OHP - College Green Medical 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 carried out an announced assessment of 7 quality statements (Person-centred Care; Care provision, integration and continuity; Providing Information; Listening to and involving people; Equity in access, Equity in experiences and outcomes and Planning for the future), under the key question Responsive and found: Leaders used people’s feedback and other evidence to improve access for people. Services were designed to make them accessible and timely for all people. The provider prioritised and allocated resources and opportunities as needed to tackle inequalities and achieve equity of access. People and communities were always at the centre of how care was planned and delivered. The health and care needs of people and communities were understood and they were actively involved in planning care that met these needs. Care, support and treatment was easily accessible, including physical access. People could access care in ways that met their personal circumstances and protected equality characteristics. People, those who support them, and staff could easily access information and advice. This supported them in managing and understanding their care and treatment. There was partnership working to make sure that care and treatment met the diverse needs of communities. People were encouraged to give feedback, which was acted on and used to deliver improvements.

This service scored 86 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People received care and support that was co-ordinated, and everyone worked well together and with the patient. People were in control of planning their care and support. People were supported to plan ahead. From the 2024 National GP patient survey, of those people that responded: 90% knew what the next step would be after contacting their GP practice 96% knew what the next step would be within two days of contacting their GP practice This was higher than local and national averages.

All staff we spoke with strived to provide high quality services that were centred on patients’ needs. Staff shared examples with us where they had gone above and beyond to ensure patients’ needs were met. This included patients who were vulnerable or those with complex needs. Staff took immediate action following learning events and complaints as needed and used information to review processes for the future. Staff worked well together, with external organisation and with patients to ensure that care was coordinated and patient centred. Patients were supported to plan ahead for important changes in their life that they could anticipate.

People received care and treatment that considered their diverse health and social care needs. The practice had a diverse workforce. This helped staff to understand patients’ needs better and deliver more effective and responsive care. There was continuity in people’s care and treatment because services were flexible and joined-up. Staff worked together and with external organisations to deliver responsive care and treatment in a way that met their assessed needs. Staff delivered and co-ordinated services while considering the needs and preferences of different people, including those with protected characteristics under the Equality Act and those at most risk of a poorer experience of care. The practice had a stable workforce and rarely used locum GPs. This ensured better continuity of care.

Feedback from the Integrated Care Board was positive about this service. Feedback from care homes which the practice provided GP services to was positive about the arrangements in place to communicate with the practice and to ensure that people’s needs were being reviewed and met in a safe and timely manner.

Patients could access extended opening hours on an evening and weekend and had access to out of hours service provided by Badger. There were processes in place to ensure people in care homes received responsive care and treatment and that care home staff had access to effective communication channels. Leaders used patient feedback to help them monitor how responsive their service was and make further improvements as needed. Each GP had an allocation of appointments they could use to book follow-up appointments in if they felt this was needed to ensure continuity of care.

From a range of patient feedback we viewed, we saw that patient feedback was mostly very positive and patients felt well informed and that staff gave clear advice and explanations. However, a small number of patients felt their medical records were not accurate. We saw that the practice took action to correct this when they became aware. Feedback from patients receiving minor surgery was positive with all patients commenting that they received sufficient information.

All staff reported that they had access to information that would support patients/carers in managing their care and treatment and they would either print the information off in a format that met their needs or send it to patients using text message. Leaders told us they shared information with patients in different ways including using TV screens that were placed on each floor.

Translation and accessibility tools were available on the practice website and there was a translation tool available on the check-in screens in the practice. We saw there was information about the practice on the notice boards in the ground and first floor waiting rooms, for example the complaints procedure, patient participation groups (PPG) information and safe surgery scheme. However, there was very little information within the practice waiting areas about health promotion or support groups including information for carers. We saw that information about support groups was available on the practice website; however, not all links worked. We saw that the website had a copy of the practice leaflet and information about the practice values / mission statement. There was information for patients about privacy and how their information was used. The practice was developing a patient peer support network. They were starting on 27 September 2024 as part of the Macmillan coffee morning to invite all their cancer patients and their carers and would provide opportunity to interact with each other, meet their cancer champion, social prescriber and would have a guest speaker who will talk about their cancer journey and recovery. They planned to have a representative from Macmillan to talk to their patients about the various available resources and benefits. Their next planned event after this would focus on dementia with support from representatives from the Alzheimer’s Society and the Birmingham Carers Hub. The provider sent us evidence, following the assessment, to show they had taken action to improve the information that was available to patients within the practice.

Mostly patient feedback that CQC received was very positive about care and treatment received. Data from the 2024 National GP patient surgery showed that of those people that responded to the survey: 96% were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. 95% say the healthcare professional they saw or spoke to was good at listening to them during their last general practice appointment. This was higher than local and national averages. The practice had carried out an in-house patient survey in January 2024 to monitor patient satisfaction in relation to access and overall satisfaction with their appointment. Data showed that 601 completed the patient survey. Of those people that responded to the survey: 71% were satisfied with the appointment they were offered.

All staff we spoke with were able to share examples of complaints that the practice had received and learning that had occurred as a result. Staff saw patient feedback as an important part of improving services. Examples of recent action taken following patient feedback included improvements to the pathology results protocol, improvements to maintain patient confidentiality on the first floor reception and improvements to systems to request appointments and support. To improve patient wellbeing a monthly walking group was established for staff and patients. To address concerns raised by people from the previous year 2022/2023 the practice had improved their complaints process, provided customer service and conflict resolution training to staff and improved processes so that feedback was integrated into their administrative and clinical meetings. They had also improved the appointments system so that patients had to answer less questions.

We reviewed the practice’s processes to receive and investigate complaints and manage information related to complaints. We reviewed three complaints in detail. We found people had different methods to provide feedback. This included through NHS and Healthwatch websites, through the complaints process, through friends and family surveys, the practice in-house survey and the national patient survey. Patients could also email the patient participation group (PPG) and there was a suggestions box. The practice monitored patient feedback from a variety of sources and shared this with staff. An annual report was produced that looked at trends, including if performance had improved compared to the previous year and what further actions were needed. The practice had effective processes in place to receive and investigate complaints. There had been 36 complaints received between September 2023 and August 2024, 34 of these partially or fully upheld. There were processes in place to share learning from complaints with staff. While the practice could demonstrate that complaints were investigated appropriately and learning was shared with staff to drive improvement. We found gaps in the complaints policy. For example, it did not give sufficient information to staff on how they should record information, for example if the complaint was resolved by a telephone call. From information we reviewed, the practice could not always demonstrate what the learning was and if this information was shared with patients. The practice had an active PPG. The PPG had supported the practice in driving improvement. From meeting minutes we viewed we saw that patients had opportunities to raise questions and they received a response from practice staff. The practice had reviewed the results from the in-house patient survey and the national GP patient survey and formed an appropriate action plan to improve where satisfaction was poor.

Data from a range of sources including the 2024 National GP patient survey, feedback on Healthwatch and NHS websites, feedback to CQC and the service’s in- house patient survey showed that patient feedback was consistently positive about accessing the service. Data from the 2024 National GP patient survey showed that of those people that responded: 80% found it easy to get through to this GP practice by phone. 71% found it easy to contact this GP practice using their website. Data from the 2024 in-house patient survey supported this. From patient feedback CQC had received, patients had commented on being able to get an appointment on the day. Feedback from care home staff was positive about being able to access the service in general, and more specifically when they needed advice and support it was always available.

Staff and leaders told us of the actions they had taken to improve access for patients. Staff reported that the introduction of an online consultation system had reduced telephone call volumes. Staff supported patients who may need help and guidance to access digital solutions to improve access for example the online consultation service or the NHS app. Staff had access to telephone call data which meant they could review capacity and demand more effectively and they could amend capacity over the week to deal with busier periods. All reception staff had access to live telephone call data and non-clinical staff would be moved from other areas if the telephone queue built up. All appointments were face to face unless requested to be telephone Staff reported that immunocompromised / supressed patients could be offered appointments first thing in the morning when the surgery was just cleaned and the waiting areas were quieter. Patients with mobility issues were mainly booked into ground floor rooms. The practice was working in partnership with a local organisation to provide a drop-in day at the practice where vulnerable families could attend to access GP services.

People’s care, treatment and support was accessible, timely and in line with best practice, quality standards and legal requirements. The practice made reasonable adjustments for people so that people could access services when they needed to, without physical or digital barriers. People were given support to overcome barriers to ensure equal access. Staff had access to interpreters. All non-clinical staff were trained on the appointment triage system and signposted patients to other services as needed. Leaders had implemented effective systems to manage demand and for deciding on how many appointments of each type were necessary. The practice offered a range of appointments and had effective processes to manage unexpected staff sickness. We reviewed the appointment system and found good availability and that appointments were being utilised effectively. Patients could access appointments either at the practice or through extended access between 8.30am - 8pm Monday to Friday and 9am-5pm on a Saturday. Patients could make an appointment by phone, the online consultation service, NHS app or in person. Leaders monitored appointment and telephone access and the method by which patients contacted the practice. They used this information to make further improvements to the service. Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of people in accessing care, treatment and support. Leaders had reviewed their processes around appointments and provided training to staff on how to support patients with additional needs and those requiring reasonable adjustments including autistic patients. However, training for staff on how to use the hearing loop was yet to be carried out. Further training was planned for September 2024 to address how practice staff could be aware of patient populations where there may be inequalities in access to health care and promote better access for these groups.

From information we viewed including patient records we reviewed, we did not find any evidence to indicate that people were discriminated against. Feedback provided by people using the service, both to the provider as well as to CQC, was positive. Staff treated people equally and without discrimination.

Staff told us all patients had a named GP and usual GP. The practice provided GP services including weekly ward rounds to 2 nursing homes and 5 residential care home. Each care home had an assigned GP to ensure continuity of care. Staff added alerts to patient records to alert staff that patients may have complex needs and that patients may need an appointment with a particular GP/staff member or they may require a longer appointment. Each GP was assigned between 20 to 40 complex patients to ensure continuity of care for those patients. 4 GPs at the practice were assigned patients that required support for substance misuse. They worked with the drug and alcohol support worker to support these patients. 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. Staff shared examples where they had worked with vulnerable patients who had complex needs, so they could be supported in a way that met their needs.

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 have access to the internet. This included collecting feedback about their registration service. The practice collected feedback from people in different ways to enable all patients the opportunity to give feedback. Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of people using their services, whether from wider society, organisational processes and culture or from individuals. Staff acted on information about people's experiences and outcomes and allocated resources and opportunities to achieve equity. Leaders had regard to the needs of people with different protected characteristics and made reasonable adjustments to support equity in experience and outcomes. The was a Safe Surgery. They offered a welcoming space for everyone who sought to use their services. They ensured that a lack of identification, proof of address, or immigration status would not prevent patient registration. They were a veteran friendly practice. The practice had a dedicated clinician who had a specialist knowledge of military related health conditions and veteran specific health services. This was important in helping ex-forces to get the best care and treatment. Staff had attended in-house training and all staff had completed online autism and learning disability training. Leaders told us they were waiting for further training Including face to face training to be arranged. Leaders explained that availability of the training was limited; however, a small number of clinicians had been able to book a space. The practice worked with a local organisation to provide a drop-in service at the practice for vulnerable families for them to access GP services.

Feedback from care home staff was positive about the practice. Residents and/or families were involved in important decisions about their future. Care plans and other documents such as ReSPECT forms were reviewed regularly.

Staff supported patients to make informed choices about their care and plan their future care while they had the capacity to do so. Staff identified and supported patients appropriately who may have been approaching the end of their life. Patient’s had personalised care plans that included decisions about what mattered to them. When people wanted to express their wishes about CPR (cardiopulmonary resuscitation), they were supported to do so and were able to change their mind if they wished. Each GP was assigned between 20 to 40 patients with complex needs. So that continuity of care could be maintained.

From patient records we reviewed we saw good record keeping that evidenced patients were involved in decisions about their care and future planning. The practice had a lead for palliative care. The practice had regular meetings to discuss palliative care patients and had systems in place to prioritise patients according to prognosis and their care needs. The practice had processes in place to review if care and preferences had been met in line with patients wishes. The practice sent us information, following the assessment, that showed their structured, proactive and collaborative approach to end-of-life care lead to better outcomes for people and that people were supported in end of life in ways that aligned with their wishes. After-death reviews were a key part of their quality assurance process and allowed the practice to identify areas for improvement so they could refine their care pathways to deliver even better outcomes.