complaint, but their involvement was in the background; there was no formal oversight, and no records were kept.Following the inspection, the Registered Manager told us complaints about trainee doctors had the oversight of their clinical supervisor, and they held records of emails about this.

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

The practice used an online system to manage appointments. People input information into a secure online consultation system and artificial intelligence (AI) made sure the information reached the correct team. When the system determined that a clinical request had been made, this was reviewed by a team of advanced clinical practitioners. The practice told us that the system had reduced unnecessary appointments. For example, they could book patients in for required blood tests before they saw a clinician. The system was able to prioritise urgent requests, such as for patients with severe mental health conditions, and text messages or emails could be sent to patients for further information if needed. If people were unable to use the system, they could telephone the practice, and a staff member would input the information for them.

We saw that there was good availability of appointments. At 11.30am on the day of our visit there were appointments available that afternoon, and routine appointments were available within a few days.

On occasions where requests exceeded capacity the system could be turned off, but we were told this was not often. During the afternoon of our visit, we heard a patient advised to try the system the following morning as the system had reached capacity for the day. Staff told us if they received an urgent request when the system was off this would be triaged by a clinician.

The practice had a visiting team to carry out home visits for elderly or frail people. The visiting team did not use the electronic system. People could telephone the practice to request a home visit, and the team would triage these requests. People were able to request to see particular GPs or nurses for continuity of care.

National GP Patient Survey results showed that 49% of respondents found it easy to contact the practice by telephone. This was slightly below the local and national average. 39% found it easy to contact the practice by the website. This was below the local and national average.

Staff and leaders actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. Staff and managers we spoke with had a good understanding of the demographics of the area. Staff had received training in equality and diversity.

There were processes to ensure people could register at the practice, and people in vulnerable circumstances such as homeless people and Travellers were treated equally. 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 results of the National GP Patient Survey showed that 89% of respondents felt their needs were met during their last general practice appointment, and this was in line with the local and national average. 81% described their overall experience of the practice as good, which was above the local and national average.

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. 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.