Eastgate 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 assessment, we rated this key question as Good. At this assessment, the rating remains the same.

This service scored 79 (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 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. Feedback from people who used the service was positive. They told us that during consultations staff listened to their concerns and preferences and agreed a plan of care together. Where appropriate, family members and carers were involved in care and treatment decisions.

Our review of clinical records showed people 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 service had arrangements in place to support person-centred care. For example, people who were due a long-term condition review could book their appointment online or by telephone on a date and time to suit them. Clinical staff told us during consultations they discussed relevant information, listened to people’s concerns and expectations, identified people’s needs and preferences and agreed a plan of care together which suited the person.

Staff told us they communicated with patients using appropriate methods, for example, not all patients received information by text message, and patients who were deaf or who had difficulty hearing were offered face-to-face appointments rather than telephone consultations. Patients’ preferences and needs were recorded on the patient’s clinical record.

The service complied with legal equality and human rights requirements, which included avoiding discrimination and having regard for the needs of people with different protected characteristics.

Feedback from care home representatives about the service on behalf of residents was generally positive. Records showed that residents received regular clinical input from a range of practice clinicians, including face-to-face visits, medicines reviews and multidisciplinary support. However, opportunities were identified to improve review processes so they better met residents' needs, preferences and involvement in decisions about their medicines. Representatives reported that medication and care reviews were often undertaken by telephone, which some residents found less suitable than face-to-face consultations and which could limit their participation in discussions and decision-making.

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.

Systems were in place to ensure people were seen by an appropriate clinician, if needed. People could request to see a GP of their choice, although there may be a longer wait.Staff told us they tried to book people in with the same clinician for a follow-up appointment for continuity. Clinicians could request to follow up people, based on their clinical needs to provide continuity of care. Feedback from people who used the service was positive regarding care provision.

Leaders had a good understanding of the needs of the local population and could refer people, or people could self-refer, to a range of services, for example, physiotherapy, mental health wellbeing, and contraception and sexual health services.

Leaders and staff told us they worked in partnership with other services to meet the needs of the local patient population, such as the integrated care board (ICB), secondary care services and local authority. They worked with local partners and were involved in various community initiatives and had tailored their services to meet the diverse needs of its community, for example, building relationships with community groups to promote the take up of screening programmes.

Examples of community engagement initiatives undertaken included setting up a series of health events (including a Health and Wellness Day, and Men’s Health Event, and engagement at religious places of worship).

The service also participated in the local community Pride event. Staff attended to connect with people of diverse sexual orientations and gender identities, a group known to experience health inequalities and barriers to accessing healthcare. Staff provided health information and advice, and shared details about local services. Feedback was positive, with attendees and existing patients welcoming the service's presence at the event and recognising their commitment to providing an inclusive and accessible service for all members of the community.

The service supplied appropriate, accurate and up-to-date information in formats tailored to meet people's individual needs.

The service had effective systems in place to store and protect confidential and sensitive personal information, including current and historic medical records. Information was held and used in line with data protection requirements and information security standards, including when managed digitally. The service was registered as a data controller with the Information Commissioner’s Office.

Information was available on the website explaining how patient information was stored, managed and protected. People were also provided with information about how to access their care records.

The service maintained a comprehensive website containing a wide range of information, including how to book appointments, request prescriptions, access test results and find self-help resources. The website included videos covering topics such as cervical screening, bowel cancer screening and other health conditions, helping people understand and access the service. The website could also be translated into more than 100 languages, including Albanian, Bengali, Romanian, Polish and Urdu, helping to ensure people could access information in a format they understood.

The service also produced monthly newsletters to keep patients informed about practice developments, upcoming events and health promotion initiatives. A wide range of health information leaflets and posters were displayed in the reception area and on noticeboards, covering a variety of health conditions, local support services such as food banks, information for carers, screening programmes, and other health and wellbeing resources available to patients and their families.

The service had access to interpreter services, including British Sign Language (BSL), and information was provided in line with the Accessible Information Standard. For example, a hearing loop was available for people who were deaf or had hearing loss. Longer appointments could be arranged where additional support was required, including for people using interpreters, neurodivergent people and people with a learning disability. Some staff members also spoke additional languages and could help facilitate communication where appropriate.

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.

People who provided feedback told us clinicians were good at listening, explained things well and made them feel comfortable during consultations. They described staff as “knowledgeable”, “personable” and said they “went above and beyond”.

The service encouraged people to provide feedback, compliments and complaints, and people could feed back in a variety of ways, including online, by email, letter, by completing a comments form, or verbally.

The service also encouraged people to give feedback through the NHS Friends and Family Test, which could be completed online. The service website included a short animated video explaining the NHS Friends and Family Test to help make the information accessible to a wider range of people. The service also recorded and shared positive feedback.

Information about how to make a complaint, including the service’s complaints policy and procedure, was available on their website. There was a ‘Complaints and Comments’ leaflet, available on the website and in waiting areas, outlining the complaints process, what people could expect and what to do if they were not satisfied with the service’s response. The Quality Assurance Manager monitored social media and responded to both critical and positive comments.

Staff were aware of the complaints procedure and told us they would advise people how to make a complaint when appropriate. Feedback and complaints were listened to, responded to and used to improve the quality of care.

Complaints were overseen by the Quality Assurance Manager and discussed at staff meetings to ensure learning was identified and shared across the service. Learning from complaints was evident, and staff were able to describe changes made as a result of patient feedback, including complaints.

The service had systems for recording, investigating and acting on complaints. In 2025/26, the practice recorded 17 complaints. We reviewed a selection of these complaints and found they had been handled in a timely way and responded to appropriately, in line with the service’s complaints policy.

The service made sure that people could access the care, support and treatment they needed when they needed it.

The service was open from 8am to 6:30pm Monday to Friday. In addition, the service provided extended hours clinics from 6:30pm to 9:30pm on Thursdays, and from 9am to 5pm on Saturdays. When the practice was closed, patients were directed to the NHS 111 service or the local urgent care service for support, treatment and advice. People could access the service by telephone, online or in-person. Fifty-five percent of patients had signed up to online services.

The service operated from a multi-storey shared building, with treatment rooms available on the ground and first floor. There were accessible toilets and designated baby changing facilities. There was paid parking adjacent to the building, as well as disabled parking spaces.

There was disabled access at the rear of the building to the ground floor; however, access to the upper-level treatment rooms for people with mobility issues was limited. The service was aware and had put in measures to reduce the impact of this. For example, we saw alerts on the computer system identifying when a patient required accessible facilities. Staff used this information to co-ordinate appointments and ensure consultations took place on the ground floor only. Where necessary, appointments were also offered at their sister practice site, which was located very nearby.

The results of the 2025 National GP Patient Survey showed 83% of people had a positive experience contacting the service. Eighty-seven percent of people found it easy to contact the service by phone and 75% found it easy using their website. These results were all significantly higher than the local and national averages.

Leaders had a good understanding of the local population and told us they reviewed appointment utilisation data to ensure the service met people’s needs. During our site visit, we reviewed appointment availability and found that there were urgent appointments available for on-the-day. Routine appointments for some services, including immunisations, cervical screening and diabetes reviews, were also available within a 2-week timeframe.

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.

The service provided care to a multi-generational population with more younger people and families. The service understood the health needs of its population and sought to provide equitable care. Staff and leaders understood the importance of providing an inclusive approach to care and made adjustments to support equity in people’s experience and outcomes. For example, offering longer appointments, and appointments with the same clinicians to maintain continuity of care. The service also used interpretation and translation services to support people with language needs.

Staff gave examples of using alternative communication methods such as emails for some patients, including those with mental health or additional needs to support them with accessing appointments and reaching out for help.

The service offered a range of appointment types including face-to-face, telephone, online video consultations and home visits to meet people’s specific needs. The service offered proportionally more face-to-face appointments with over 80% of their appointments being in-person compared to 15% remote (telephone and video consultations) in response to the needs and preferences of their local population.

Staff treated people equally and without discrimination. All staff had completed training in Equality and Diversity, and in supporting people with Learning Disabilities and Autism. 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 followed processes to ensure people could register at the practice, including those in vulnerable circumstances such as homeless people and asylum seekers.

Staff used systems to capture and review feedback from people who used the service, including those who did not speak English or have access to the internet. Patient feedback was gathered through a range of channels, including feedback cards, digital feedback, NHS Friends and Family Test responses and online reviews. Feedback provided by people using the service, both to the provider as well as to CQC, was positive.

Leaders proactively sought ways to address barriers to improving people’s experience. They ensured gaps in service were addressed by the practice. For example, they recognised that some women may face barriers to accessing cervical screening, such as concerns about privacy or feeling uncomfortable during appointments. In response, the service provided a female-only cervical screening clinic, where only female staff were on the premises. This supported women to feel more at ease, enabling them to make informed choices and increasing uptake of screening. The service reported there was an increase in uptake of cervical smears following the introduction of this initiative.

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. People were supported to make informed choices about their care and plan their future care while they have the mental capacity to do so.

The service had systems and processes in place to identify people who may be approaching the end of their life, including those with protected characteristics under the Equality Act and people whose circumstances may make them vulnerable. The service maintained a register of people with palliative care needs and people at the end of their life. They had systems in place to support and review people, which included people who were housebound, and worked in partnership with other organisations. Clinical staff attended regular multidisciplinary (MDT) team meetings where people who were receiving palliative and end-of-life care were discussed and reviewed. Minutes of meetings we reviewed confirmed this.

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were made in line with relevant legislation and were appropriate. Patients, and where necessary, relatives and carers were involved in considering the patients’ choices and decisions.

There was a process in place to ensure DNACPR forms were reviewed when the patient’s condition or circumstances changed.

The service carried out regular searches to ensure decisions and documentation were up to date and complete. This enabled them to identify where information had been amended by other services and to work collaboratively with them to ensure records reflected patients’ wishes. During our records review we saw an example of an issue identified through the searches, where a DNACPR alert had been added by an external healthcare professional without supporting evidence of a discussion or documentation. The service was taking action, including reviewing and re‑completing the necessary forms where needed.