Gosberton Medical Centre

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

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 good. At this assessment, the rating is outstanding.

The practice sought innovative ways to further enhance people’s health and wellbeing. The use of social prescribing at the practice had made a difference to people’s lives. Staff worked together to help patients receive alternative therapies in order to improve their health and quality of life. Supporting people in these ways was a key priority for the practice.

People were involved in decisions about their care. The service provided information people could understand. People knew how to give feedback and were confident the service took it seriously and acted on it. 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.

This service scored 89 (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 was exceptional at making 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.

Our review of clinical records showed patients were supported to understand their condition and were involved in planning for their care needs. They were also involved in decisions about their care.

The practice team consistently demonstrated a holistic approach to care with individual patient needs at the centre of this. There was a high referral rate within the practice to the social prescriber, compared to other practices in the area. Their assessment of patients focused on what was important to the individual patient, which ensured patients’ practical, social and emotional needs were considered alongside physical health needs.

The social prescriber initially worked one to one with patients who were referred to them by the practice, or who self-referred, to formulate a personalised care and support plan.

To further support patients holistically the practice had initiated and created a Wellbeing Gardenon land adjacent to the practice which was used by patients with learning disabilities and mental health needs.

They had also initiated and developed hydrotherapy sessions, a wellbeing hub with various support groups and health walks to benefit their patients. These were all well attended.

The service had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The practice had embedded social prescribing into its approach to patient care, leading to a high level of referrals to the social prescriber. All staff members played an active role in identifying and referring patients, ensuring social prescribing was a core part of patient care.

They also worked closely with other resources such as the physiotherapy team and mental health practitioner who were based at the practice to ensure a joined-up approach and continuity.

We saw the practice worked in partnership with other services to meet the needs of its patient population. The practice had tailored its services to meet the needs of its community, for example, identifying gaps in local services and creating community groups as well as building relationships with existing community groups to bridge these gaps.

The social prescriber had created a local NHS wellbeing hub which patients could access and provided peer support groups for bereavement support, respiratory support, menopause and chronic pain. There were also other groups such as art therapy, yoga and gardening groups. Patients were still able to attend these supportive groups after their work with the social prescriber ended to maintain the benefits achieved and continue supporting their wellbeing to avoid further issues.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The practice had access to interpreter and translation services and a hearing loop.

A range of information on aspects of health for all ages and local support groups was available in the practice and via the practice website. Health information leaflets were available.

In order to ensure patients and staff were kept informed, the practice produced a monthly newsletter which was available on the practice website. This included information on service updates, new initiatives, health campaigns and other practice news.

The PPG were key to supporting the practice in providing information and engaging with the practice population and wider community, for example at community events or through patient education and drop in sessions.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

We saw complaints were managed in line with the practice’s policy. Learning from complaints was evident and staff were able to give examples of changes made as a result of patient feedback, including complaints.

The service routinely asked people to complete Friends and Family Test feedback forms. They reviewed the feedback for any trends or themes and then took action to address them. Feedback was overwhelmingly positive. Feedback was also gathered through other mechanisms such as the practice website, verbal comments, and emails. Learning points were shared with the staff team as well as positive feedback.

The PPG were active in gathering and relaying patient feedback to the practice and were positive about their level of involvement in discussions about proposed changes in response to feedback.

The service was exceptional at ensuring people could access the care, support and treatment they needed.

National GP Patient Survey data and feedback received from people was already positive about their experience of contacting the practice. Indicators showed 72% of respondents were positive about their overall experience of contacting the practice, just above the national average of 70%. In addition, 66% of respondents were positive about how easy it was to contact their GP practice on the phone, in line with the national average of 53%.

Staff told us how they audited access to the practice and demonstrated actions taken as a result. They had recently introduced an appointment triage system and were able to demonstrate the positive impact of this for both staff and patients, in respect of timely and appropriate access to appointments and improved efficiency.

The appointment system the service implemented consistently ensured both urgent and routine care was well managed and all patients, including those with barriers, could access the service equitably. Patients could access the triage system online, but reception staff were able to support patients who telephoned or came into the practice, to make and access appointments in the same way.

Patient feedback about the new triage system was positive with patients describing it as quick and efficient.

There were extended appointments for people with a learning disability and other complex needs. People could access the service to suit their needs for example online, in person, by telephone or by post. Treatment rooms were available on the ground floor and first floor and there was a lift available to access the first floor if required.

The practice had installed a medicine vending machine outside the practice to enable patients to collect their medicines at a time to suit them 24 hours a day.

A FENO (Fractional Exhaled Nitric Oxide) machine (used to aid in the diagnosis of asthma) had recently been purchased by the practice to help address health inequality and offer the service inhouse to allow quicker diagnoses and to avoid patients having to travel. The practice had helped to establish a volunteer car service, which transported patients to social prescribing and wellbeing groups ensuring inclusivity and equity of access.

Staff and leaders were innovative in how they listened to information about people who were most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

Feedback provided by people using the service, both to the provider as well as to CQC, was positive. Staff treated people equally and without discrimination.

Leaders proactively sought ways to address any barriers to improving people’s experience and worked with local organisations, including within the voluntary sector, to address any local health inequalities.

Staff understood the importance of providing an inclusive approach to care and made adjustments to support equity in people’s experience and outcomes. The provider had processes to ensure people could register at the practice, including those in vulnerable circumstances such as homeless people and Travellers.

The practice and social prescriber had worked together to improve equity of experience and outcomes and set up a number of initiatives to support patients holistically and improve their mental and physical health. Some initiatives were later adopted by the PCN, such as support groups.

As part of the holistic approach to ensure equity in outcomes for patients, services organised by the social prescriber for patients of the practice included yoga, a respiratory group, a chronic pain group, a bereavement group and art therapy. To promote accessibility these services were available in the local community at a local garden centre.

The practice had identified a need for hydrotherapy to support patients, for example those with chronic pain and mobility issues. An Aqua therapy group was set up at the local hydrotherapy pool and sessions were led by an aqua therapy instructor. This service was provided by the practice with support from fundraising by the PPG and private donations.

We were given an example of a patient who had benefitted from these services as they had been able to progress from needing walking sticks to support themselves to no longer needing sticks or surgery.

We also saw evidence of a reduction in opiate prescribing since the introduction of the hydrotherapy and pain support group.

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. The practice was proactive in identifying patients approaching end of life and sensitive to their needs for advanced care planning.

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.