Preston Hill Surgery

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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 found that the service was providing responsive services because the practice organised and delivered services to meet people's needs taking account of their preferences and potential inequalities. People were able to access care and treatment from the service within an appropriate timescale for their needs. The service took complaints and other patient feedback seriously and responded appropriately to improve the quality of care.

This service scored 79 (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 National GP Patient Survey (2023) showed that 98% of respondents felt the healthcare professional they saw had all the information they needed about them during their last general practice appointment (ICS result 91%, National result 92%). Patients participating in the assessment also commented positively on this and could give examples of how their individual needs and preferences had been fully taken into account.

The practice team used care planning and review to achieve people’s desired outcomes from their care and carried out regular reviews. People and their families were involved in this process. The practice had documented complex case studies which demonstrated the steps the practice team had taken to engage more vulnerable people who were not responding to services. As a result, and in partnership with other healthcare teams, they had successfully engaged people and their families; identified and treated previously undiagnosed health conditions; registered people who did not already have a GP and identified local services, activities and carers’ support, for example, where people could communicate in their first language.

The GP worked with other health and social care professionals to support integrated care. For example, the lead GP worked jointly with the community learning disability nurse to review the care of registered patients living in a local supported living home and ensured that people’s ‘health passports’ were updated with any relevant changes. A health passport includes relevant details about a person’s disability, needs and preferences and can be useful when people are using services (such as hospital services) where staff might not know them well.

The manager of a local supported accommodation service told us that the lead-GP had worked with them to positively engage people about their health in a way that other health professionals had not done.

The lead GP had identified areas of particular health need and used this information to develop the range of services available at the practice. For example, there was a relatively high prevalence of diabetes in the local population so the GP had completed additional training to enable them to initiate insulin therapy at the practice. The lead GP told us they were able to provide a more holistic service in the primary care setting. The practice had audited the impact of initiation of insulin after introducing the service which showed a positive impact on diabetic control.

People told us clinicians were thorough and explained information in a way they could understand. Some patients told us that staff explained information in a language they could easily understand which made it easier for the patient to make a decision about their treatment.

The provider ran various events to inform patients of the support available to them. The practice had identified areas where people might need more information, for example, they had found that people often did not define themselves as ‘carers’ when providing informal care for a family member and had run events to raise awareness of the role and available resources.

Staff updates and inhouse guidance included useful resources about specific conditions. For example, the annual health check for people with a learning disability included a vision check. (Vision problems have been shown to be under-diagnosed in this patient group). This enabled the practice team to direct patients who needed a sight test to an online list of local optometrists that welcome people with learning disabilities.

People told us they were listened to and they were involved in decisions about their care and treatment. Results from the National GP Patient Survey (2023) showed that: 83% of respondents said the healthcare professional they saw or spoke to was good at listening to them during their last general practice appointment (ICS result 85%, National result 87%). And 92% reported being involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment (ICS result 89%, National result 90%).

Feedback was encouraged and patient views including complaints were used as a source of learning. The staff team aimed to resolve complaints and concerns immediately but understood the complaints process if people wanted to make a formal complaint.

Information about making a complaint was available on the practice website and on request. We noted the practice could have made it easier for patients to make a complaint whilst at the practice as the current process was to ask a member of staff for this information. The provider acted on this following our assessment. The practice had designed a prominent poster for the waiting area asking for people's feedback more generally.

Patients participating in the assessment were generally positive about the availability of appointments. Some people commented that they were able to book to see the GP of their choice and this was something they valued. The practice carried out its own patient survey in 2023. This showed people's aggregated rating of getting through on the phone as 4.5 out of 5.

The provider had worked on improving accessibility. Nationally published data (February 2024) showed that the practice was performing in line with the national average for the number of appointments it provided per thousand patients. The practice had recruited an additional GP to increase available capacity and had put on weekend sessions, for example, offering cervical screening appointments at a time convenient to eligible people. Staff told us how they were able to prioritise access for patients in more vulnerable circumstances, for example, patients with learning disability had walk-in access if needed.

The practice had participated in a national primary care programme to review and improve access to the service alongside other practices in the primary care network (PCN). The practice reviewed accessibility and any underlying barriers (for example, by investigating peaks and troughs in capacity and demand and training needs among the wider practice team to make better use of the skill mix). As a result, the practice had taken a range of actions to improve access and equity of access, for example, training a member of staff as an NHS App champion to teach patients how to download and use the NHS App. The practice continued to monitor and benchmark their performance against other practices in the PCN.

Feedback provided by people using the service was positive. People did not identify any concerns about unfair treatment or discrimination.

Leaders proactively sought ways to address any barriers to improving people’s experience and worked with local organisations to address 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. The lead GP had an interest in learning disability and had developed a strategy to improve health outcomes with this patient group. The strategy covered: staff training; regular internal updates; a ‘ward round’ of patients living in supported living accommodation with specialist input; proactive call and recall invitations for annual health checks; referral and signposting to local activities (for example gym sessions) through the social prescribers; tailored health advice through the health and wellbeing coach; access to tailored therapies (for example, desensitisation therapy to help patients become comfortable with the process of blood testing) and the production of easy read resources within the practice, for example about the national cancer screening programmes.

The provider had processes to ensure people could register at the practice, including those in vulnerable circumstances such as homeless people. The practice maintained registers of patients in vulnerable circumstances. Protocols for these groups of patients covered registration; accessibility of appointments; the importance of GP input at an early stage; continuity of care; preventative health checks and immunisation; and referral to the social prescriber if people were experiencing wider social issues. The practice had signed up as a ‘Safe Surgery’ under the Doctors of the World UK initiative to tackle barriers to access faced by migrant patients. Staff received regular training on equality and diversity and on specific topics such as working with patients with learning disability and autism.

Patients told us they had appropriate support and time to make decisions.

Staff supported patients to make decisions and where appropriate, assessed and recorded a patient’s mental capacity to make a decision. The practice team identified particular groups of patients for whom planning for the future was an important consideration, for example, it maintained a register of young people leaving care.

The practice used the ReSPECT framework (Recommended Summary Plan for Emergency Care and Treatment) to discuss and record people’s wishes for their care in the event of an emergency medical situation during which they might not have the capacity to express their choices. Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) decisions were made in line with relevant legislation and showed that the patient’s views had been sought and respected.