Manor and Park Group 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

The provider had a good understanding of the local population and complied with the accessible information standards. They had arrangements in place to identify peoples’ communication needs and preferences. There were mechanisms in place for collecting and acting on patient feedback. However, patients continued to report difficulty accessing an appointment and accessing the practice by telephone with no improvement on patient feedback in the national GP patient survey since the last inspection. The provider had taken action to recruit more clinical staff and had trialled a new appointment system which was due to be implemented in May 2024. However, these were not sufficiently embedded to be able to demonstrate patient impact at the time of the assessment.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People we spoke with during the assessment told us they were happy with their care and treatment and felt involved in decisions about their care. The latest national GP patent survey results showed 78.3% of patients stated they were involved as much as they wanted to be in decisions about their care and treatment (national average 90.3%).

Leaders told us that patients could request to see a GP of their choice or choose to see the same GP for follow up. It may be a longer wait but we reviewed the clinical system and saw appointments were blocked out to accommodate this. Staff were able to offer patients the option of being seen in the extended access clinics in the city. This service was open until 10pm and staff could book patients directly into these appointments. Patients were referred to secondary care using the NHS e-referral service so in some instances could select where they would like to be seen.

Leaders had a good understanding of the local population and complied with the accessible information standards. They had arrangements in place to identify peoples’ communication needs and preferences and offered interpretation services for those patients whose first language was not English. The provider had successfully managed to recruit additional clinical staff which gave patients more choice and flexibility of clinicians.

Staff actively referred patients to social prescribing to support with their wellbeing and social issues. Staff had received training in equality and diversity. The provider had appointments that were blocked off for patients who wanted to see the GP of their choice, they may have to wait longer for this but we saw appointment slots allocated for it. It also enabled clinicians to be able to book a patient back in to see themselves when required for continuity of care.

We reviewed the access recovery plan that had been submitted to the commissioners detailing plans to improve access.

We did not receive any concerns from people regarding not being able to access appropriate, accurate and up-to-date information in a way that suited their need.

There was an accessible standards policy in place. Interpreter services were available for those patients whose first language was not English. Both sites had hearing loops available. All consultations took place on the ground floor level. The practice shared a link on their website to the NHS accessible standards information and there was a range of information available in both practices.

Staff told us information was available to patients in different formats and that they would highlight on a patients’ record if they had any communication or accessibility needs. This would be gathered at point of registration or opportunistically. Staff explained the process for registering patients with no fixed abode and told us that patients with communication needs, could be sent communication via text messaging.

Leaders told us that they would speak to any patient who was not happy in the practice or would phone them and invite them in to discuss their concerns.

The practice had a complaints policy and kept a log of patient complaints, including any mumbles and grumbles which they used to review themes and trends. We reviewed 2 complaint responses and found these were dealt with appropriately. The patient was given an apology when appropriate, and learning was taken from it, for example, a GP had responded to say that they would reflect on the patient’s comments about their manner. The practice had a complaints leaflet which included details of where to escalate their concerns if they were not happy with the practice’s response to their complaint. The practice had a freedom to speak up policy which staff told us they were aware of. They had also completed a review of the GP national patient survey data results and had implemented changes as a result to the telephone system. They had also reviewed the appointment system and were due to commence a new system with total GP triage from May 2024 as a result of patient feedback regarding accessing an appointment.

The practice had a patient participation group (PPG). The most recent minutes we reviewed highlighted concerns around the Manor Park opening hours which was also identified in the national friends and family feedback. Leaders had a plan to address this. They had successfully recruited to clinical staff vacancies and both sites were now fully open from January 2024. Leaders used the national friends and family form to gain patient feedback. Data we reviewed from February 2024 showed 32 of the 41 patient responses were positive about their experience.

The current appointment system was to call at 8am or attend the desk at 8am. Once appointments were gone, patients would be signposted to alternative services, for example, the walk-in centre or they could call back the following day. The service was open 8am to 6pm Monday to Friday with the exception of Thursdays when the practice closed at 12 noon. When the practice was closed, calls would be transferred to the out of hours service. The practice also had access to the extended hours clinics in the city which they could book patients directly into, these clinics were open until 10pm. Current data available, including national GP patient survey data indicated that patient satisfaction with access was low and had been low for several years despite CQC rating the service requires improvement and telling them they 'should' listen to patient feedback with regard to access previously. We saw that the provider had submitted an access recovery plan to their commissioners and that they had an action plan to improve access. However, at the time of this assessment these systems were not implemented or embedded sufficiently to demonstrate improvement or impact on patients accessing services. We observed appropriate end of life care procedures and processes were in place and the provider held regular multidisciplinary team meetings to discuss care plans for patients who were receiving end of life care. The service offered home visits where appropriate.

Leaders told us that they had listened to patient feedback with regard to access and had implemented new systems and ways of working to try to improve it. However, at the time of this assessment these were not sufficiently embedded to be able to demonstrate improvement or positive impact for patients. Leaders told us they had reviewed the appointment system and had created a working group to look at the 8am rush at the front desk and ways to prevent patients queueing from 7am outside. A total GP triage system had been trialled in October and November 2023. The provider was in consultation with patients and intended to implement this as their new appointment system from May 2024. Leaders told us this would give equity to services as patients who phoned or those who queued would all be added to the call list then the GP would decide when an appointment was appropriate depending on clinical need. Leaders told us they had successfully managed to recruit to all clinical vacancies as of January 2024 which resulted in the Manor Park site being fully re-opened. Leaders told us that they reviewed telephone call monitoring data which suggested call wait times were minimal and did not reflect what patients were reporting.

People told us through give feedback on care forms into CQC, through the NHS website and data from the latest national GP patient survey that they had difficulty getting through to the practice by telephone and had difficulty accessing an appointment. The most recent published national GP patient survey results showed 12.6% responded positively to how easy it was to get through to someone at their GP practice on the phone. This is a significant negative variation from the national average of 49.6%. However, this is an improvement from 7.7% in the April 2022 survey although since 2018 it has continually fell below national averages. 22.8% of patients were very or fairly satisfied with their GP practice appointment times. This is a negative variation from the national average of 52.8%. This has been below national averages since 2018. 19.9% of patients responded positively to their overall experience of making an appointment. This is a negative variation from the national average of 54.4%. This has been below national averages since 2018. Feedback into CQC mostly related to access to an appointment or by telephone. We spoke with 6 patients about access to services on the day of the site visit and they all said they had not tried to telephone for an appointment, they just came and queued for an appointment outside from 7am so they knew they could get one.

Staff told us that they respected and appreciated people's backgrounds and cultural values and that they had received training in equality and diversity. However, patients including patients who may be vulnerable told us they had difficulty accessing the practice by telephone and for an appointment despite the provider being told at their last inspection that they should listen to patient feedback with regard to access and feedback on the national GP patient survey had shown no improvement over time. Leaders had an action plan in place to address access and equity in outcomes for patients and had started to make some improvements, however, these were not fully implemented or sufficiently embedded at the time of this assessment to be able to demonstrate improvement or positive impact for patients.

Feedback from people into CQC, NHS website and from the national GP patient survey results showed patients dissatisfaction with getting an appointment or getting through to the practice by telephone. Patients we spoke with told us they did not try to telephone but would queue outside an hour before the practice opened to be able to get an appointment. People told us they were treated in a way that recognised their particular needs.

Patients, including patients who may be vulnerable told us they had difficulty accessing the practice for an appointment. We received feedback from patients who were not able to access an appointment easily due to the Manor Park site being temporarily closed at certain times of the day and they found it difficult to travel to the Park site. The provider had an action plan in place to address access and had started to make improvements with the Manor Park site re-opening fully from January 2024. They had plans to change the appointment system to total GP triage which would meant patients would be seen on suitability and urgency rather than who could get through to the practice at 8am to book an appointment. However, at the time of this assessment the changes to the appointment system were not fully implemented or sufficiently embedded to be able to demonstrate improvement or positive impact for patients. The practice complied with legal equality and human rights requirements, including avoiding discrimination, having regard for the needs of people with different protected characteristics. The practice had information available in alternative formats and equipment in place to support patients who had a hearing impairment. The service sought the views of people by reviewing feedback on the national friends and family forms and by reviewing the results of the national GP patient survey data, although any actions taken to address feedback with regard to access had not improved patient experiences at the time of the assessment.

The practice had systems in place to support patients at the end of their life. We reviewed 5 records of patients who had a DNACPR (do not attempt resuscitation) in place. All had been completed appropriately following national guidelines. Staff attended regular MDT meetings where patients who were receiving end of life care were discussed. We observed their medical records were updated to reflect any actions or changes made to their care plan.

We did not receive any feedback or concerns from people regarding this.

Staff told us they attended regular multidisciplinary (MDT) team meetings where patients who were receiving end of life care were discussed.