Parson Drove Surgery

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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

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 Requires Improvement. At this inspection, the rating remains Requires Improvement. This is because the service did not always have fully established processes in place.

We assessed a total of 7 quality statements from this key question. People could mostly access the care, support and treatment they needed when they needed it. However, some patients told us that sometimes they felt the practice was unable to manage clinical risks and meet their care needs.

This service scored 50 (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 GP national patient survey data indicated the practice mostly made sure people were at the centre of their care and treatment choices. 80% felt that during their last appointment, the healthcare professional was very good or fairly good at treating them with care and concern. This was below the local area national averages of 85%.

Patients that provided feedback to us told us that they felt that their care and treatment was not always responsive. They shared examples of times they had experienced delayed care or felt their concerns were dismissed by staff.

Staff had been trained in equality and diversity, safeguarding and mental capacity. Leaders also provided examples of kindness, compassion and dignity shown by staff to patients. However, some staff were unable to tell us how they regularly involved patients in making shared decisions about their care and treatment plans.

Patient feedback reflected some gaps in communication between the GP, hospital and pharmacy. Staff who undertook referrals to secondary care understood systems and processes in place to minimise any potential delays.

Leaders collected patient feedback, however, could not always demonstrate how they used this information to make further improvements. Some staff we spoke to onsite did not have an awareness of people who required additional assistance or who needed longer appointments to be made.

We received some positive feedback from partners in the ICB in relation to the improvements that had been made since our previous inspection to ensure safe systems of care, including when patients are receiving care and treatment from a range of services. They remained concerned that there were areas that required addressing and whether the provider had the capacity to sustain these improvements.

The provider had been working closely with the Primary Care Network (PCN) to reduce waiting times for patients and provide local community support. A representative from the local hospital had provided updates and useful information to the provider during a meeting with the PPG.

The practice had posters on display in the waiting area and reception providing information on different groups and helplines for people to access support. Leaders also discussed individual patient care at multidisciplinary meetings to ensure patients received the treatment they required.

The practice had created new policies and ways of working since our previous inspection. The practice was working on refining and embedding these processes however some staff we spoke with were unclear about their role in ensuring continuity of care.

Some people told us they did not always receive accurate information from the practice and that staff were not always helpful in providing information.

However, some patients provided positive feedback. The remote searches of clinical records as part of our assessment did not raise any concerns with regards to communication with patients regarding their care.

The provider told us they complied with the Accessible Information Standard. They told us for patients who English was not the first Language, or deaf and sign language users they could access other provisions, such as a hearing loop at the reception desk or translation services were available. People could make subject access requests, and their medical records and online access were available.

There had been significant events involving a data breach. The provider had conducted a thorough investigation report, which included a root cause analysis for one of the events. However, another did not have the same level of investigation.

The practice supplied appropriate information in formats that were tailored to individual needs.

There was a Caldicott protocol in place as well as clearly identified Caldicott guardians. In addition, the practice had a reasonable adjustments policy which included information about Accessible Information Standards.

We were not assured that people received information in a timely way, particularly in relation to the delays in urgent referrals. We found 3 occasions when there had been a delay in urgent referrals to secondary care. These delays had been reported as a significant event, however, the learning had not mitigated the risk.

People knew how to give feedback about their experiences of care and support including how to raise any concerns or issues. They could do so in a range of accessible ways, such as submitting a formal complaint to the practice, written online NHS and unverified google feedback, sending their feedback to CQC and completing Friends and Family tests, as well as the national GP patient survey.

Some people, their family, friends and other carers did not always feel confident that if they complained, they would be taken seriously and treated compassionately. They also told us responses to their complaints were either not investigated or not investigated in good time.

Patient feedback demonstrated that complaints were not always responded to in line with the practice complaints policy. The provider gave assurances that they had taken action to reduce these delays.

A patient participation group (PPG) was made up of people registered with the practice and acted as representatives of peoples’ views. The PPG was looking to recruit more members.

Since our previous inspection leaders had created an action plan of improvement. This action plan was a positive start; however, it lacked detail such as time frames for implementing each action and who would be responsible for ensuring the action had been completed and sustained.

We examined a sample of complaints and found they had not always been managed satisfactorily and in a timely manner. Although the practice had implemented a new system for complaints, patients did not always receive a written outcome, which was not in line with the practice policy.

People could leave feedback via the NHS website, the practice website, the Friends and Family test (FFT), or in person. However, the practice had not responded to all feedback by people who used the service.

Results from the GP patient survey showed 34% of patients found it easy to contact the practice by phone. This was below the national average of 50%. 38% of patients responded positively to the experience of making an appointment using the practice’s website. This is also lower than the national average of 48%. 45% reported that they find it easy to contact the practice using the NHS App, this is in line with the national average.

The provider used the information collected for Quality and Outcomes Framework and performance against national screening programmes to monitor access for patients.

Leaders told us that the number of pre-booked appointments had increased by 15% and online bookings increased by 30%. Leaders shared information that demonstrated the percentage of patients able to see a GP within 24 hours had increased by 20%. Leaders said that this was reflected in recent surveys, however we did not see evidence of these.

Patients were able to make an appointment on the same day, at home or work, at a time that suited them. Patients were also able to alter appointments if needed. If someone did not attend an appointment this was followed up with a phone call from the service.

The practice had some processes in place to respond to the needs of their population. For example, a paramedic and pharmacist support. The practice had a duty doctor available to provide urgent on the day appointments if required. However, there had been a number of significant events relating to access.

Appointment policies had been created and implemented since our previous inspection. Some staff told us that there had been new arrangements put in place to improve tracking referrals, including electronic referrals and the oversight of urgent referrals. Staff who undertook referrals to secondary care mostly understood systems and processes in place to minimise any potential delays. We saw resources available for staff for local referral processes and arrangements.

The PPG supported the practice to shape service enhancement by giving valued patient feedback obtained into service provision. We saw minutes from meetings held in July and September 2024 where changes in service delivery and management were discussed, and views of the PPG members was sought. However, we did not see evidence that the changes discussed had always been implemented.

Leaders told us they had adjusted services to offer longer appointment times for people with a mental health condition. Staff and leaders also told us that amendments could be made to appointments to accommodate those patients with a learning disability. This relied on patients identifying themselves as needing adjustments made and requesting these. We did not see any signposting by staff and leaders or analysis of other groups that may require support to access care.

There were some systems in place to support patients who face communication barriers to access treatment, including those who might be digitally excluded. For example, interpreter services were available for patients whose first language was not English.

The provider had processes to ensure people could register at the practice, including those in vulnerable circumstances. However, not all staff we spoke to were aware of these processes.

We did not receive any concerns from patients specifically about planning for the future and end of life care. Therefore, we did not receive enough evidence from patients to score this evidence category.

Staff and leaders mostly understood the requirements of legislation when considering consent and decision making. The practice held monthly multidisciplinary meetings to share and discuss information relating to care and treatment, these were also attended by district nursing and palliative care staff.

Not all staff were able to demonstrate that they understood the importance of assessing and documenting capacity in discussions about care and treatment. Staff were not always able to identify when patients had a DNACPR in place and could not locate these in the patient record.

During the assessment, we conducted a review of 10 medical records for patients with a coded Do not attempt cardiopulmonary resuscitation (DNACPR) decision. Not all were accessible to clinicians when checked. Some coding had not been updated following a change in patient condition. People’s wishes and choices regarding their care and treatment and future planning were mostly recorded within their records. Some records had not been reviewed in accordance with national guidance from the British Medical Association (BMA).