Roundwood Surgery

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

At our last assessment we rated this key question as outstanding. At this assessment, the rating remains outstanding. This meant people were treated equally and without discrimination and the service met people's needs.. We have rated this key question outstanding in person centred care, listening to and involving people. equity in access and equity in experience and outcomes. This meant people’s needs were met through good organisation and delivery.

This service scored 93 (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 recognised the diverse population needs and fully understood their diverse practice demographic and language barriers. For example, invitations to cervical smear clinics were available in different languages to try and encourage attendance, and telephone translators were utilised where required. Wellbeing and diet advice was adapted to reflect the diversity of cultures and diets.

In conjunction with the PCN the practice collaborated with the Beacon Project to offer medical and non-medical support to the severe multiple disadvantaged and homeless population who were registered with the Roundwood Surgery. There are 375 people on their severe multiple disadvantaged register across the PCN. The project supported excluded and marginalised people and provided hot meals, showers and clean clothes. The project supported 50 to 70 homeless people on a regular basis, who were also offered laundry services, sleeping bags and tents. The Beacon Project worked in conjunction with drug and alcohol services, housing support, and debt and benefit advice by offering space for specialists to meet with people in a non-judgemental capacity at this facility.

The PCN employed a part time care coordinator to liaise with clinicians, local charitable agencies, and social services to deliver holistic care for this cohort of people. GPs provided an “open door” policy which enabled people to access health care professionals without an appointment for people without an abode, telephone or watch in between their surgery and without booking in advance. The service was supported by the Mayor of Mansfield and has now been expanded across the wider PCN.

Accessible standards and barriers to care were considered for people, with alerts added to medical records so that the receptionist were aware upon contact that the person had additional needs. For example, people who were blind or hard of hearing were collected from the waiting room by the clinicians and leaflets were available in braille and a hearing loop was installed at reception. Autistic people or people with learning disabilities were offered a quiet place to wait for appointments.

The practice identified that people over 14 years of age with learning disabilities were historically disadvantaged and often had poorer physical and mental health outcomes. Historically, the practice identified that on average only 35% of people with a learning disability had received an annual health check to review medications, blood pressure, weight and discussed general health; for example, respiratory, gastro-intestinal, urinary systems and contraception and cancer screening services. The Roundwood Surgery reached out to people and their carers and encouraged them to accept an invite for a learning disability health check. Recall letters and wellbeing advice were provided to people with learning disabilities in appropriate formats. The practice employed a specialist trained learning disabilities nurse to support and care for people with learning disabilities in conjunction with the GPs and health care assistant. Health checks were offered at the surgery or in peoples own homes or care homes. By working with this cohort of people and employing the dedicated learning disability nurse, learning disability health check uptake increased, with over 80% of people being seen during 2024/2025. The national target for people to receive a learning disability health check was 75% which the practice surpassed.

The service 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. In conjunction with the PCN, the practice provided a ‘sleep station’ service to help people manage their sleep hygiene. We reviewed case studies collated from people who had utilised the service and we looked at the overall outcomes and benefits for people. The findings concluded that people’s sleep efficiency, on average, increased to 95% efficiency, and they were able to function better the next day after sleep. Also, people reported that depression and anxiety symptoms experienced prior to the service had resolved.

People’s urgent needs were responded to promptly and where appropriate people were referred to external stakeholders for further investigation within the prescribed timeframes. Our review of clinical records showed people were supported to understand their condition and were involved in planning for their care needs. Housebound people could access electrocardiograms (ECGs) in their own homes to monitor their long term and acute conditions.

Clinicians spoke highly about effective signposting by the reception team; they felt people were directed to the right clinician the first time, which enabled them to provide effective person-centred care. For example, referring people to the pharmacy for minor illnesses and to the social prescriber where the person did not have a health care need.

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.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The service had access to interpreter services, including British Sign Language. SMS texts or letters were sent to people in their own language, or interpreters were used to book appointments and translate during consultations. Information about the need to book an interpreter was recorded on people’s records and additional time was provided for appointments. Staff told us they had access to services for translating documents into appropriate languages, including into English. A hearing loop was also available. People were informed to how to access their care records.

The service encouraged feedback from people and made it easy for people to share feedback and ideas in various formats, such as complaints and compliments, surveys or suggestions about their care, treatment, and support. The practice told us that they actively listened to the complainants and tried to resolve issues at a local resolution stage. We saw complaints were managed in line with the service’s policy. Complaints we reviewed showed the practice responded to feedback appropriately, openly and in a non-defensive manner. Learning from complaints was evident and staff were able to identify changes made because of people feedback, including complaints. Staff were aware of their duty of candour and to be open and honest when things went wrong. The service involved people in decisions about their care and told them what had changed as a result. The service routinely asked people to complete Friends and Family Test feedback forms and reviewed the feedback for any trends or themes. SMS messages were sent out to people following their appointment to request feedback, alternatively, clinicians handed out feedback forms asking people to rate their consultation experience.

During our assessment we spoke with a member of the Patient Participation Group (PPG) who informed us that the leaders listened to people. They expressed that there had been difficulties in getting through on the telephone and leaders responded to feedback on this by installing the facility for people to request a telephone call back from the practice, which was working well.

The practice identified gaps in peoples understanding of how to access online access to health care services including, booking of appointments online, requesting medications online and viewing medical records online via the NHS App. The practice embraced the opportunity to work with NHS Digital and the wider PCN through a six-month workstream, which culminated in the PPG, practice staff and wider members of the working group, demonstrating the use and benefits of the NHS App to the wider population. NHS Digital held promotional events held at influenza clinics, Mansfield library, community centres, King’s Mill hospital and in practices within the PCN. The learning was also promoted by the local bus company with advertising on the vehicles and training sessions were held in the practice to train the clinical and administrative staff in the use of the NHS App.

Roundwood have continued to consult with people mainly on a face-to-face basis with clinicians stating that they prefer this approach to managing healthcare, as it helps build personal relationships and trust with people and allows for a whole person, holistic approach to care, considering visual and physical examinations. The opportunity for telephone consultations were also available when preferred by the people. Roundwood PPG supported this approach of access to health care services, confirming they preferred to consult with GPs on a face-to-face basis.

The PPG helped the practice identify problems and suggested solutions which the practice implemented. A recent example was difficulty parking at Wood Street branch surgery, located in the town centre, where shoppers parked their cars, reducing capacity for people to park in the car park. The PPG recommended the use of a car park management company and were involved in the implementation and signage of the car park management system. This initiative had a positive impact, resulting in increased parking capacity for people.

The service made sure that people could access the care, support, and treatment they needed when they needed it. People had the choice of a face-to-face appointment or a telephone appointment, pre-bookable or on the day. People were offered an appointment appropriate for their assessed need or directed to an alternative service, for example, a pharmacist, health visitor or dentist, dependent upon the person’s problem.

People who required routine appointments outside of the usual working hours had access to evening and weekend appointments. These appointments were booked on behalf of people by the service.

Housebound people were offered routine home visits from the practice nurse team for their long-term condition reviews, and management of general health and chronic diseases, consultations, blood tests and diabetic foot checks as well as cervical screening and vaccinations.

People living in a care home, received a ward round on a weekly basis from a multidisciplinary team which included a GP, pharmacist, dietician, care home nurse, care assistants and care co-ordinators to offer healthcare in a holistic manner for all people and including people who were coming towards the end of their life journey. Data provided at our assessment, evidenced that since the beginning of 2025, the practice had completed 366 face-to-face ward-round consultations. In addition to the weekly ward rounds, the clinical team also carried out a further 117 home visits to people residing at the care home, who were unwell, and the care home had requested a separate home visit for.

Concerned parents were encouraged to contact the surgery for GP advice for their unwell child. GPs triage the problem to ascertain the urgency of need and offer guidance, support, or a face-to-face appointment regardless of the appointment capacity.

Data from the national GP Patient Survey showed 65.9% of respondents were positive about their overall experience of contacting the practice which was comparative with the national average of 67%. The majority of feedback received by CQC from people was positive about their experience of contacting the practice. This was supported by the PPG who told us people were able to request appointments in person, by telephone or via online requests with ease.

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. Feedback provided by people using the service, was positive about being treated fairly. Following consultations clinicians provided feedback forms. We saw nine feedback forms which were collected from people seen in February 2025. All the feedback forms rated the clinicians as ‘very good’ or ‘excellent’ in a range of questions, which included, how was the clinicians at the following: ‘making you feed at ease’ and ‘helping to take control’. People commented that the clinicians, explained carefully what they needed to know, did not make them feel rushed, GPs listened to them and made sure that they understood, were very thorough in their examination, did not judge and provided reassurance.

We reviewed Friends and Family Test (FFT) feedback forms, and one person commented that, the doctor provided external advocacy for them where other health practitioners had not taken their health seriously, it is so reassuring knowing I have got a GP who will advocate for me. National NHS Friends and Family results for Roundwood Surgery January 2025, evidenced that 90% of people would recommend Roundwood Surgery to their family and friends; this result was consistent for the previous twelve months.

Staff treated people equally and without discrimination. The provider had processes to ensure people could register at the service, including those in vulnerable circumstances such as refugees, homeless people, and travellers. The new patient registration form was available in different languages. Refugees who were registered at the practice, were provided the opportunity to have support organisation attend the practice with them to help explain the NHS system and support them with any language barriers in the initial attendances. The senior GP partner at the surgery assisted newly registered Ukrainian refugees with non-medical services which included assistance to claim benefits, obtain school places, fundraising for school uniforms, bus passes, and help with housing applications.

The practice, through the PCN, provided a mental health occupational therapist who specialised in dementia support for families in their own homes. Feedback from people who used the services, their family and/or carers was positive. They commented that they had a better understanding of the condition and had more confidence to deal with life’s problems; the home visiting team was a vital service for dementia patients who would otherwise have little help; one person commented that it was the first time someone had asked how they were managing.

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. For example, the out of hours services and other health care professionals involved in the care of this group of people. We were assured that safeguards were in place to ensure that decisions were made which were in the person’s best interest. When people did not have mental capacity to make their own decisions regarding end-of-life care, family members and carers were involved in decision making.