Modality Partnership (AWC) Also known as Modality Partnership

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

This assessment was triggered due to information received by CQC from patients, other stakeholders and other healthcare professionals. The concerns related to accessibility to the service. Particularly, issues with the total triage system, long waiting times on the telephone and a perception that appointments could no longer be made in person at the practice. We found the provider had appropriate processes in place to ensure patients could continue to book an appointment in a way which suited them. This included providing support to vulnerable and elderly patients to access appointments. Leaders and staff spoke positively about the appointment system and the improvements this had supported to ensure patients were able to access appointments according to clinical need. We found the provider was proactive in improving community well-being and tackling health inequalities.

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.

We did not look at Person-centred Care during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The feedback we received from staff via remote interviews and completed questionnaires indicated that all staff had an understanding of patient views of the service. We spoke with leaders who told us that patient experience of the service was improving and that this had been demonstrated by patient feedback to the provider and via social media platforms. Where this had been largely negative previously, the provider was beginning to receive compliments also. They acknowledged that some patients were still unhappy with the system and had taken steps to improve this. For example: working with staff to reinforce the message that if a patient needs help and assistance to make an appointment, they must take the time to do this and taking steps to improve the telephone system to advise patients of expected waiting times rather than giving them their position in the queue. We received positive feedback from staff regarding the service overall, the changes to the appointment system and their experience of working at the service. They told us that patient education, regarding the total triage system, was one of the main challenges and were positive about the engagement and education sessions provided for patients to date. There were suggestions that continuation of these sessions would be helpful. We also received generic comments regarding staffing levels and although staff felt there were enough staff to provide a safe service, more staff would improve it. We heard from leaders how they were in the process of recruiting staff to the contact centre, however had experienced issues so this was ongoing.

Prior to the implementation of the total triage, the provider worked with a group of patients to test the system and seek feedback and suggestions. Additional sessions were held where patient services assistants worked with patients in role play scenarios to fully test the system and identify any improvements that could be made. We heard examples, from staff and patients, of changes the provider had made in response to feedback. For example, the number of questions on the triage form had been reduced, a dedicated option for other healthcare professionals to contact the practice added, and the colouring on the form had been changed to make it clear for all patients to read. There was a comprehensive complaints policy in place and information to support patients who wanted to make a complaint. We were informed that complaints were managed at local level as each site operated as an individual practice. The provider had a schedule of regular meetings which enabled them to review information such as capacity and demand for appointments, complaints, significant events and feedback from patients and staff. There were systems for review of information at local level and for escalation and review by medical director and the board. The provider carried out in-house patient surveys to obtain patient feedback. We saw the latest survey had been sent to approximately 60,000 patients via text message in April 2024, and approximately 8,700 responses had been received. Of these 6659 reported it was not very easy or not easy at all to get through to the practice by telephone. We heard from representatives from the patient panel who told us how they felt their views were listened to. For example, the panel had suggested that the provider website required updating. We found that the provider was in the process of updating this in line with NHS requirements at the time of our assessment.

Prior to the assessment CQC had directly received 29 patient contacts. From these we identified themes with concerns regarding accessibility issues such as the inability to access face-to-face appointments, and technical issues related to the new online booking tool. The latest National GP Patient Survey, undertaken in 2023, showed that patients were happy with clinical care, felt listened to and were given enough time during their last appointment. However, responses were less positive regarding their experience of accessing an appointment. NHS Friends and Family Test results from April 2024 showed that from 1,340 responses received 65% would have been either extremely likely or likely to recommend the practice to others, and 35% were neither likely or unlikely to recommend, or were unlikely or extremely unlikely to recommend. The provider had developed an action plan which outlined changes in response to the accessibility concerns. This included a move to the a total triage system (launched in April 2023) which ensured all appointment requests were assessed by individual clinical need, and the introduction of the Voice Connect secure automated repeat prescription telephone ordering service. As part of the assessment, we spoke with 2 patients. They both told us that they felt services provided by the practice were accessible to them, and that they found that the process of completing the online access tool used to make appointments was easy and equitable.

Managers and leaders we spoke with demonstrated they were aware of the challenges to patient access and had acted to improve services. For example, they had introduced a digital total triage system to manage patient flows and had analysed demand and capacity to ensure that staffing levels and services were appropriate. The provider told us that this improved data and understanding of demand, allowed them to successfully forward plan, and recognise when additional resources needed to be redeployed across the practice sites. They recognised that a section of their patient population needed support to use the online total triage system and had put in place measures to assist these people. Actions included allocating staff to assist in the completion of the online service request form, and the delivery of roadshows in practice locations to raise awareness and confidence amongst patients in the use of the new system. Data regarding the system, and associated issues were closely managed by the provider and discussed at fortnightly working group meetings. Leaders told us that they had worked closely with staff regarding the introduction of these new ways of working and that staff satisfaction and confidence in the changes implemented had increased, with the most recent staff survey indicating positivity around the changes being 70%. Modality AWC received an average of just over 28,000 online patient requests per month. We saw that appointment provision had increased by 11% compared to 2022/23. The practice on average provided 566 appointments per 1,000 registered patients, which was above their Integrated Commissioning Board and National averages of 523 and 471 appointments respectively.

The provider’s leadership team told us that they had recognised the need to reassess how services were delivered to improve patient management and ensure a safe and equitable delivery of services. In April 2023 the provider introduced a total triage system. This required every patient who contacts the practice to first provide some information on the reasons for contact with them. This information was assessed by a clinician and patients were offered the most appropriate help and support. To utilise the service patients needed to add details such as symptoms to an online form. Patients who were unable to complete the form themselves were supported to do so (either on the telephone or in person at the practice) by staff from the practice. In addition, we saw that the provider delivered training and awareness raising sessions on completion of the online form at the main practice, branch practices and at community facilities to help patients understand and utilise the new system. We also heard from the provider that prior to the launch of the new system, they had sought to publicise this widely. Completed assessments were triaged within 30 to 60 minutes of submission. Outcomes following triage included same day face-to-face appointments, telephone and online appointments, text advice, routine appointments, or referral and signposting to other more appropriate services. At the time of this assessment the provider saw 80% of all requests for services coming in directly online (without the assistance of staff). The providers recognised that assisting patients to complete the form added to call waiting times both in person and on the telephone. In early April 2024 the average telephone waiting time was around 20 minutes, however this had started to reduce to around 13 minutes in late April 2024, as staff became more proficient at assisting people and demand for assistance reduced.

Prior to the announcement of the assessment, CQC had received 29 contacts regarding the service. This included feedback from patients and other stakeholders including health care professionals. A further 11 patients contacted us during the assessment process, 1 contact was positive and 10 negative. The feedback we received highlighted issues with access to the service including long waiting times when contacting the practice by telephone, dissatisfaction with the digital total triage system and examples of when elderly or vulnerable patients (or their representatives) had felt they had not found it easy to access an appointment. Concerns were also raised regarding issues accessing appointments when the digital total triage system was closed during practice hours. We reviewed the information received directly by CQC, along with information collected during remote interviews with 2 patients registered at the practice. Whilst we recognised that the information we received represented a very small percentage of the registered population (approximately 0.03%), we looked for assurance during our assessment of what steps the provider had in place to support these patients. We found that there were systems in place to ensure all patients could access appointments. We heard from staff, leaders and patients that appointments could still be booked by attending the practice in person, or by contacting the practice by telephone. Although all requests for appointments were submitted via a digital total triage form, the provider had put processes in place to ensure patients who were unable to do this, could be supported by a member of the practice team, and for the request to be made. The positive feedback we received directly to CQC informed us of how patients had used the digital total triage system and been offered an appointment around 2 hours later.

We spoke with 7 representatives from the service who all demonstrated a commitment to ensuring equity of experience of outcomes for all patients. They told us they had recognised that prior to the introduction of the digital total triage system, patients had been struggling to access the service by telephone, and in some cases had not had the time to continue to hold on the telephone and speak to a staff member. Clinicians and managers told us how the new system supported the service to be more equitable by enabling all requests for appointments to be managed throughout the day according to clinical need rather than on a first come first served basis. Feedback we received from patient services assistants (via remote interviews and questionnaires) gave examples of how they supported patients to book appointments and were happy to do so. We heard examples of how some patients had been supported to book an appointment whilst at the practice and attended later the same day for a face-to-face appointment. Other examples included patients leaving the practice feeling happy that they would be able to use the system independently the next time they needed to. Leaders demonstrated a good understanding of the large patient demographic, which encompassed different cultures and levels of deprivation. There was a strong emphasis on the importance of each constituent branch practice working at a local level, with the ability to be supported by the larger partnership as and when required. Leaders told us of 6 newly recruited staff members who were able to speak more than 1 language to better support the whole population. There was a commitment to engagement with local community organisations, leaders told us how they had hosted an event at a local sports venue to carry out health checks and vaccinations. We were told how the provider worked with 26 voluntary services and a member of the nursing team had created a website with access to other sectors.

The provider was able to demonstrate they proactively worked to support equity of experience of outcomes for all registered patients and supplied substantial evidence of additional activities to support the improvement of population health. We were able to review digital engagement sessions hosted by the provider prior to implementation of the new total triage system. These included question and answer sessions to support patients and the wider community with any concerns. Face-to- face sessions were also made available at all branches. Implementation of digital tablets at each location enabled staff to support and educate patients on the use of the total triage system. All staff we spoke with were aware of how to add notifications to the clinical system to ensure patients who required support or reasonable adjustments could be easily identified. However, we were told this information was captured at the point of registration, therefore it may not take into account existing patients requiring reasonable adjustments as a result of the switch to a total triage system. The provider had a range of community outreach programmes to improve access for the whole population, these had originally been initiated in 2021 and had been continually developed and expanded. For example: High Street Health – community based clinics offering services including long-term conditions reviews, phlebotomy, severe mental health and learning disability physical health checks and immunisations such as childhood, COVID-19 and influenza. They attended 33 events with 4,000 people taking part, and leading to 1,500 interventions. Inclusion health clinics – Targeting the population groups that experience the worst health outcomes and access to healthcare. This includes refugees, asylum seekers, homeless people and sex workers. Offering patients an accessible, non-judgemental and safe space to address their health needs.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.