Archived: Tollgate Health Centre

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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

People were involved in decisions about their care. The service provided information people could understand. People knew how to give feedback however systems to record, investigate and learn from complaints were not effective and not used to drive improvement and shared with staff. The service was easy to access, and patient feedback was positive. The service was not able to demonstrate it worked to reduce health and care inequalities through training and feedback. Staff and leaders did not work consistently with external agencies to ensure people’s care and treatment was delivered in a way that was responsive to people’s needs. At our last assessment, we rated this key question as good. At this assessment, the rating has changed to requires improvement. We identified breaches of regulation in relation to safe care and treatment, staffing and good governance.

This service scored 43 (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 did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide 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. Staff discussed palliative care patients in multidisciplinary meetings.However staff were unable to tell us how they regularly involved patients in making shared decision about their care and treatment. Leaders told us that the patient participation group was active, however we were not provided with details of the participants to share their views. In addition, we found no evidence to demonstrate the outcome of national patient surveys had been reviewed and used to make improvements.

There were significant shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.

We found no evidence to demonstrate the outcome of the national patient survey had been reviewed and used to make improvement. We saw the practice worked inconsistently in partnership with other services to meet the needs of its patient population. We saw limited examples of how the practice had tailored its services to meet the diverse needs of its community, for example, building relationships with community groups to promote the take up of screening programmes. Staff were unable to provide examples of established mechanisms for engaging with the community healthcare provider. The practice told us they attended primary care network meetings; however, we did not see evidence of these meetings and actions.

The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The practice website did not contain up-to-date staff and practice information. There was no support information for carers when they needed to find further information and access community and advocacy services. Information to promote the take up of screening and immunisation programmes was available in a range of languages. The practice had access to interpreter services, including British Sign Language. Information provided by the service met the Accessible Information Standard. Patients were informed as to how to access their care records.

The service did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not involve people in decisions about their care or tell them what had changed as a result.

Complaints were not managed in line with the practice’s policy and in line with national guidance. Learning from complaints was not evident and staff were unable to identify changes made as a result of patient feedback, including complaints. The practice had not formed an action plan to improve patient satisfaction following national and in-house patient survey nor did they provide evidence of how they used the NHS Friends and Family Test (FFT) data to drive improvement. Individual complaints and incidents were discussed in an inconsistent manner in practice meetings. Leaders were unable to demonstrate they had processes in place to review trends and monitor if performance had improved compared to previous years and what actions were needed. Leaders told us they had an active Patient Participation Group who had support the practice, however we were not provided contact details for the group to speak with them directly.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

National GP Patient Survey data was mostly positive about accessing the service; however, leaders were unable to describe how feedback from members of the community had identified changes to improve access to the service. People could access the service to suit their needs for example online, in person and by telephone. Treatment rooms were available on the ground floor, and we saw there was a large waiting area with sufficient seating. There was a hearing loop and access to interpreters, however reception staff had not been trained to support people with hearing needs. Monitoring of mandatory training compliance was ineffective. We found training was incomplete and overdue, for example accessible information standard training, equity and diversity, mental capacity and training to support people with a learning disability.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Feedback provided by people using the service, both to the provider as well as to CQC, was both positive and negative. Staff treated people equally and without discrimination. Staff did not always demonstrate they understood the importance of providing an inclusive approach to care and made adjustments to support equity in people’s experience and outcomes, for example people with learning disabilities and who may also have an autistic spectrum disorder needs were not always considered on an individual basis when requesting appointments. The provider had processes to ensure people could register at the practice, including those in vulnerable circumstances such as homeless people and Travellers. We did not see effective systems to capture and review feedback from people using the service, including those who did not speak English or have access to the internet. Not all people had received treatment in line with national guidance, including some people with diabetes and asthma. People could leave feedback via the NHS website, the Friends and Family Test (FFT) or in person. We found no evidence to demonstrate the outcome of patient feedback had been reviewed and used to make improvements.

People were not always 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.

There were registers held for those who were identified as vulnerable, or on the palliative care register or at the end of their life, however staff who had provided support to maintain these registered had left the practice. 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.