South Hylton Surgery Also known as Sunderland GP Alliance Limited

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 has changed to outstanding.

This service scored 93 (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 was exceptional at making 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 collected by CQC indicated that patients felt listened to, and that the practice recognised individual needs. According to the NHS England GP Patient Survey 2024, only 43.8% of patients would describe their overall experience of South Hylton Surgery as good. Following the publication of these results, leaders at South Hylton Surgery conducted their own patient survey using the same questions. The response rate of the practice’s survey was more than double that of the NHS England GP Patient Survey 2024. According to the practice’s survey, 70% of patients who responded would describe their overall experience of South Hylton Surgery as good, the national average of the NHS England GP Patient Survey 2024 being 74%. The NHS England GP Patient survey showed that 87% of people felt that they were involved as much as they wanted to be in decisions about their care and treatment. In addition to this, in November 2024, 233 people completed the friends and family test survey. Of those 233 people, 220 (94%) would describe their overall experience of the service as good or very good. Since our last assessment, practice leaders had developed and introduced a new role; that of wellbeing and safeguarding lead. This was in response to leaders identifying a potential gap in care for those people who needed more preventative holistic or social support. We saw this role had been well utilised and worked in collaboration with social prescribers, clinicians within the practice, and external support to provide joined up care. We were shown an example in which a person was supported by the wellbeing and safeguarding lead with food, clothing, and daily living essentials by working in collaboration with social services, local charities and social prescribers.

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. We saw the practice worked in partnership with other services to meet the needs of its patient population. The practice had tailored its services to meet the diverse needs of its community, for example, creating a specific system within the online access system for care home residents, and providing winter vaccinations for care home residents and house-bound patients in a flexible and timely manner. Close and positive relationships were held with community services, aligned care homes, and the local primary school. Leaders told us that resuscitation training had been provided by the practice to the children at the local primary school. Leaders of the aligned care homes told us that they had no problems in accessing care for their residents, and there was good continuity of care provided by the practice. Each aligned care home had a named GP to ensure consistency. The practice had supported care home leaders in collecting data regarding access, to monitor the implementation of the online access system with this specific population. The patient participation group (PPG) told us they had a positive experience with how the practice worked with them to improve the quality of care and service for patients. We were told that the PPG had been involved in the development and roll-out of the online access system and had been given live demonstrations of its use before it was introduced. Practice leaders had created posters, leaflets, and website visuals to explain to people how the provision of care would be changing up to 12 months in advance of the implementation. The practice had also engaged with the local community centre and provided a demonstration of the online access system to the Patients of South Hylton Group.

The service was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The practice had information on their website to support national priorities and initiatives to improve the populations health. For example stop smoking campaigns, diabetes prevention, and vaccinations. Various resources such as communication aids, interpretation services, and confidentiality request cards were available to patients. There was a variety of information available within the waiting room, and information provided by the service met the Accessible Information Standard. Patients were informed as to how to access their care records and make a complaint if needed. Translation services were available both in person and via telephone. Leaders had conducted a staff survey to keep a record of all languages that staff were able to speak for any instance in which a translator may not be available, or if this was a more appropriate option. Leaders were able to provide examples of reasonable adjustments that had been implemented on an individual scale. Senior leaders reviewed all subject access requests on a quarterly basis to ensure these had been responded to and actioned within the appropriate time frame. A representative from the PPG told us that they were provided with information regarding changes being made to the access system up to 12 months prior to it being implemented. We saw resources that had been created by the practice that communicated the changes being made in various formats. Practice leaders also told us that they had attended a meeting of the Patients of South Hylton Group to provide information on the system. Practice leaders were able to provide examples of their communication and providing information to the community. Most recently, a new system has been implemented in which text messages were sent to patients with normal test results to keep people informed on their health.

The service was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. They always involved people in decisions about their care and told them what had changed as a result. A representative from the Patient Participation Group (PPG) told us that they felt included in discussions, and that their feedback was listened to by practice leadership. According to the NHS England GP Patient Survey 2024, 72.6% of patients who responded felt that they were listened to by the healthcare professional at their last appointment. Leaders told us that feedback was regularly collected from patients via the Friends and Family Test. This data was reviewed by the practice team and displayed on the website and in the practice waiting room. Staff told us that they were able to share feedback and ideas with leaders and felt this was taken into consideration and acted upon. Practice leaders had reviewed data collected in the NHS England GP Patient Survey 2024 and had created an action plan to address the concerns highlighted within the feedback. This had been done prior to our inspection. We reviewed meeting minutes that showed the practice had discussed the survey results on many occasions. We saw evidence of a robust complaints process. Complaints were reviewed and responded to in line with practice policy, and themes and trends were reviewed by senior leaders. Complaints and significant events were discussed within documented meetings, with learning points distributed to staff. We saw examples of changes that had been made to processes and audits that had been introduced as a result of patient feedback, complaints, or significant events. Practice leaders told us that individual needs of people were always considered, and people were involved in decisions about their own health. For example, health care plans including written clinical information were given to patients to take home.

The service made sure that people could access the care, support and treatment they needed when they needed it. In response to the National GP Patient Survey data and feedback from members of the community, leaders had identified changes to improve access to the service. For example, they had introduced a new system for people to contact the surgery online. 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. Our observation of the physical environment did not raise any concerns. Leaders told us that appointment data was reviewed regularly. Following the introduction of the new online access system in April 2023, leaders had audited access data every 3 months to review the effectiveness of implementation. The practice provided evidence which demonstrated that their new approach was being well received by patients. Admissions data was reviewed by leaders for those people at the highest risk. For example, patients with chronic obstructive pulmonary disorder (COPD) that had been admitted to hospital as a result of COPD in 2023, were reviewed by the nursing team. Repeat A&E attendances were also reviewed on an individual basis by clinicians. Leaders told us about a new data reporting tool that was available to them, with which they would be able to identify people who accessed the practice more frequently, to identify the appropriate support needed. We saw the practice’s access policy, which had considered and included resources for patient groups that may experience barriers to accessing healthcare. For example, the practice had a process in place to allow people with no fixed address to register as patients with the practice.

Staff and leaders were innovative in how they listened to information about people who were most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this. Feedback from people collected by the provider and CQC was positive. Leaders proactively sought ways to address any barriers to improving people’s experience. The provider had processes to ensure people could register at the practice, including those in vulnerable circumstances such as people with no fixed address. Leaders told us that people could contact the practice in various ways, to meet individual needs. Resources were made available to patients, such as communication cards, that allowed people to make their needs known to the practice in an attempt to eliminate barriers to accessing care. Electronic tablets were available in the waiting area to allow online access for those without technology in the home. Practice leaders had reviewed their online access system and identified a 20% increase in patients using online systems since last year. Phone line waiting times as well as time spent on the phone with a member of staff had reduced in this time. Leaders told us how they engaged with hard to reach groups, providing home visits to those who had not responded to correspondence from the practice. These visits provided healthcare by an advanced practitioner, as well as social and mental health support by the wellbeing lead. Practice leaders were aware of challenges being faced by primary care services and were working to improve. For example, recognising the challenges with opioid prescribing and conducting an audit and review of all people prescribed certain medications, which included consultations with the patients themselves. Leaders told us that they worked with the Carers Centre, as well as Veterans in Crisis to support staff with training needs around these groups.

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. Aligned care home staff provided positive feedback in this area, describing the work done by the practice as person-centred and caring. We were told that DNACPR documentation and emergency healthcare plans were reviewed regularly by the practice and kept up to date. Leaders told us that there was a GP with a special interest and training in end of life and palliative care, however continuity of care was also considered for people who had received long-standing care from another GP at the practice.