Clare House

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 have rated the practice as Outstanding for providing responsive services because: Results from the national GP survey have been consistently above the expected outcome since the previous inspection. We received over 250 ‘give feedback on care’ submissions which were all positive about accessing the practice; availability of appointments; and involvement in care planning and decision making. Suitable appointments were offered based on clinical need and vulnerable people or those with protected characteristics were able to access care and treatment in ways that met their personal circumstances. The practice used data on appointment types and calls to the practice to continuous review and improve the service it offered.

This service scored 100 (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 survey (01/01/2023 to 30/04/2023) showed 98.7% of patients stated that during their last GP appointment they were involved as much as they wanted to be in decisions about their care and treatment. This was above with the expected result of 90.3%. Information from give feedback on care submissions mentioned GPs listening and involving patients in decisions on care and treatment. Patients said they were listened to and their concerns were dealt with in a compassionate manner. Staff were considered to be sympathetic, knowledgeable and kind. Patients who provided us with feedback said they were given sufficient information to make a decision on care and treatment.

All calls and online requests were triaged by the on the day team and passed to the most relevant member of staff to manage. Triaging clinicians were able to book in follow up appointments in order to promote continuity of care. When needed a paramedic who was part of the acute on the day team was able to carry out home visits. The practice made reasonable adjustments when people found it hard to access services. There were arrangements in place for people who need translation services. The practice complied with the Accessible Information Standard. The practice could accommodate people who worked or needed later access outside of core hours. Cervical screening appointments were offered outside of working hours.

People who used the service knew what the next step would be after contacting the practice. Staff interviewed said that they worked with secondary care; voluntary agencies; and members of multidisciplinary teams to provide joined up care and treatment. Examples given included working with the local council to support people to improve their living conditions which were having an adverse effect on their health.

We did not receive specific feedback on this area.

The practice had a range of meetings to discuss patient care. These included daily huddles, clinical meetings and specific meetings on long term conditions and patients with complex needs.

We did not receive specific feedback on this area from patients.

The practice provided appropriate, accurate, and up-to-date information in formats tailored to individual needs. For example, the practice reviewed the consent forms and patient information about surgical procedures. The practice made changes so that information was provided in different formats, including verbal, written and text links with videos prepared by the practice, to suit different peoples’ needs.

Interpretation services were available for patients who did not have English as a first language. People with hearing impairment could request for British Sign Language interpreter. The practice was equipped with audio induction loops. The practice’s website contained accessibility information. For example, people could request information on the practice’s website in a different format like large print, easy read, audio recording or braille The practice designed its website to enhance accessibility.

The practice website provided information on how to share compliments and concerns. People who raised concerns were listened to and provided with feedback.

There was a designated member of staff to respond to complaints supported by the practice manager, other management staff and clinicians when needed.

The practice had a complaints policy in place. People who used the service were able to raise concerns online, by speaking with the practice, or in person. When things went wrong the practice apologised and provided support. The practice manager maintained a record of complaints and concerns received which included when the complaint was received, a summary of the concerns and whether a significant event needed to be raised. The records showed when an initial holding letter had been sent and the timescale for an investigation and when a full response to the complainant was due. This process was monitored regularly, if there were delays with responding to a complainant then this was recorded and the person notified. Trends and themes were identified and action plans were developed to improve the service. Themes and trends arising from concerns and complaints were collated and discussed at significant event and complaints meetings. Minutes from these meetings were circulated to all staff for information and to action any learning needed. Audits were carried out to ensure that required actions had been taken and completed.

Results from the national GP survey (01/01/2023 to 30/04/2023) showed: That 67.2% of patients responded positively to the experience of making an appointment, compared with the expected result of 54.4%. (no statistical variation) That 72.4% of patients were very satisfied or fairly satisfied with the GP practice appointment times, compared with the expected result of 52.8%.(tending towards positive variation). That 54.2% of patients responded positively to how easy it was to get through to someone at their GP practice on the phone, compared with the expected result of 49.6%. (no statistical variation). That 84.9% of patients were satisfied with the appointment they were offered, compared with the expected result of 72%. (tending towards positive variation). The premises were wheelchair accessible, and all clinical rooms were on the ground floor. The practices have hearing loops. People could access appointments online, over the phone and in person. Pre-booked appointments at extended hours in the evenings during weekdays or on Saturdays were available to enhance access for working people.

The practice carried out a quality improvement project to improve patient appointment access. The practice had a Capacity and Access plan which demonstrated how data was used to flex appointment types, with the aim for the patient to be directed to the right person first time. Call data was used to assist with staffing levels. When needed the number of staff taking calls could be increased and future staff rotas were planned with more cover at peak times when trends showed call volumes were higher. Clinicians triaged online requests and risk rated them so that urgent cases were seen in a timely manner. Appointment availability was discussed in meetings and at a strategy meeting in June 2024 it was noted that after increasing the number of slots where patients could text in requests. These were being filled and by having one GP managing these requests, it enabled other GPs to see more patients on a routine basis.

Information was collated on the number of appointment requests, tests undertaken, prescription requests, surgical procedures. In bound call numbers were monitored and staff could easily see how many calls were in the queue to be answered and the length of time a person had been waiting, and number of calls abandoned. During busy times other members of staff would assist the patient service team to answer calls, to avoid people waiting. Data was collated and reviewed monthly and used to plan appointment types and staffing numbers. The practice offered a range of appointments. These included emergency on the day, pre-bookable and clinics for conditions such as diabetes or asthma reviews. The acute on the day team were able to book patients in directly for a telephone consultation or face to face appointment, if needed after a patient was triaged.

During our assessment, we found evidence that the practice sought, managed and responded to patient feedback. Feedback provided by patients to us and the provider was positive. People who used the service considered staff treated people equally and without discrimination. Vulnerable people were supported with their contact with the practice and appropriate clinicians. For example, people who needed support with their mental health were able to access the social prescriber. A duty GP reviewed all requests for access to services each day to ensure people saw an appropriate clinician within a satisfactory timescale to meet their needs.

The practice provided minor surgeries at the main site. The practice undertook a project to look into the unmet health needs of local asylum seekers who registered with their practice and following this provided outreach services for health checks to be carried out for asylum seekers. The practice shared their experience to help the other practices to support asylum seekers. For transgender patients arrangements were in place to ensure they continued to receive appropriate health checks and their preferred name was used.

Systems and processes were in place to assist in identifying patients who may need extra support. This included alerts on patients records to show what support they needed with communication such as interpreters. The practice was responsive to the needs of older patients and offered home visits and urgent appointments for those with enhanced needs and complex medical issues. The practice adjusted the delivery of its services to meet the needs of patients with a learning disability. The practice liaised regularly with the community services to discuss and manage the needs of patients with complex medical issues. There was policy on equality, diversity and inclusion.

Staff supported people to make informed choices about their care and plan their future care. People’s wishes and choices regarding their care and treatment and future planning was recorded within their records. There was information in the reception area on palliative care and services offered by the practice, such as home visiting.

Clinical staff used the Devon and Cornwall Shared Care Record treatment escalation plan (TEP) to assess and support people in reaching decisions about end-of-life care. This identified that peoples’ views had been sought and respected. We saw information had been shared appropriately with relevant agencies.

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were made in line with relevant legislation, were appropriate and recorded clearly. Staff documented patients’ wishes on their records, which were accessible to local health providers. The practice had a named GP to coordinate and oversee decisions regarding advance care planning, end-of-life care, and DNACPR.