Saltley Centre for Health Care

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 carried out an announced assessment of all the quality statements under this key question between 13 and 16 May 2024. People’s feedback and other evidence was used to improve access for people. Services were designed to make them accessible and timely for people who were most likely to have difficulty accessing care. Significant changes had been made to the appointments system to improve access to care. The provider prioritised, allocated resources and opportunities as needed to tackle inequalities and achieve equity of access. We recognise the pressure that practices are currently working under, and the efforts staff are making to maintain levels of access for their patients. At the same time, our strategy makes a commitment to deliver regulation driven by people’s needs and experiences of care. Although we saw the practice had taken action to improve access, this was not yet reflected in the GP patient survey data.

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.

The results of the most recent national GP patient survey (01/01/2023 to 30/04/2023) showed the percentage of respondents who stated that during their last GP appointment they were involved as much as they wanted to be in decisions about their care and treatment was 73.4% compared to 90.3% national average. Patients we spoke with were largely positive about the approach of the clinicians and none expressed concerns about not feeling involved in their care, bias or being treated as individuals. Results of an in-house patient survey undertaken between January and March 2024 showed 76.9% stated their needs had been met following their most recent appointment. Similarly, 76.9% said they felt involved in their treatment and care. The practice also sought feedback from patients with long term conditions, to assess if they had an agreed care plan with a healthcare professional from the GP practice. 81.6% of patients stated that they did have a care plan in place. All of these patients responded positively to a further question asking if they had found the care plan to be helpful in managing their condition(s).

The practice understood the needs of its local population and had developed services in response to those needs. Leaders were able to demonstrate a good understanding of the practice’s demographics, challenges they faced and systems in place which placed patients at the centre of care. Referral systems were in place to ensure patients received consistent, coordinated, person-centred care when they moved between services.

Staff and leaders spoke positively about the patient population they served. They recognised their population were ethnically diverse and situated in an area of high deprivation. They were able to describe processes to ensure patients received joined-up care, for example through effective multi-disciplinary working where needed. Staff described reasonable adjustments available to support patients and the ability to offer choices where possible. Many members of staff were long standing and those we spoke with demonstrated a commitment to the community they served.

We received limited feedback from partner organisations working with the practice to deliver care. We found no concerns and the practice was able to provide multiple examples of systems in place to demonstrate effective working with multi-disciplinary teams, the practice's primary care network (PCN), the wider provider organisation and it's patient participation group (PPG).

All staff had completed training in equality and diversity and training on supporting people with Learning Disabilities and Autistic people. End of life care and safeguarding was delivered through effective partnership and multi-disciplinary working. Registers of different patient groups, including people with a learning disability, mental health concerns and those requiring palliative care was maintained. The provider undertook analysis of the local population and worked with other local services to support patients in the most appropriate way. Patients we spoke with were positive about their interactions with staff. Results of an in-house patient survey undertaken between January and March 2024, showed 87.7% felt they were given enough time during their appointment and 78.4% felt the healthcare professional recognised and/or understood any mental health needs they had. 83.1% felt positive about their experience of the GP and 78.5% found the receptionists to be helpful. All of these results were significantly improved when compared to the practice’s performance in the national GP patient survey (01/01/2023 to 30/04/2023). In addition, the practice sought feedback on how often patients were able to see their preferred GP or healthcare professional, to which 81.6% of patients responded positively. 64% of patients responded positively when asked if they were offered a choice of appointment.

None of the patients we spoke with or received feedback from raised any concerns in relation to accessing appropriate, accurate and up to date information.

Staff and leaders assured us efforts were made to keep practice information up to date. They described being able to use interpreting and translation for people who don’t speak English as a first language and for d/Deaf people who use British Sign Language. People who had difficulty with reading, writing or using digital services were supported with accessible information. Many staff were multi-lingual and able to converse and support patients in a familiar language if preferred.

Systems were in place to maintain accurate information. This included keeping the practice website up to date. Processes ensured patient’s individual needs to have information in an accessible way were identified, recorded, highlighted and shared. These needs were met and reviewed to support their care and treatment in line with the Accessible Information Standard. We saw there were notice boards in the patient areas that were also well maintained and provided an array of appropriate information for patients and carers. The practice’s opening times were well advertised, as was information on how to complain. Systems were in place to ensure information about people that is collected and shared meets data protection legislation requirements. Patients were informed on how to access their health and care records and decide which personal information can be shared with other people, including their family or care staff.

A representative of the patient participation group (PPG) informed us the practice was proactive in seeking and encouraging feedback from patients. They described how complaints were discussed in PPG meetings and members were encouraged to provide feedback. The practice undertook its own in-house patient survey which was available electronically and also in paper format to encourage completion. None of the patients we spoke with raised concerns about their ability to provide feedback or complain.

Staff and leaders told us patient’s views were acted on to improve services and culture. Staff described how complaints were discussed in practice meetings and areas of improvement were identified and shared. Leaders spoke positively about engagement with the PPG. Leaders discussed systems in place to formally review results of both the national GP patient survey and the in-house patient survey. These reviews included the development of action plans to address areas identified as in need of improvement.

The practice had a complaints policy and process. We saw complaints were handled by a designated individual in the leadership team and evidence we reviewed demonstrated investigations were thorough and timely. Patients were provided with a response to their complaints and advised of appropriate actions they could take if they were not satisfied with the outcome of the practice’s investigations. 8 complaints had been received in the 12 months preceding our assessment and none of these had been referred to the Ombudsman. Evidence reviewed demonstrated that action plans formulated in response to patient surveys were monitored to ensure improvements were working and patient satisfaction with service delivery was increasing

We reviewed the practice's results in the 2023 national GP patient survey. This found patients’ responses to questions about how easy it was to get through to someone at their GP practice on the phone, how satisfied they were with their GP practice appointment times, how satisfied they were with the appointment(s) they were offered and their overall experience of making an appointment were below the national average. The practice’s results were significantly lower than the national average for patients who found it easy to get through on the phone which was 15.2% compared to the national average of 49.6%. The majority of patients we spoke with said they were still struggling to access appointments. Action plans following the 2023 national GP patient survey showed that leaders had reviewed the results and taken action in response to try and improve patient satisfaction with access. Patient feedback gathered by the practice was more positive. Although not directly comparable to the National GP Patient Survey, an inhouse patient survey undertaken by the practice between January and March 2024 showed increased levels of satisfaction which had coincided with significant changes to the appointment system and the introduction of vConsult (an online consultation service for non-urgent patient requests). For example, of 65 patients who responded, 58.5% had found it easy to get through to someone on the telephone, 81.6% found they were able to see or speak to their preferred GP at least some of the time and 75.4% found it easy to book an appointment. Patients whose first language was not English or where they had other communication needs were able access interpretation services. The practice was accessible to patients with mobility needs, with ramp access to the premises and a large waiting area.

Leaders and staff demonstrated they were aware of the challenges to patient access and had acted to improve it. The practice audited demand and capacity and used this information to support improvements to the appointments system. Staff were trained in care navigation and reception targets had been implemented. Staff advised introduction of vConsult for patients requesting non-urgent appointments or support had been well received and was working well to reduce pressures on the telephone system. Services were altered to meet demand and evidence demonstrated these systems were working effectively. We heard about other changes made including work to improve patient knowledge of other ways to receive treatment, including from local pharmacies, and of the different clinical staff in the practice. Leaders could demonstrate how these changes were assessed to make sure patients were not disadvantaged and how the impact of the changes was being monitored. The practice provided opportunities and support for different groups of patient population to overcome health inequalities, including adjustments to the registration and to how patients could communicate with the practice. The practice worked with other local stakeholders to improve access to primary care.

Patients could book appointments by telephone (with support from staff), online and in person. Appointments were available face to face, by telephone, or as a home visit. In response to the results of the national GP patient survey and as part of the General Practice Improvement Intensive programme the practice made significant improvements to the telephone system, which included the introduction of a callback function. Following those improvements telephone call wait times dropped on average from 19 minutes in March 2023 to 7 minutes in March 2024. Processes were developed in line with the demands of the practice’s patient population who were situated in an area with high levels of deprivation. Systems were in place to recall and invite patients to attend for childhood immunisations and cervical cancer screening. The practice had arrangements in place for prioritising patients. Staff were trained in care navigation which enabled them to signpost to other services and had documented information to support them with this for example, pharmacy first (an NHS scheme where patients are able to consult with a community pharmacist for specific minor ailments) or first contact clinicians through their Primary Care Network (PCN) such as pharmacist, mental health practitioner and social prescriber. The practice opening times at Saltley Centre for Health care was 8am to 7pm Monday to Friday and at Fernbank Medical Practice from 8.30am to 6.30pm. In addition, Fernbank Medical Practice hosted an extended access hub on a Saturday from 9am to 5pm. When the practice was closed, patients were advised to contact NHS 111, those calling the practice were automatically re-directed to the out of hours provider.

People told us they felt empowered by the practice staff to give their views and felt the practice supported their rights to equality and their human rights. People told us they felt any cases of discrimination or inequality would be listened to and acted on to improve care. None of the patients we spoke with raised concerns relating to equity in experiences or outcomes.

The practice provided opportunities and support for different groups of patient population to overcome health inequalities. The practice was registered as a safe surgery supporting people without any identification or address to register. It was also an IRIS trained practice (IRIS is a specialist domestic violence and abuse training and support programme for General Practices). Staff demonstrated confidence in supporting all patients, particularly those facing risks of health inequalities. They told us they worked hard to support vulnerable patients to receive equal access to care and improved outcomes. Leaders told us how they took a proactive approach to support those that may struggle to access appointments. Alerts were used on the clinical system to identify those who made need reasonable adjustments so that they could be accommodated. Staff demonstrated an awareness of patients who may be at risk of digital exclusion and took steps to support them. In January 2024, the practice held a targeted digital exclusion event. Working with national and local partners they were able to provide free mobile data SIMs to 61 patients. These patients were guided through the setup of the NHS App and other functions to support them in understanding how to utilise digital technologies. The free programme provided the SIM for 6 months free of charge, after which individuals could opt onto a pay as you go programme. At the same event, an organisation providing free numeracy skills courses provided information and access to its services, for both patients and staff.

The practice complied with legal equality and human rights requirements, including avoiding discrimination, having regard to the needs of people with different protected characteristics and making reasonable adjustments to support equity in experience and outcomes. For example, identified vulnerable patients had access to a bypass number to enable them to speak to the practice urgently when needed, this included patients receiving end of life care and those who awaiting death certification for a relative. People’s care, treatment and support promoted equality, removed barriers or delays and protected people’s rights. The practice had systems in place to obtain and review patient feedback. This information was used to review the patient experience and address any instances of discrimination. The practice had information available in alternative formats and equipment in place to support patients who had a hearing impairment. The practice had taken steps to promote patient confidentiality.

We could not collect the evidence to score this evidence category. Our observations raised no concerns.

Staff and leaders had an awareness of systems in place to support patients requiring end of life care. They advised there was a register of patients and that multi-disciplinary meetings were held with relevant healthcare professionals to ensure the best possible care was available. These patients also had access to a bypass number to seek urgent support from the practice when needed.

Clinicians understood the requirements of legislation and guidance for consent and decision making. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were made in line with relevant legislation and were appropriate. As part of our assessment, we reviewed DNACPR decisions made within the last 12 months. We undertook a random review of four records which were detailed and comprehensive. We identified that decision forms were retained and signed by an appropriate clinician. There was a dedicated clinical lead for overseeing DNACPR systems and these were reviewed routinely every 6 months. Care notes outlined how the decision had been discussed with patients, and how an assessment of the patient’s mental capacity had been undertaken. However, documented evidence of mental capacity assessments was not readily available. The practice was prompt to respond and provide assurance that systems would be strengthened through the introduction of an additional proforma to clearly demonstrate decision specific mental capacity assessments were made. A flag had also been added to patient’s electronic records to indicate to staff that a DNACPR decision was in place.