East Harling & Kenninghall Medical Practice

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

This means we looked for evidence the service understood the needs of the people and communities they served and put them at the centre of how care was planned and delivered. We looked for evidence people accessed the care and treatment they needed when they needed it.

At our last inspection we rated this key question Good.

At this inspection, the rating has changed to Requires Improvement.

This is because feedback from patients highlighted issues in relation to access, lack of clinical capacity, visibility of partners, and a lack of consistency in clinical staff.

People were generally involved in decisions about their care. The service did not always provide information people could understand. People knew how to give feedback but they were not confident the service took it seriously and acted on it. The service was not easy to access for all patients.

People were involved in planning their care and understood options around choosing to withdraw or not receive care.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received a total of 211 responses from members of the public via our 'give feedback on care'. The main theme identified was difficulties with appointment availability. We received negative feedback about appointment availability from 112 people. In addition, 50 people told us that telephone answering times were poor and the system sometimes cut the call while they were in the queue. 41 people told us that they had experienced delayed referrals and/or missed care, of which 8 people said that due to being unhappy with the care they received from the practice that they had paid privately for healthcare

People told us that telephone answering times were poor and the system sometimes cut the call while they were in the queue. Some patients told us that they did not always feel that their care was person centred.

However, some other people explained examples of times that they had received personalised care and felt satisfied with the care and treatment they had been given.

Staff told us how they care for patients in a responsive way and were able to give us some examples of when they have provided empathetic and person-centred care to patients in distress or needing urgent assistance.

Leaders told us they had started a menopause clinic. This was created in response to patient need but initially this was scheduled during the week. On reviewing the patient demographic, they realised that the patients were predominantly working age so changed the day to Saturday to encourage uptake. Feedback was very positive regarding this service.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People told us through our Give Feedback on Care that they had poor experiences of getting information from the practice. We heard from 18 people who highlighted concerns regarding the challenges in comparison to 2 people who had positive feedback regarding this.

A listening event held by Healthwatch in April 2024 also heard from patients struggling to obtain information.

Staff and leaders told us that they had access to translation services if required.

Staff told us that due to the constraints on capacity – both staffing and physical space – they were not always able to give people the information that they required. Leaders were aware of these challenges and were trying to put in place new systems and processes.

The practice had policies in place including extensive data protection policies, covering all aspects of data management and information sharing.

However we found these were not always followed. We saw evidence of a data breach. Some staff and the PPG reported that information was not always shared.

Patients told us that they did not always feel listened to when sharing concerns regarding their experience of care.

We were told by patients that they did not always receive a response to their complaints in line with the policy.

Patients raised concerns that a public meeting arranged by the practice to address concerns was not attended by any of the GP partners. They stated that they were concerned by the lack of engagement and visibility of the partners.

The Patient Participation Group had recently reformed, and the new Chair highlighted that there had been good engagement with the new Practice Manager. The feedback from patients in the month prior to the on-site inspection had been more positive.

We continued to be told about concerns regarding availability of GP partners however.

Staff and leaders told us the recent changes to the practice had enabled them to respond more effectively to patients.

There had been changes to the way that complaints were handled and greater oversight of this. We saw evidence that there were deviations from the policy in that some complaints that we reviewed had not had a written complaint response issued. This meant that the practice was unable to provide assurances regarding outcomes when patients raised their concerns to other parties.

The new Practice Manager had engaged with the PPG and was undertaking additional work to gain the views of the patients.

Leaders told us that the results of feedback through their messaging tool and the Friends and Family test showed improvement in May following the implementation of the waiting list initiative.

The practice had policies in place to enable them to be able to listen to patients, staff and stakeholders. These included a Complaints policy, a Being Open policy and a Significant Event policy. We did see that at times these policies were not fully adhered to.

They had recently resumed the PPG and were starting to explore how they could work together effectively.

We were told that patients struggled to access the care and treatment they needed at the time that they needed it. Patients would be referred to 111 or walk in services which, due to the rural nature of the practice, were not accessible for some populations.

We heard that for some people there were challenges learning about and accessing new systems and processes to make appointments.

Patients were able to register at the service without proof of address in line with recommendations.

Patients who had reasonable adjustments in place due to a disability told us that these were not always followed such as alternative methods of contacting the practice for people with a hearing impairment that could not use the telephone. This had led to delays in care when the agreed adjustment was not responded to.

Feedback gathered on site by the inspection team highlighted that access had been easier for some patients recently following changes implemented. On the day of inspection there were still appointments available at 11am.

The practice had an access policy in place.

Data that the practice collected to monitor outcomes for patients showed that there had been an improvement in unanswered phone calls between February 2024 and June 2024.

In February 2024 before the introduction of the waiting list initiative the call data was:

3176 Answered, 960 Unanswered, 4197 Abandoned phone calls.

In June 2024 the call data was:

3299 Answered, 636 Unanswered, 2771 Abandoned phone calls.

Leaders told us that they had further plans to increase capacity in the phone system by adding a call back function. They had also introduced an option for patients to cancel appointments. They hoped that this would reduce the number of missed appointments which would further improve their capacity as this was currently higher than they would like.

We were also told that they would be introducing an electronic consultation system, this would open with a small number of slots initially and then gradually increase. Leaders told us that this would commence in August 2024.

The practice had an access policy in place which staff were aware of.

There had been recent changes made to the way patient’s accessed routine appointments with the creation of the waiting list. A protocol had been created to support staff with this new process. It was not clear from this protocol that appropriate triage was completed before patients were placed on the waiting list.

The latest National GP Patient Survey results showed 92% of respondents stated that during their last GP appointment they were involved as much as they wanted to be in decision about their care and treatment. This was in line with the expected national average.

Patients told us that at times there was a lack of consistency in the clinicians that they were seen by which led to changes in treatment or delayed care.

Staff told us that they completed NHS health checks to ensure that patients received the care they needed. In the previous 12 months 2086 patients were eligible for these checks – the practice had offered 466 checks and of these 207 were completed. Staff told us that the capacity issues affected their ability to provide these.

There was access to social prescribers to help patients access appropriate support including those who may experience inequality or poorer outcomes.

There were systems in place to support patients who faced communication barriers to treatment. There was information available for patients to support them to understand how to access services, including on websites and telephone messages.

The practice were aware of the need to make sure that all groups of patients were able to access the practice. Digital exclusion was a concern raised by patients and the PPG. Although there were policies in place regarding accessibility, we saw evidence that these were not embedded such as reasonable adjustments not being honoured.

The practice complaints procedure was not wholly effective, and we saw that not all complaints were responded to in a timely and effective way to improve the quality of care.

The practice had received a high level of complaints and had taken steps to try to understand the concerns by holding meetings with patients, the practice manager and the PPG.

Feedback from the care home was positive about discussions around care planning and the inclusion of families and carers in decision making.

We did not receive any other feedback from patients and carers about this area.

Staff and leaders told us they understood the requirements of legislation when considering consent and decision making.

There were multidisciplinary meetings with palliative care to ensure good end of life care. Staff and leaders showed that they had clear oversight of patients and these were discussed regularly.

There was a DNACPR policy in place and our checks showed that the policy was being followed.

We saw good quality documentation and records of discussions surrounding these decisions were completed.