The Humbleyard Practice

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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

We assessed 7 quality statements from this key question. Our rating for this key question is Good. We have combined the score for this area with scores based on the rating from the last inspection, which was Requires Improvement. The provider complied with legal equality and human rights requirements. People were regularly involved in planning and making shared decisions about their care and treatment, so it was centred around them and their needs. Despite recruitment challenges, the provider had taken action to ensure that people could access timely care, treatment and support. This included tackling inequalities by ensuring that people who were most likely to have difficulty accessing care achieved equity of access. The provider used people’s feedback and other evidence to actively seek to improve access for people.

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.

People told us they were regularly involved in planning and making decisions about their care and treatment; and that staff ensured care was centred around their needs. The latest national GP patient survey results highlighted that 89% of respondents were involved as much as they wanted to in decision about their care.

Staff routinely involved patients in planning and delivering care, supported by clinical systems which highlighted patients’ individual needs. This ensured that people understood their condition, care and treatment options (including any associated risks and benefits) and any advice provided. For example, the practice’s clinical pharmacist routinely spoke with patients about possible side effects before they were prescribed blood thinning medications.

Staff routinely delivered care and treatment in a way that met patients’ needs and which was co-ordinated with other services.

The practice had partnered with a local community pharmacy to raise patients’ awareness about common conditions that could be treated by local pharmacies. A local community pharmacist spoke positively about the initiative and how information was shared between teams and services to ensure continuity of care.

Continuity of care was reviewed at regular multi-disciplinary meetings involving social services, district nursing, palliative nursing and health visiting teams.

People told us they had access to information and advice that was accurate, up-to-date and provided in a way that they could understand.

Staff gave examples of how the practice tailored information to individual patient’s needs. This included making reasonable adjustments for disabled people, interpreting and translation for people who didn’t speak English as a first language; and for d/Deaf people who used British Sign Language. People who had difficulty with reading, writing or using digital services were supported with accessible information.

Systems were in place to ensure that patients’ individual needs to have information in an accessible way were identified, recorded, highlighted and shared. For example, the practice’s on-line appointments system offered automatic translation: allowing patients to write in another languages and for staff to see this is English (and vice versa).

Patients told us that they knew how to give feedback about their experiences of care and support including how to raise any concerns or issues.

Staff saw learning from complaints and concerns as an opportunity for improvement. They gave examples of how they incorporated learning into daily practice. For example, the practice’s recent introduction of a new phone system had been driven by complaints about phone access.

The practice’s complaints policy ensured that patient complaints were explored thoroughly and that patients received a response in good time. We looked at a selection of complaints and saw that these had been dealt with in an open and transparent way; and that learning had been used to improve the service.

People were positive about the quality of their care and treatment that they received. Latest national GP Patient Survey results showed positive feedback on involvement in care decisions (86%), levels of trust in health care professionals (91%) and levels of care and concern shown by health care professionals (83%). However, the survey also highlighted that people remained dissatisfied about the availability of appointments (for example only 24% were offered a choice of time or day for their appointment). We noted GP recruitment challenges and a rapidly increasing patient list size continued to impact on the practice’s ability to provide timely and flexible access. However, we saw extensive evidence of how the practice had taken action to improve access. For example, leaders had recently introduced an on-line triaging system to help patients access the most appropriate appointment option. Survey data provided by the practice highlighted that the new system had already received positive patient feedback. The practice had also partnered with a local community pharmacy to raise patients’ awareness about common conditions that could be treated by local pharmacies. The provider shared data which highlighted that the new scheme had already freed up GP appointments for patients who needed them most. Leaders continued however, to be mindful that some patients preferred to access the practice by phone. We noted the GP Patient Survey highlighted that patients were dissatisfied about phone access (with only 14% of respondents feeding back that it was easy to access the practice by phone). Leaders were aware of performance and had undertaken a detailed analysis to fully understand the challenge and enable access to good quality care, treatment and support. Following this analysis, in September 2024 a new phone system was introduced with call back and call analysis functionality. The practice’s website added functionality to negate people having to phone the practice.

Leaders were aware that patient satisfaction was low regarding appointment access and highlighted additional activity aimed at improving access. For example, a GP now supported the team triaging routine health problems submitted via the practice’s online triaging platform. Leaders spoke positively about how this had improved triaging; often enabling a health problem to be solved without the need of an appointment. We were also told that the practice had revised how its long term conditions team operated; with the team now calling patients to book blood test appointments. This removed the need for patients to call in and therefore freed up phone and online capacity. Leaders spoke positively about how improved performance monitoring arrangements had enabled the practice to target scarce resources and enable access to good quality care, treatment and support.

Action had been taken since our last inspection, such that the practice now had clear roles and systems of accountability to monitor and enable access to good quality care, treatment and support. Regular performance monitoring and risk analysis meetings took place so as to monitor and assess how the type/proportion of appointments and the skill mix of staff, met the needs of the local population. Patient feedback, complaints, performance data and risk analysis data were routinely used at these meetings, so as to monitor access and ensure that patients had access to good quality care and treatment.

People’s feedback to both the provider and CQC was positive. Latest GP patient survey was also positive; highlighting for example that 91% of respondents felt that their needs had been met.

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 understood the importance of providing an inclusive approach to care and made adjustments to support equity in people’s experience and outcomes.

The provider had processes to ensure people could register at the practice, including those in vulnerable circumstances such as homeless people and Travellers. Staff used appropriate systems to capture and review feedback from people using the service, including those who did not speak English or have access to the internet. We also saw evidence of how the practice engaged people who faced barriers in accessing care and who were therefore most likely to have a poorer experience or outcomes. For example, the practice offered home visits to patients with a learning disability or those experiencing poor mental health (and who found it difficult to attend for appointments). The practice also engaged with local mental health teams to accompany patients to their annual review.

Patients told us they were supported to make informed choices about their care and plan their future care.

The practice’s DNACPR policy aimed to ensure that patients were always at the centre of their care (including advance care planning and DNACPR decisions). We reviewed and discussed a selection of patient records with GPs which confirmed this was happening and also that families and representatives had been supported, as partners in personalised care.

We were told that monthly meetings took place where the practice reviewed palliative patient records to ensure they contained completed Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms. We noted the practice had recently introduced a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policy.