Petroc Group 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

The provider aimed to ensure patients were at the centre of their care and treatment choices and working in partnership with them for responding to any relevant changes in their needs. However, further improvements were needed to achieve this, including involving patients in assessment and review of their care and treatments when needed, working closely with patients to improve communication with patients and using patients’ feedback to inform service planning and delivery.

There were joined up work with services in the community to ensure flexibility, choice and continuity of care for patients. The practice had systems for recording, storing and keeping confidential and sensitive personal information securely such as patient’s clinical records. The practice had processes for receiving and handling patient feedback and complaint. Patients were able to share feedback and complaints about their care and treatment and support online, by speaking with the practice, or completing Family and Friends forms which were available in the waiting room and online. However, we found ongoing concerns in the quality statements for listening to and involving people. We found the practice had not always responded to patients’ complaints and had not provided appropriate information to the patients with regards to their rights to escalate their concerns to the Parliamentary Health Service Ombudsman (PHSO) under the Local Authority /Social Services and National Health Service Complaints (England) Regulations (2009).

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Results from the national GP survey 2024 showed 79% of participants felt, they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. This was lower than 91% national results.

Staff told us that all calls and online requests were triaged and passed to the most relevant member of staff to manage. The online system used by the practice enabled an alert to be placed on patients with the highest need, and triaging GPs were also made aware of this alert. Triaging GPs were able to book in follow up appointments in order to promote continuity of care. When needed the paramedic who was part of the acute on the day team was able to carry out home visits. The practice made reasonable adjustments when patients found it hard to access services. Appointments with nurses were arranged flexibly depending on patients’ needs and conditions such as child immunisation, screening and reviews. The practice could accommodate patients who worked or needed later access. Health screening appointments were offered outside of working hours. Patients could be seen on any of the provider’s surgery locations, offering flexibility for access. People were offered support with completing Klinik form by the reception staff, when needed. However, a patient had raised concerns over lack of confidentiality with sharing personal information at reception area where other people had queued and hence he had not used the service even when he needed it. Staff worked with services in the communities to meet the needs of patients with complex needs.

Staff told us they aimed at providing holistic care and treatment for patients. There were established links with services in the community including specialist nurses, social prescribing team, local authority and voluntary organisations. This enabled better care for patients with complex needs, long term conditions and those at risk of abuse or neglect. The social prescribing role provided support to patients covering areas of needs including health, finances, housing, children and relationships. People were signposted to other organisations such as a local volunteer led café, Age UK, bereavement, counselling and dementia care services. A library of resources was developed which was held on the Watergate PCN website. Patients with long term health conditions in particular people with diabetes, were supported through bespoke health education programme consisting of three sessions delivered by specialists covering medicines, treatment, health risk, lifestyle, exercise and diet. There were also plans to develop a healthy eating project.

We spoke to the lead for social prescribing team who told us the practice was working with them on supporting patients with health conditions such as prediabetes and diabetes to achieve positive outcomes both in health and in interacting with other services in the community that could meet their needs in a holistic way.

The importance of flexibility, informed choice and continuity of care was reflected in the services provided. The practice had established links for referral to the services in local community to support patients with complex and social needs.

There were two care homes where the practice had registered patients. Weekly ‘ward rounds’ were carried out by GPs, either virtually or in person to provide continuity of care. Staff in the care homes would also contact the practice when needed if a patient had an urgent care need.

The data from GP Patient survey 2024 showed 23% of participants find it easy to contact this GP practice using their website. This was lower than 48% national result.

Some patients felt more privacy was needed when reception staff were supporting patients with booking appointments or filing in Klinik form at reception area, to ensure confidentiality.

Staff contacted patients with prediabetes in writing with guidance and advice and followed up with a call to discuss information. Staff told us since previous inspection, information has become more explicitly available including updates around the practice's working system and training. Staff told us if patients had no access to the online system for making an appointment, they would call the patients to provide support

The practice had systems for recording, storing and keeping confidential and sensitive personal information securely such as patient’s clinical records. Information provided on the practice’s website explaining that the practice held and used patient information in line with requirements and information security standards including when held and used digitally. Information on the website also advised patients how their information was stored and managed. Staff had signed confidentiality statement and were required to complete the training in relation to information governance and the General Data Protection Regulation (GDPR) as part of their mandatory training. Patients could bring a friend or relative with them to their appointments and interpreting services and pop-up support was available for deaf patients. Patients had access to useful numbers in the reception area e.g. for safeguarding, maternity, bypass number for acute team and protocols such as fire safety. There was a notice board for the social prescriber in waiting room and rolling TV screen with health information. The practice’s website provided useful information such as health advice including family health, long term conditions, and physio self-referral. The website provided a video guide on using online services including how to complete a Klinik form. The patient information leaflet on the complaint procedure was provided on the practice’s website. However, the information provided was not fully in line with the practice’s complaints policy and procedures and did not advise patients of their rights under the Local Authority /Social Services and National Health Service Complaints (England) Regulations (2009). There was information on the website for those wishing to join Patient Participation Group. There were CCTV signs in place.

Results from national GP survey 2024 showed a total of 74% of respondents said that the healthcare professional they saw or spoke to was good at listening to them during their last general practice appointment. This was lower than 87% national result.

We saw record of complaints kept by the practice and actions taken in response to individual complaint.

Some patients told us they did not get a response to their complaints.

Staff were aware of how to access the complaints procedure and knew what action to take if a complaint was made. Reception staff told us that if they received verbal complaints they would try and resolve the issue when possible. An example given was when a patient wanted to see a GP but no appointments were available that day. The practice manager assisted and an appointment for the following day was made, which the patient agreed to. Reception staff were also aware of the feedback forms that patients could complete if they wished to put their concerns in writing. The practice manager said that none of the complaints they had received were referred or sent directly to the Parliamentary Health Service Ombudsman.

We found that the patient information leaflet on complaint procedure, given on the practice’s website, which was also available from reception, did not contain necessary details of complainant’s choices described as the stages one and two under the Local Authority /Social Services and National Health Service Complaints (England) Regulations (2009), including patients right to escalate their complaint to the Parliamentary Health Service Ombudsman (PHSO) within the conditions given in the Regulations.

The practice had a complaints policy. Patients were able to raise concerns by speaking with the practice, or completing Family and Friends forms, available in the waiting room and online. Information available to patients about how to make a complaint did not include details of how they could escalate their concerns to the Parliamentary Health Service Ombudsman (PHSO), if they were unhappy with the response from the practice. Complaints were discussed in quarterly meetings and details of decisions were noted. Minutes from these meetings were circulated to all staff for information and to action any learning needed. However, the implementation of decisions made were not always recorded. For example, a complaint/significant event logged in November 2023, had noted for discussion in early cancer review meetings. There was no follow up notes on the record to show that this had been actioned. Where complaints and significant events were discussed in meetings, a final decision was not always noted. For example, in meeting of March 2024, it had been discussed that GPs could conduct speculative blood pressure monitoring checks for patients with diabetes to reduce possible preventative risks, in less complicated 15 minutes appointments. However, it was unclear if a decision had been made on the subject as none was recorded. Current system did not ensure complaints could be effectively tracked for monitoring and auditing purposes. The process lacked input from the Patient Participation Group.

The most recent GP Patient Survey data, from April 2024, showed the practice performed below the local and national averages for the percentage of people who: • find it easy to get through to this GP practice by phone 5% compared to 50% national result • find it easy to contact this GP practice using their website 23% compared to 48% national result • find it easy to contact this GP practice using the NHS App 15% compared to 45% national result. The record of patient complaints maintained by the practice showed difficulty with Klinik forms and appointment availability made up the highest percentage of the complaints. Patient feedback to CQC showed patients were experiencing ongoing difficulty with using Klinik form, accessing appointments, delays on the phone and not having had received a call when expected.

Staff told us that their online consulting system was usually operational from 8.30am to 6pm. However, there were times when volumes of requests became unsafe, due to time and a lack of staff availability. On average the practice received 200 to 300 requests via this route during opening hours. When access had to be limited the practice did this in consultation with other agencies to promote safe management. Staff told us, if patients telephoned whilst the online consulting system was offline in usual opening hours, reception staff would take details and the information passed to a clinician to be triaged and acted upon. The practice had recently had a new telephone system installed which enabled them to monitor call volumes. At the time of the site visit they had a months’ worth of data which covered number of calls; number of calls that were abandoned and which part of the service patients were directed to. They planned to use this data to develop and improve patient experience.

The practice offered a range of appointment types to patients, including telephone, online consultations, face-to-face, home visits, emergency on the day, pre-bookable and clinics for conditions such as diabetes or asthma reviews and health screening. People could request double appointments if they had specific needs, such as needing an interpreter. The acute on the day team could book patients in directly for a telephone consultation or face to face appointment, if needed after a patient was triaged. GPs and Locums had an allocated 15 minutes per appointment. Nurses would see patients depending on the condition such as childhood immunisation or health screening and reviews. There were systems in place for supporting people with completing the Klinik form online if needed and patients could access a simplified form available in reception area. Patients were provided with information about how to access the service. There was a Klinik guidance and step by step video available on website. Accurx text also had been sent to patients with information on how to use the form. The practice had used Local Medical Committees guidance for when to switch off online services for safe management. If patients telephoned during this period, reception staff would take details and the patient would be triaged. Patients were called back and were signposted to NHS 111 services when relevant, or emergency services if needed. The practice collated information on appointment types offered and used this information to plan staffing numbers and skill mix, and anticipate how many appointments were needed.

Despite actions taken by the practice to facilitate better access for patients, patients’ feedback to CQC, the provider’s complaints records and GP Patient Survey data 2024, showed that the patients were experiencing on-going difficulties with meeting patients needs for accessing the service.

A patient told us about their experience of using the service, the issue of stigma in mental health and the need for staff awareness. Another patient told us about the concerns, they felt about patients who are not computer literate and needed support for accessing services online. A patient had raised concerns with the service about older generation not having been catered for by the service.

Staff aimed at making adjustments, where possible to meet patients’ needs. For example, they said that if a patient has learning disabilities they would link with specialist nurses in the community to discuss care and treatment. A pre-screening questionnaire would be sent out to be completed before a consultation and if needed patients could be accompanied by a carer or family member for support during a consultation.

Patients were informed that chaperones were available. Staff who acted as a chaperone had completed training. A chaperone is an impartial observer present during an examination or consultation when a patient may feel vulnerable, for example during an intimate examination. A chaperone acts to protect both patients and staff.

When patients had specific communication needs then arrangements were made for appropriate support such as interpreting services or written information in a format accessible to the patient.

Support was also provided through the primary care network, which had a dedicated website with information on how to access support and information on finances, housing, children and relationships. There were links for patients to self refer to physiotherapy, counselling services and health management. Information on social prescribing was also displayed in the practice and leaflets were available for patients who were unable to access online services.

For transgender patients arrangements were in place to ensure they continued to receive appropriate health checks and their preferred name was used.

Systems and processes were in place to assist in identifying patients who may needed extra support. This included alerts on patients records to show what support they needed with communication such as interpreters.

Late health clinics were made available for parents and those working.

The practice was responsive to the needs of older patients and offered home visits and urgent appointments for those with enhanced needs and complex medical issues.

The practice adjusted the delivery of its services to meet the needs of patients with a learning disability.

The practice liaised regularly with the community services to discuss and manage the needs of patients with complex medical issues.

We did not receive specific examples from people about planning for the future.

Staff told us they recorded all verbal consent agreed or denied in the patients record. If capacity to give consent was unclear, staff would seek advice and ensure that the appropriate legal route was used to ensure the patients best interest was served.

There was information in reception area that were relevant to the care of people with Palliative care needs. This included a Palliative care board and services offered by the practice such as home visiting.

The practice worked with the community matron from the frailty team who responded to patients with acute needs and had links with PCN care home meetings. Palliative care/Multi Disciplinary Team (MDT) complex care meetings were held and the practice was planning to start working together with the district nurses specifically to discuss palliative care patients. The practice had identified issues with coding in other areas and had planned to standardise coding across the practice to ensure all relevant areas were covered.