West Derby Medical Centre

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 in this key question. Our rating for this key question has remained as requires improvement. At the last inspection the system of managing patient access did not mitigate the risks of delays in patients contacting the practice and obtaining an appointment. The provider had made improvements to access. However, feedback from patients indicated that they continued to be dissatisfied with the arrangements for access. We found that there was a breach of regulation relating to Good Governance. The provider did not have an effective system to seek patient views about contacting the service and getting a timely appointment, act upon them and evaluate that the action taken had led to improved patient satisfaction. Systems were in place to ensure people received co-ordinated care and treatment and they could access information and advice. People’s care and treatment was delivered in a way that met their assessed needs. We found the practice website should contain further information as to how the service promoted equity in access for patients. There were processes to obtain feedback from people who used the service. We identified that improvements should be made to the complaints process.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was no specific feedback from people who used the service about person-centred care.

Staff told us how they involved people in their care to ensure they understood their condition, care and treatment options (including any associated risks and benefits) and any advice provided. They took a holistic approach to people’s well-being and referred, and sign posted people to services for support with issues impacting on their health such as loneliness, finances and housing. The service made reasonable adjustments where appropriate to support people with their care and treatment.

Staff and leaders told us that people’s care and treatment was delivered in a way that met their assessed needs. Leaders knew the needs of their patient population and delivered services or took action to deliver services that met these needs. For example, since the last inspection a phlebotomy service had been set-up to increase patient safety in relation to the prescribing of high-risk medicines. The service was a veteran friendly practice as it recognised the importance of supporting the care and treatment of people who had served in the armed forces. A vulnerable patient champion supported patients to attend for appointments and reviews of their health.

The Integrated Care Board (ICB) told us that ideas and strategies to meet the needs of the patient population were discussed with the provider.

There were processes to monitor and meet the health care needs of the local patient population. Systems were in place to ensure people received co-ordinated care and treatment. Staff had undertaken Equality and Diversity training, and the needs and preferences of people were taken into account when delivering care and treatment. The provider had further training planned to support staff in meeting the needs of people with autism and people with a learning disability to ensure all the newer staff completed this.

There was no specific feedback from people who used the service about the provision of information.

Staff and leaders told us how they ensured people’s individual needs to have information in an accessible way were identified, recorded, highlighted and shared. People who used the service, their family and carers (where appropriate) were provided with information that was safe and secure. People who had difficulty using digital services were supported and there were plans to promote this further by having portable electronic devices that staff could use to help patients attending the practice.

There were systems in place to tailor information to individual needs. Reasonable adjustments were made for disabled people, interpreting and translation for people who do not speak English as a first language and for deaf people who use British Sign Language. Training in information governance, which included General Data Protection Regulation (GDPR) was provided to staff.

We met with two members of the Patient Participation Group (PPG). They told us that the PPG met with representatives from the practice every three months and that they could feedback on what was working well and where improvements were needed. They told us that the membership of the PPG was small, and they were hoping this would improve. They told us that the main issue reported to them by patients was wait times for appointments, contacting the practice and continuity of GPs. They said they could be better informed about the action the practice was taking to address this. The PPG told us that there had been improvements to access.

Staff and leaders were familiar with the processes for people to provide feedback about their care and treatment. Feedback could be made through the complaints and suggestions process, through a brief in-house survey and through the PPG. Feedback could be made in-person, by phone or on-line. Leaders provided examples of how improvements had been made as a result of listening to feedback from people who used the service. For example, as a result of complaints about the delay in receiving prescriptions, a review of this process was undertaken, and workload distribution was reviewed. Some responses to staff surveys was that staff did not feel they were informed about complaints or that learning from them was shared. The provider told us that there was a process to keep staff informed about complaints and any learning, however, they would take action to ensure all staff felt included in this.

There was a process for the management of complaints. We reviewed a sample of three complaints. The sample we looked at showed the timeframe for acknowledging complaints did not always adhere to the provider’s policy of three days for two of the complaints. This had been identified and a system put in place to address this. The complaints we reviewed did not fully document the investigation undertaken. A revised template for recording complaints was put in place following the assessment. Duty of candour was evident in responses to complaints. Information about making a complaint on the provider’s website should include details of advocacy services and the role of the commissioner of the service and the Parliamentary Health Service Ombudsman.

We reviewed patient feedback from several sources and identified themes from the responses. The main theme of feedback was that people were dissatisfied with how they accessed the service and getting a timely appointment: CQC received 24 pieces of feedback from patients between February 2024 to September 2024. The main theme was access to the service by telephone to make an appointment and lack of appointments. CQC asked the practice to publicise this assessment and ask people for their feedback. The provider did this, including texting 11,805 patients. We received feedback from 90 people. 46% told us improvements were needed to contacting the practice and being able to get a timely appointment. 16% of people made positive comments about the clinical and non-clinical staff team. 13% referred to positive experiences when making an appointment . 11% referred to rude/disinterested staff. 5% reported a delay in prescriptions and 5% a lack of privacy at the reception area. This feedback should inform the provider’s future engagement with patients. The National GP Survey carried out from January 2024 – March 2024 indicated low satisfaction rates with access:- 47% of respondents to the National GP Survey reported a good overall experience of contacting the practice (national average 67%). 16% of respondents to the National GP Survey reported an easy experience of contacting the service by phone (national average 50%). 50% of respondents to the National GP Survey reported that they waited about the right amount of time for their last appointment (national average 66%). Feedback left on the NHS Website for the last 12 months showed there were 14 responses. The main theme (8 respondents) was difficulty getting through to the practice by telephone and accessing an appointment.

Leaders told us how they had acted on patient feedback to improve access. A new telephone system was put in place in July 2024 that allowed a call queue system and a call-back facility. Staffing numbers and skill mix had been reviewed and improvements made to the appointment system. Non-clinical staff were trained as care navigators and directed patients to the clinician or service that could best meet their needs. They could also sign post patients to non-clinical services to support them with non-medical issues impacting on their health. Leaders told us that there had been changes to staffing over the last 12 months. A number of the non-clinical team were new. The service currently had vacancies for one non-clinical member of staff and a practice nurse. A GP had been recruited to replace a paramedic and would be starting work in April 2025. Arrangements for cover for vacant posts were in place. Leaders told us how they were promoting staff retention by varying staff roles, introducing new patterns of working and staff development. Leaders told us that they had received feedback about the attitude of staff and that they had looked into this, and taken action as needed. They focused on customer services at monthly meetings and were planning on re-visiting training on customer care and managing patient expectations in the new year. The majority of staff felt the numbers of staff were sufficient, although 2 said they felt there should be more appointments made available and 3 considered there should be more GPs.

The core opening times were 8am to 6.30pm Monday - Friday. Extended access appointments were available at the practice and through the PCN. People could make an appointment by calling the practice, attending in person or online. Routine doctor appointments could be made 2 weeks in advance. There were arrangements to prioritise patients to ensure urgent needs were met on the same day. Home visits were made following an assessment of need. Patients were directed to 111 if they needed care and treatment when the practice was closed. On the day of the assessment urgent appointments were available. Two-week routine appointments had been fully utilised. Improvements had been made to access since the last inspection. A new telephone system allowing patient callback had been put in place. Leaders told us 12,683 patients had utilised the callback system since this was made available in July 2024. A wall board allowed monitoring of when phones were becoming busy so more staff could be deployed to answer them. The provider had also introduced systems to reduce reliance on the phone system such as an electronic consultation form. The provider planned appointments three months in advance and took account of times when demand for appointments was highest. They monitored appointments not used to inform the type of appointments to offer and with which clinician. This influenced the decision of which type of clinicians to recruit. The number of appointments offered was based on the providers contractual obligations and was above the minimum guidelines. The provider reviewed patient feedback. However, they had not taken effective action to assure themselves that the changes they had introduced were having a positive impact on patient experiences of contacting the practice or getting an appointment in a timely manner.

There was no specific feedback from people who used the service about equity in experience and outcome.

Leaders sought ways to address any barriers to people’s experience and worked with local organisations and the PCN to address any local health inequalities. For example, the PCN had a health inequalities lead and the practice was working with them to pilot clinics to meet the needs of people with neurodiversity. Staff understood the importance of providing an inclusive approach to care and made adjustments to support equity in people’s experience and outcomes. For example, longer appointments could be provided for patients who had a learning disability or who needed to use a translator.

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 or digital devices. The provider had regard to the needs of people with different protected characteristics and made reasonable adjustments to support equity in experience and outcomes. Some staff had received training on meeting the needs of people with a learning disability and people with autism. As a number of new staff had started working at the service this training was planned again for 2025. We found the website should contain further information as to how the service promotes equity in access for patients. A vulnerable patient champion supported patients to access services to improve uptake of appointments and screening for vulnerable patients.

Records viewed showed that when people expressed their wishes about their future care such as cardiopulmonary resuscitation, this was documented and reviewed.

Staff and leaders told us how they made sure when people wanted to express their wishes for the future, they were supported to do so. Leaders made sure external services were involved or updated when needed. Leaders told us that end-of-life audits were undertaken to look at the quality of end-of-life care.

There were systems and processes to ensure people who may be approaching the end of their life were identified (including those with protected characteristics under the Equality Act and people whose circumstances may make them vulnerable). There was a process to share this information with other services and staff.