The Heron 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

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 remains the same.

This service scored 75 (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 delivered care in a way that reflected people's individual circumstances, preferences and needs. Staff promoted shared decision-making and involved families, carers and advocates where appropriate.

Seventy-nine percent of respondents to the GP Patient Survey felt their needs were met during their last appointment, compared with 87% locally and 90% nationally and 69% felt they waited the right amount of time for their appointment. This remained above the local average of 62% and was comparable with the national average of 69%.

All staff had completed the Oliver McGowan Mandatory Training on Learning Disability and Autism.

The service worked collaboratively with a range of healthcare and community partners to provide coordinated care. Staff participated in multidisciplinary meetings and shared information across teams through meetings, messaging systems and clinical records. End of life information was shared through established systems to support joined-up care across services. The service also maintained close working relationships with local authority resettlement teams, welfare organisations and voluntary sector partners to support vulnerable groups within the local population.

The service prioritised continuity of care alongside timely access. Patients were supported to see their preferred clinician where appropriate, while maintaining access to urgent assessment when required. National GP Patient Survey results showed 55% of respondents reported seeing or speaking to their preferred healthcare professional, compared with a national figure of 42%. The service also audited continuity arrangements and monitored outcomes to support the delivery of coordinated care.

The service recognised the importance of providing information in ways people could understand and access. Communication needs and preferences were recorded within patient records and staff used interpreter services, translated materials and accessible formats where required. Information was made available in large print and other accessible formats, and the service maintained systems to support compliance with the Accessible Information Standard.

Patients were provided with information in a variety of formats to support engagement with their care. The service offered translated outreach materials, hearing loop facilities and automated messaging systems which communicated normal test results directly to patients. Staff also adjusted the way information was provided where this was needed to support understanding and informed decision-making.

Information to promote the take up of screening and immunisation programmes was available in Turkish. The practice had access to interpreter services, including British Sign Language. Patients were informed as to how to access their care records.

The service actively sought and acted upon feedback from people who used the service. Feedback was gathered through the Friends and Family Test, complaints, surveys and the Patient Participation Group (PPG) and the GP Patient Survey. Leaders reviewed themes arising from patient feedback and used this information to inform service developments and improvements.

The service demonstrated examples of involving patients in service development. The PPG worked with the service to support engagement initiatives within the local community. Feedback from patients resulted in improvements to the environment and communication arrangements. The service also told us that some patients who had previously raised complaints had subsequently joined the PPG, demonstrating confidence in the way concerns were managed and addressed.

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

The service had implemented a range of measures to improve access and reduce barriers to care. A digital triage and demand management tool had been introduced to manage demand more effectively and reduce pressure on telephone lines, while ensuring all requests received clinical review. The system also supported patients who could not access services online, with staff completing requests on behalf of patients where necessary. Data provided by the service showed that 14% of enquiries were submitted with support from staff, demonstrating flexibility in meeting differing levels of digital capability.

The service monitored access data and patient feedback when considering service improvements. GP Patient Survey data showed that 72% of respondents reported a positive overall experience of contacting the service, which was broadly in line with expected levels. However, only 39% reported that it was easy to contact the service by telephone, compared with the local average of 55% and national average of 57%. Leaders recognised this as an area requiring further improvement.

The service had reviewed these findings and developed an action plan with measurable targets.

The premises were accessible and included features such as wheelchair access, hearing loop facilities, accessible toilet facilities and a reception tablet to support access for people unable to use online systems independently.

The service took action to identify and respond to potential inequalities in health outcomes and experiences. Equality monitoring information was reviewed against access and uptake data, and patient feedback was sought from groups more likely to experience barriers to care. Complaints and significant events were reviewed to identify any themes relating to discrimination or unequal experiences.

Staff demonstrated an understanding of the needs of people who may require additional support. For example, patients with autism spectrum disorder or a learning disability were identified through alerts within clinical records and could be offered additional appointment time, adapted environments and alternative consultation approaches where appropriate. Staff described examples where care was adapted to meet individual sensory or communication needs, including consultations taking place in the practice garden when this better met a person's needs.

The service had also sought to improve outcomes for underserved groups within its population.

Feedback provided by people using the service, both to the provider as well as to CQC, was positive.

The service supported people to plan for future care needs and preferences. Systems were in place to identify people approaching the end of life and ensure their wishes were recorded and shared with relevant professionals. Staff maintained a palliative care register and discussed patients through established clinical review processes. Preferred place of care and preferred place of death were documented and regularly reviewed as part of ongoing care planning.

Information relating to end-of-life care planning, including advance care preferences and resuscitation decisions, was recorded and shared through established electronic systems to promote continuity across services. The service also undertook proactive reviews and home visiting arrangements for patients receiving palliative or proactive care, helping to ensure future needs were anticipated and planned for. 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.

The service demonstrated a proactive approach to future population health needs. Leaders were seeking funding to expand their community outreach model to support immunisation delivery within underserved communities, particularly where traditional invitation-based approaches had been less effective. This reflected a commitment to addressing future health inequalities and improving preventive care uptake.