Rectory Meadow 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

We looked for evidence that the service met people’s needs, and that staff treated people equally and without discrimination.

At our last inspection, we rated this key question as Good. At this inspection, the rating remains the same and continues to be rated Good.

This service scored 86 (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 made sure patients 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.

Care plans reflected physical, mental, emotional, and social needs of patients including those related to protected characteristics under the Equality Act. 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.

Accessible standards and barriers to care were considered for people, with alerts added to medical records so that staff were aware the person had additional needs.

Leaders and staff, we spoke with, 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.

The practice used a telephone system dashboard which had a range of functions, 1 of the functions allowed the practice to review any repeated incoming calls to ensure patients calling more than once received person centred care including assistance if needed.

The patient participation group (PPG) were positive about the practice taking on board patient feedback and were assured any suggestions were taken seriously to improve patient care.

The practice 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. Staff told us this was a result of long-standing staff, a low staff turnover and a named GP service (for non-urgent problems).

We saw the practice worked in partnership with other services to meet the needs of its patient population. For example, the practice was part of a 5-member Primary Care Network (PCN), which offered extended access and access to a range professionals including pharmacist, mental health practitioner, and health and wellbeing coaches. Feedback from system partners within the PCN was positive.

We also saw the practice hosted and worked with a local physio service to provide a weekly physio class with a range of seated and standing exercises with a view to improve general strength, flexibility, balance and fitness – this was in line with local health priorities. For most classes, attendance was high with occasional waiting lists.

Furthermore, the practice also worked with health visitors, the local hospice, palliative nurses and the district nursing team. Regular meetings were held to review the needs of people who were approaching the end of their lives.

There were established mechanisms for engaging with the community healthcare provider.

The long-standing clinical staff team provided continuity and stability with minimal requirements for locum staff. Staff had forged excellent working relationships with many multi-disciplinary professionals to meet the needs of patients and all staff we spoke with were familiar with the patients who attended the practice.

Staff we spoke to highlighted the importance of building relationships with patients and care continuity, this was reflected in patient feedback regarding continuity of care, for example, the National GP patient survey highlighted:

• 55%of respondents usually got to see or speak to their preferred healthcare professional. This was significantly higher when compared to the local average (44%) and national average (40%).

The practice supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The practice had access to interpreter services, including British Sign Language. During our clinical searches we saw patients had their individual adjustments and preferences coded onto their record. For example, a patient used a dedicated text messaging service to communicate with the practice. Information provided by the service met the Accessible Information Standard. Patients were informed as to how to access their care records.

Further results from the National GP patient survey showed that 94% of respondents knew what the next step would be after contacting the practice. This was higher when compared to the local average (84%) and national average (83%).

The practice 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.

Whilst minimal, we saw complaints were managed in line with the practice’s policy. Learning from feedback was evident and staff were able to identify changes made as a result of patient feedback, including complaints, compliments and patient suggestions. Complaints we reviewed showed the practice responded to feedback appropriately, openly and in a candid manner. Staff were aware of their duty of candour and to be open and honest when things went wrong.

In the National GP patient survey, 90% of respondents felt that during their last appointment, the healthcare professional was very good or fairly good at listening to them. This was comparable to the local average (88%) and the national average (87%).

We noted that 93% of respondents indicated that during their last appointment they were involved as much as they wanted to be in decisions about their care and treatment. This was comparable when compared to both the local average (92%) and national average (91%).

The practice regularly ran audits on their patient feedback to review and make improvements; and also share good news stories and patient testimonials. The practice regularly met with members of their PPG, representatives from the PPG told us they felt the practice listened to them and they had a good relationship with them. This included ongoing 2-way conversations to improve access, using the PPG members to suggest, review and test ideas when implementing new systems.

The practice ensured all patients could access the care, support and treatment they needed when they needed it. This included a range of improvements to the appointment system, which remained under constant review using patient feedback. For example, a daily minor ailments clinic and where possible, telephone call-backs were at agreeable, preferred times to accommodate patients availability.

In the National GP patient survey, patients’ responses to the survey questions about how they accessed services were positive, for example:

• 55% of respondents found it easy to get through to the practice by phone. This was comparable when compared to both the local average (54%) and national average (53%).
• 77% of respondents described their experience of contacting their GP practice as good. This was higher when compared to both the local average (70%) and the national average (70%).

During the site visit, we reviewed the appointment system alongside the performance dashboard. We saw non-urgent GP and nurse appointments were available on the day of our visit and we saw the average wait time for inbound phone calls was under 2 minutes. Leaders and reception staff told us the introduction of online access had significantly reduced call volumes. Further data we received demonstrated significant reductions in both call answering times and missed calls.

During the inspection, patients who we spoke with complimented the appointment system, advising of very good telephone access and an appointment system which promoted continuity of care it worked for their family.

Staff and leaders actively listened to information about people who are 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, 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 and community 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. There were processes to ensure people could register at the practice, including those in vulnerable circumstances such as homeless people and Travellers. For example, the practice was also a registered ‘Safe Surgery’ and supported patients or potential patients who were homeless, in temporary accommodation or seeking asylum. A ‘Safe Surgery’ is a GP practice with a declared commitment to addressing the barriers people face in accessing healthcare or support, including refugees.

Leaders were alert to discrimination and inequality that could disadvantage different groups of people using their services. They proactively sought out ways to address these barriers to improve people’s access, experience and outcomes.

Staff used appropriate systems to capture and review feedback from people using the service, including those who did not speak English or have access to the internet.

Feedback provided by people using the service, in feedback collected by the practice and via the National GP patient survey regarding experiences and outcomes, was positive. For example:

• 83% of respondents felt they waited about the right amount of time for their last appointment. This was significantly higher when compared to both the local average (67%) and the national average (67%).
• 89% of respondents described their overall experience of the practice as good. This was significantly higher when compared to both the local average (76%) and the national average (75%).

Patients and their families were given exceptional support to plan for important life changes, so they could 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.

Similar to health promotion events, the practice both supported and hosted education events to support conversations about death and end of life care. This included close work with Chiltern Compass (a local group with an interest in matters concerning death, end of life and bereavement) and a local hospice about dignity in death and dying well. Furthermore, we saw the practice worked with a local solicitor as the practice hosted events to support conversations about death and subsequent plans both legal and financial plans. The practice advised these events were well attended.