Northfield 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

At our previous inspection, the practice was rated inadequate at providing a responsive service because, services were not planned or delivered in a way that met people's needs. They were unable to demonstrate that they had taken appropriate actions to address lower areas of satisfaction from patient feedback and were unable to demonstrate that any actions had been taken to record or address complaints. At this assessment we have rated the practice as requires improvement for providing a responsive service. Data from the National GP Patient Survey showed that patients had problems accessing the practice by telephone. The practice had taken steps to improve this, this included recruiting more reception staff. They also planned on upgrading to a new telephone system. The practice had a patient experience manager was responsible for dealing with complaints, and liasing with patients to gather feedback. This information was all collated and used to look for themes and trends and identifying areas that could be improved. However data from the National GP Patient Survey was still below both local and national averages therefore we did not have assurances that these improvements made from the previous inspection were fully embedded and would be sustained.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The latest National GP Patient Survey results showed that 76.4% of patients stated that they were involved as much as they wanted to be in decisions about their care and treatment. The local average for this is 88.1% and the national average is 90.3%.

Leaders told us that patients could request to see a GP of their choice. Staff were able to offer patients the option of being seen in extended access clinics which happened outside of normal opening hours, either on an evening or at weekends. However, the latest results from the National GP Patient Survey in regard to the overall experience of the GP practice was lower than local and national averages. The practice achieved 42.8% compared with 68.9% locally and 71.3% nationally. Leaders told us that staff had completed mental capacity act and equality and diversity training. Leaders had attended local nursing homes to improve joint working and gather feedback from residents.

Staff and leaders had an understanding of the local population and complied with accessible information standards. They had arrangements in place to identify people’s communication needs and preferences and offered interpretation services for those patients whose first language was not English.

We did not receive any feedback from partner organisations about care provision, integration and continuity.

Staff were able to refer patients to social prescribers to support their wellbeing and social issues. Staff had received training in equality and diversity. There was an action plan for hard to reach communities that the practice was developing to assist patients to access healthcare. The practice had recently appointed a patient experience manager who oversaw this piece of work; however we could not gain assurance that this had yet made a meaningful difference to patients around their continuity of care.

We received 1 piece of feedback from a patient who struggled to get advice following a medicine related query.

Staff told us information was available to patients in different formats and they would highlight on patients’ record if they had any communication or accessibility needs. This was usually gathered at registration but would be done opportunistically if possible. Staff told us they had identified that carers where not being coded correctly on their clinical system. This was now rectified, and the practice had also updated their processes.

There was an accessible standards policy in place. The practice was able to organise interpreter services for those patients whose first language was not English. All consultations took place on the ground floor level. At our previous inspection we did not have assurances that accurate and up-to-date information was tailored to individual needs, at this assessment this had improved.

The practice had recently restarted its patient participation group (PPG). We reviewed the last available minutes from the meeting, recommendations were made from the group, this included creating leaflets for patients that could not always get online. We received 1 piece of feedback that there had been a delay when dealing with a complaint.

Leaders told us they would speak to any patient who was not happy in the practice, or that they would phone them and invite them in to discuss any concerns. Leaders shared with us some examples of change following patient feedback. This included, extending appointment times, and showing patients how to use the NHS App. However, the latest available data from the National GP Patient Survey results show that the practice achieved considerably less than local and national averages regarding patients who responded positively to the overall experience of their practice. The practice achieved 42.8% compared with 68.9% locally and 71.3% nationally. These results differed from internal feedback that the practice had received. They found that 71% of patients responded that their experience was either very good, good or satisfactory. Leaders also told us about engagement work that was carried out in the local community, which included the traveller community and local charities such as Artistic spectrum, Be Well Doncaster and Age UK.

At our previous inspection the practice was unable to demonstrate that there was a system in place to log, respond and address complaints. At this assessment we found the practice had a complaints policy and kept a log of all complaints, this included formal and informal complaints which were used to look for themes and trends. There was a patient experience manager in place who dealt with complaints and engaged with patients on a regular basis. The practice had a complaints leaflet which included details of where to escalate their concerns if they were not happy with the practice’s response to their complaint. The Integrated Care Board (ICB) told us the patient experience manager had done a lot of work to improve patient engagement. Weekly text questionnaires were sent out to patients after their appointments to gain feedback, this feedback was more positive than the National GP Patient Survey showed.

People told us through give feedback on care submissions to CQC and data from the latest National GP Patient Survey that they had difficulty getting through to the practice by telephone. The most recent published National GP Patient Survey results showed that 21.4% of patients responded positively to how easy it was to get through to someone at their GP practice on the phone. This is significant variation from the national average of 49.6%. However, this was an improvement from 11.13% in the April 2022 survey. The practice also scored below local and national averages for patients that were very or fairly satisfied with their GP appointment times, they achieved 31% (an improvement from 29% in 2022) compared to the local average 51.8% and national average 52.8%. In total 30.4% of patients responded positively to their overall experience of making an appointment, the local average for this was 52.6% and the national average 54.4%.

Leaders told us that they had listened to patient feedback with regard to access. They provided data to show their call answering times had improved, leaders told us that they reviewed telephone call monitoring data which suggested call wait times were minimal and did not reflect what patients were reporting. The provider also planned on upgrading their current telephone system in the near future. However, as this was not in place at the time of the assessment, we had no assurances what improvements this would make to patients.

The current appointment system was to call at 8am or attend the reception desk at 8am. Once appointments were gone, patients would be signposted to alternative services, for example, the urgent treatment centre, pharmacies or NHS 111. Staff were trained in care navigation to assess patient’s needs. If patient’s symptoms were urgent then reception staff were able to consult with a clinician and if appropriate there were emergency slots for appointments which could be utilised. The practice was open from 8am to 6pm Monday, Tuesday, Wednesday and Friday and 8am to 8pm on Thursday. Extended access appointments were available 8am to 1pm on Saturdays. Although National GP Patient Survey data showed that patient satisfaction scores with access via telephone had improved it was still significantly below national averages. The practice achieved 21.4% of patients responded positively to how easy it was to get through to someone at their GP practice on the phone, the national average for this was 49.6%. Results also showed negative variation from local and national averages for patients experiences of making an appointment. The provider achieved 30.4% of patients responded positively to their overall experience of making an appointment, the local average for this was 52.6% and the national average 54.4%.

Feedback from people reporting into CQC and from the National GP Patient Survey showed patients dissatisfaction with getting an appointment or getting through to the practice by telephone. A carer of a patient told us they had experienced issues accessing the practice as individual needs of a patient with learning disabilities (LD) had not been assessed by the practice. We fed this back to the practice; they planned on carrying out refresher training with administration staff to improve this.

Staff told us that they respected and appreciated people’s backgrounds and cultural values and that they had received training in equality and diversity. However, patients told us that they had difficulty accessing the practice by telephone and for an appointment. Leaders had an action plan following the results of the National GP Patient Survey and some improvements had been made. Internal data showed that call answer times had improved however, these were not fully implemented or sufficiently embedded to demonstrate improvement or positive impact to address access and equity in outcomes for patients.

Patients, including those who may be vulnerable told us they had difficulty accessing the practice for an appointment. The practice used care navigation to refer to other services when required, this included to pharmacies, NHS 111 and the urgent treatment centre. The practice complied with legal equality and human rights requirements, including avoiding discrimination, and having regard for the needs of people with protected characteristics. The practice had information available in alternative formats and equipment in place to support patients who had a hearing impairment. The service sought the views of people by requesting feedback after patients had attended the practice for an appointment and by reviewing the results of the National GP Patient Survey data. However any actions taken to address feedback with regard to access had not always improved patient experiences at the time of the assessment.

We did not receive any feedback or concerns from people regarding this.

Staff told us they regularly attended multidisciplinary team (MDT) meetings where patients who received end of life care were discussed.

The practice had systems in place to support patients at the end of their life. We reviewed MDT meeting minutes where the practice worked with the district nursing team to identify patients with specific needs. As part of our clinical searches we observed patients’ medical records and saw they were updated to reflect any actions or changes made to their care plan.