High Green Medical Practice

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 assessed all quality statements from this key question. Our rating for this key question is good. There were processes in place to deliver care in a coordinated way which met people's needs. There was a mix of face to face and telephone appointments with both urgent and pre-bookable slots available. There were arrangements in place to support people with additional needs. Policies were in place to support people near the end of their lives. However, we found the practice did not utilise fully means of obtaining patient feedback to improve services other than the national GP survey and complaints.

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.

Results from the latest national GP survey (unverified by CQC) showed 88% of respondents said they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment, compared to the local average of 90% and national average of 91%. We saw feedback received by the practice from a patient who had completed an online request for GP advice or appointments. The patient was responded to within an hour and was seen that morning. After discussion the clinician, who they said was very helpful, they were referred immediately for a two-week wait suspected cancer consultation at the hospital.

The management team told us they collected feedback from staff following the implementation of their total triage system for booking appointments. Staff told them the opportunity for patients to ask queries online had increased patient participation in their care and empowered them to be more involved in managing their health needs.

Leaders told us 54% of the registered patient list first language was not English, of which 80% required an interpreter. Black and Minority Ethnic (BME) groups formed 46% of the practice population and 66% of the population were classed as the most deprived 20% of the population in England. They were aware of the challenges in accessing blood tests on site and would have wanted to provide the service. However, the service was provided as part of a package of services by the commissioners and they did not have capacity to provide the other services in the package. A member of the nursing team told us the practice had a diverse population, therefore they provided services flexibly in order to meet the different needs of their patients. For example, they held clinics for cervical smears early in the morning and later in the evening to try and encourage attendance, with longer slots given when an interpreter was required. The practice used specially trained telephone interpreters who called people to book appointments and also during the appointment. They also accommodated people if they were running late for a smear appointment or for baby immunisations.

We did not receive feedback from partners in relation to this quality statement, however, GPs we spoke with at the practice told us they worked with the ICB to commission services to meet the needs of their population. For example, the practice participated in a Women's Health Hub Programme which looked at ways to improve women's health including cervical cancer screening.

There was a process for identifying people with extra healthcare and communication needs. Alerts were added to their clinical records so that staff were immediately aware of how to assist them. Reminders were highlighted on records of patients who were overdue reviews, smears or vaccinations so that any staff interacting with them encouraged them to book an appointment.

Patient feedback collected by the provider included a compliment from a patient about how the practice made their services accessible to them outside their working hours, and supporting them despite their language barrier.

Staff told us via feedback forms completed as part of our assessment that they communicated with patients in different formats, and had access to forms and leaflets translated in different languages.

There were processes for communicating with patients in their preferred language. These included mobile text messaging, letters and the use of interpreters via telephone or in person, both during booking process and the consultations themselves.

Data from the latest national GP patient survey (unverified by CQC) showed 82% of respondents said the healthcare professional they saw or spoke to was good at listening to them during their last general practice appointment, compared to the local average of 86% and national average of 87%. People we spoke with during our onsite assessment told us they felt able to raise concerns about their care if they needed to. The practice did not have an active patient participation group at the time of our assessment; however people's views were collected through the NHS Friends and Family Test, comments, compliments and complaints.

Management told us they collected feedback from people in various formats, such as, complaints and compliments, through incidents, surveys and suggestions. For example, they sent a questionnaire to people about access, whose responses were collated and a report written which was shared with patients. They told us all complaints were shared anonymously with the practice team to learn from events.

A complaints and compliments process was available on the practice website, with leaflets available in the waiting area for the surgery. The practice had received six formal complaints in the 12 months preceding our assessment. Our review of the complaints found they had all been responded to in a timely manner and in line with the NHS complaints policy and procedure.

Results from the latest national GP patient survey (unverified by CQC) showed 37% of respondents said they find it easy to get through to this GP practice by phone, compared to the local average of 46% and national average of 50%. 48% of respondents said they find it easy to contact this GP practice using their website, compared to the local average of 39% and national average 48%. 48% of respondents said they find it easy to contact this GP practice using the NHS App, compared to the local average of 43% and national average of 45%.

Leaders told us the practice received approximately 120 appointment requests per day and could provide approximately 50 appointments. The requests were managed by giving people face-to-face appointments, telephone appointments with health care professionals, or referred to external health care professionals such as a pharmacist, health visitor or dentist, dependent upon their problems. Staff told us they had received 3,525 requests via their online requests system between 1 April 2024 and 22 May 2024, and 86% of these had been dealt with within 24 hours. 25% of appointments were made by phone or in-person. The online requests system was open from 8am to 5pm; this was adjusted to meet capacity if some staff were absent. Staff told us people's experience had improved significantly since the implementation of the new total triage system. The increased number of online requests freed up telephone lines, thereby reducing waiting times to speak to someone. People who were unable to book or request appointments online could do so via telephone or in person. All requests were triaged using the same system to ensure equal access.

The practice monitored the number of new patients registering to join and those leaving the practice against demand for appointments. Following our assessment, a neighbouring practice closed and some of its patients were transferred to High Green Medical Practice. The systems used in within the practice could provide information on call waiting times, volumes of appointments and how the appointments were provided (face to face, online, telephone). This was analysed alongside feedback from reception staff to measure demand and flex staff rotas to suit. Some appointment slots were blocked for long term conditions reviews to ensure patients could book in advance.

We received feedback from one person in the 12 months preceding our assessment, who told us they had tried to book an appointment via the telephone and were advised to to book online. They tried to book online; however, the online request tool was closed. They called the practice again and were told that they had rung too late and that they should have called between 8am-9am. The person explained that they ended up going to the urgent care centre. Feedback from people we spoke to on the day of our onsite assessment indicated most people would prefer to be able to book appointments directly and at a time that suits them and with a clinician of their choice.

Staff told us that patients with a disability, for example a visual impairment, had alerts added to their records to make staff aware of their needs so they could make reasonable adjustments to support them. They told us they had access to interpreters for patients whose first language was not English or for patients with a hearing impairment. Patients with a learning disability were offered double appointments to provide additional time to discuss their needs. Leaders told us they regularly audited their response times to online requests since the implementation of the triage system, and results showed they were able to respond to more than 50% of the requests within 24 hours.

Information was available on the practice website on how to access an appointments online and by the telephone when the practice was open, and how to access urgent care when the practice was closed. There was a process for identifying and coding housebound patients, who were offered home visits. There were processes in place for prioritising vulnerable groups at risk of deterioration, including children and people receiving end of life care.

A Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) plan was available in all three patient records we reviewed as part of our assessment. We saw decisions and care plans were created through conversations between a person, their families or advocates and health care professionals. They recorded the person’s priorities for care and treatment that could help to achieve the outcome that they would want, that would not help, or that they would not want.

Staff told us people were asked for their preferences during care and treatment when they were likely to transition into end-of-life stage in the next 12 months.

A policy was in place to support staff in the management of care for patients near the end of their lives. This included the management of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) plans and Recommended Summary Plans for Emergency Care and Treatment (ReSPECT). There was a nominated GP lead within the practice for end of life care. We reviewed the minutes from the multidisciplinary palliative care clinical meetings. We found that systems were discussed to improve outcomes for patients. For example, an elderly person provided their wishes pertaining to choices relating to their care. The person had stated that should they have an end-of-life event, they would only want to be resuscitated if they would have a good quality of life following resuscitation. We were informed that anyone with a complex health need, who are likely to be nearing the end of their life has a ReSPECT plan.