The Osmaston Surgery Also known as Dr I R Shand & Partners

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

There had been some improvements in how the practice responded to the needs of patients since our previous assessment. There were systems in place to support continuity of care and extended access to appointments. The practice worked collaboratively with local public health services to promote equity in experience and outcomes for ethic minority groups to improve health outcomes for this group of patients. Information received from the Integrated Care Board for March 2024 showed that 95% of appointments were carried out within 14 days of booking, which was above the local and national averages, and 83% of appointments were face to face of which 45% were with a GP. Systems were now in place to support patients near the end of their life. However, we found ongoing concerns in the quality statements for listening to and involving people and equity in access. Complaints were not always investigated or responded to and patients were not always informed of next steps if they were unhappy with the outcome of an investigation into their complaint. All 4 indicators from the latest GP national patient survey for access to appointments were below local and national averages. Despite plans put in place by the practice to address this, patient satisfaction with ease of getting through to the practice on the phone had continued to fall since our previous assessment.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received 5 patient comments from Healthwatch regarding patients’ experiences of person-centered care. One patient was concerned that staff did not accept them as themselves and that translation services did not meet their needs. A housebound patient was concerned that when a GP provided a home visit they did not always diagnose the problem correctly. One patient felt disadvantaged as they were unable to drive to the practice to enable them to queue outside to get an appointment.

A member of the nursing team carried out reviews for patients with a learning disability and tailored them to meet the individual needs of patients.

Staff told us that appointments were available during the evenings and at weekends at the Hub. This provided patients with flexibility if they were unable to attend during usual practice hours. Leaders told us they worked collaboratively with the local Primary Care Network and were moving towards the day to day nursing care being delivered through the Hub model. Long-term condition clinics and cervical screening were available on a daily basis at the Hub. Staff were encouraged to inform patients that these appointments were part of the practice appointments and with consent, staff working at the Hub had access to the electronic patient records. Staff told us that patients were happy to attend appointments at the Hub, as it was located on a bus route and also had ample car parking.

The provider worked with partners to reflects the needs of their practice population. A member of the Derbyshire Health Inequalities Partnership told us that the practice was aware of the demographics of their practice population and had recently started to work with them to improve health outcomes for the ethnic population that the practice served. We received positive feedback from a representative of Derby City Council who told us that the practice had reached out to the local council to work with them to improve childhood vaccination uptake. The provider completed a toolkit created by Derby City Council to understand the current offer, gaps and how to improve. Actions had been taken in response to this. For example, a pop up clinic for patients who had not received their MMR vaccination had been created and immunisation information was sent out to new mothers prior to their baby’s 8 week development check.

Leaders had a good understanding of the local population and complied with the accessible information standards within the surgery. Staff had received training in equality and diversity.

Feedback from Healthwatch demonstrated that some patients were given written information to help them access additional services. However, another patient commented they did not receive any information about their condition.

Staff told us they were able to access translation services for patients whose first language was not English and British Sign Language interpreters for patients with impaired hearing. Leaders told us they were aware of the challenges of communicating with the diverse practice population. They were working with public health to improve the uptake of childhood immunisations through the provision of literature in a range of different languages. They told us they worked with the social prescribers who had good links with the community and were able to interact with people in their own language.

As part of the process to improve the uptake to cervical screening, the practice included a link to a video when texting patients to request they book an appointment for their cervical screening. Through our remote clinical searches, we found that patients were given information about risks relating to their medicines in order to make an informed choice of any additional action or precautions they needed to take.

The latest national patient survey showed that 74% of respondents stated that the last time they had a general practice appointment, the healthcare professional was good or very good at listening to them. This was below the local average of 86% and the national average of 85%.

Staff were aware of the process to follow if a patient needed to raise a complaint about the service. They told us the main issue patients raised was the challenge around accessing appointments. Staff told us they tried to manage concerns as they arose and that learning from complaints was shared with staff at team meetings and through emails. The complaints process was included in the practice leaflet. Leaders told us they encouraged staff to manage complaints as they arose and were developing a system to assist staff to respond appropriately. Leaders planned to provide complaints training for staff.

There was a policy in place for investigating and responding to complaints however, it had not always been adhered to. We reviewed 2 complaints received by the practice. One had not been responded to or investigated. The other had been investigated and responded to however, the patient had not been informed of their right to go to the Parliamentary and Health Service Ombudsman (PSHO), in line with the practice’s complaints policy. Systems were in place to record, monitor and review complaints for trends and themes. We spoke with a patient who had been a member of the Patient Participation Group (PPG). They told us that the PPG had not met since 26 March 2020 however, they were in the process of re-establishing the PPG.

All 4 indicators from the latest GP national patient survey for access to appointments were below local and national averages. Only 24% of respondents responded positively to how easy it was to get through to someone at their GP practice on the phone compared with 33% of respondents at our previous assessment. This was significantly below the national average of 50%. Patient feedback provided by Healthwatch from the previous 12 months supported this finding. Patients said it was difficult to get through to the practice by phone to book an appointment and when they managed to speak with a receptionist, all of the appointments had been booked. Some patients chose to visit in person and queue before the practice opened, to try to book an appointment. They commented this disadvantaged patients who were unable to travel to the practice and queue. Patients also commented they were offered phone appointments when they preferred a face to face appointment. The 4 comments posted on the NHS Choices webpage since our previous assessment were all negative. Three related to very poor access to appointments and 1 related to a lack of support from GPs. The CQC received 22 complaints from patients prior to our assessment of which 15 related to poor access to appointments. The practice had received 8 complaints within the last 12 months related to poor phone access to appointments. The practice was aware of this and were reviewing their phone system. However, information received from the Integrated Care Board (ICB) for March 2024 showed that 95% of appointments were carried out within 14 days of booking which was greater than the local average of 85% and the national average of 88%. Eighty-three percent of appointments were face to face of which 45% were with a GP. On the day appointments for March 2024 were 59%.

Practice nurse appointments were the most difficult to book due to a depleted nursing team. This meant patients’ needs were not always met in a timely manner. Processes were in place to support patients to be seen by the most appropriate clinician to meet their needs however, staff told us these systems were not always effective. Leaders were aware that the phone system was not fit for purpose and there were delays in calls being answered. They told us they had increased the availability of booking appointments on line and had expanded the clinical workforce to include a range of health care professionals who delivered acute clinics enabling GPs to see more complex patients. Staff told us that the practice offered on the day and pre-bookable appointments with a range of clinicians. Home visit requests were triaged by the duty GP. Extended access appointments were offered through the hub in the evenings and at weekends. To improve equity to access to appointments, changes had been made to the appointment booking system and patients could only book appointments on line or over the telephone. On the day appointments were released in stages throughout the morning. We reviewed the appointment booking system on a day during our assessment and found that appointments were still available for that week.

Policies to support access to appointments were in place and were reviewed at regular intervals. The appointment rotas were structured and included time for additional roles and tasks. Other patient services were available through the local Primary Care Network (PCN). For example, physiotherapy, occupational therapy, mental health and substance misuse support and care home ward rounds. However, these processes need to be embedded into practice as the changes.

A patient told us that due to their disability, they were always provided with an appointment in a ground floor consultation room. If they were not accompanied by a family member when attending the practice, the receptionists took them to the consultation room when it was time to do so. A member of the Derbyshire Health Inequalities Partnership told us that the practice and the social prescriber had put plans in place to work with the partnership to address health inequalities for ethnic minority groups. For example, one of the GP partners was attending a meeting at the community center in May 2024 to engage with women and discuss the importance of cervical screening. They also had plans in place to raise the importance of childhood immunisation.

Leaders told us there could be challenges in engaging with patients due to high deprivation and the diverse and transient population of patients registered with the practice. They were aware that the uptake for cervical screening and childhood immunisations was below the expected minimum uptake. Leaders had engaged with public health to tackle these issues. Appointments were available evenings and weekends through the hub to assist. The practice worked with Derbyshire Health Inequalities Partnership to engage with the local mosques to promote the uptake of screening within the practice population.

Leaders had developed an improvement plan following our previous assessment. The improvement plan was rated and reviewed monthly with the support of the local Integrated Care Board. The plan included the need to engage with public health services to promote equity in experience and outcomes for ethic minority groups who hesitated to engage with national health promotion initiatives.

A representative from a care home where the practice provided care and treatment told us that if a person living in the home had a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) plan in place the plan was reviewed by the practice in a timely manner. Where appropriate, family and people who lived in the home were included in these decisions.

The provider told us they had systems in place to support patients near the end of their life. They told us that the care provided to this group of patients was monitored every 2 months as part of a wider multidisciplinary team and weekly within the surgery. Minutes we reviewed confirmed this.

There were policies in place to support planning for the future. For example, end of life care. Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) decisions were made in line with relevant legislation and were appropriate. We reviewed the records of 4 patients with a DNACPR in place. In 2 of the records a copy of the DNACPR was available and where possible the patients’ views had been sought and respected. However, in the other 2 records a copy of the DNACPR plan was not available. We found that clear discussions were recorded in the patients’ records regarding the decision to put in place a DNACPR plan. The provider was aware copies of the plans were not available in patient records, where required, and had completed searches to identify these patients. Requests for a copy of the plans had been made to the appropriate carers so that they could be scanned into patients’ records.