Wellington Medical Practice

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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

Responsive – this means we looked for evidence that the provider met people’s needs. We assessed all of the quality statements from this key question. Our rating for this key question is requires improvement. At the last assessment, we rated the practice as inadequate because the National GP Patient Survey 2023 results for the practice was significantly lower than local and national averages across all 4 indicators in respect of accessing the service. Feedback in relation to the practice providing responsive services was poor. Complaints were not always managed effectively. There had been improvements in how the practice responded to the needs of patients since our previous assessment. There were systems in place to support continuity of care and extended access to appointments and a decrease in the number of complaints raised by patients regarding access. However, all indicators from the latest GP national patient survey for access to appointments were below local and national averages. The next GP national patient survey, due to be published in July 2025, may demonstrate the impact of their action plan to address patient satisfaction on access. We found that complaints were investigated and responded to. Patients were informed of next steps if they were unhappy with the outcome of an investigation into their complaint. We found staff treated people equally and without discrimination. The provider complied with legal equality and human rights requirements.

This service scored 61 (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 receive any feedback or concerns from people regarding this quality statement.

Leaders told us that in response to patient feedback, they had reviewed their care model and reviewed the clinical skill mix. This review resulted in increasing GP visibility and GP appointments. The practice was part of the Wrekin Primary Care Network (PCN), a wider network of GP practices that worked collaboratively to deliver primary care services. The Primary Care Network offered extended access appointments Monday to Friday between 6.30pm and 8pm, Saturdays 9am to 5pm and some Sundays. This meant the practice offered patients the option of being seen in extended access clinics.

Staff told us that appointments were available for those with urgent need on the same day and the next routine appointment with an unspecified GP was within a week. Practice staff were able to refer patients to social prescribers to sign post and support patients with the understanding of the social, economic, and environmental factors that impact patients' health and well-being. Staff told us they worked to build relationships with community organisations, social services agencies, religious institutions, and local government entities, whenever possible to improve patient care in the forms of multidisciplinary teams.

We received no specific feedback from partners regarding care provision, integration and continuity. Partners reported that the practice had completed an action plan following the CQCs last inspection and had developed an action plan with the ICB. They had completed all these improvement actions.

The practice had considered resource mapping to identify community organisations, support groups, social services, and programs available to address these needs. Leaders had a good understanding of the local population and complied with the accessible information standard within the surgery. Staff had received training in equality and diversity.

We received no specific feedback from patients regarding the provision of information.

Staff we spoke with told of their awareness of any actions taken to meet the NHS England’s Accessible Information Standard (AIS). They confirmed they had completed information governance training which included General Data Protection Regulation (GDPR). The practice was able to organise interpreter services for patients whose first language was not English. Leaders demonstrated they understood the needs of their local population and had developed services in response to those needs. The importance of flexibility, informed choice and continuity of care was reflected in the services provided. Appointments included a mixture of telephone, face-to-face and home visits, which were noted on the practice website.

Staff had awareness and actions were taken to meet NHS England’s Accessible Information Standard. There were arrangements in place for people who required translation services. There were systems in place to support patients who faced communication barriers to access treatment, including those who might be digitally excluded. Staff received training to support awareness of information governance.

Recruitment to the Patient Participation Group (PPG) had been difficult, which meant that listening and involving people who used the service had been challenging. The PPG expressed the need for more PPG presence in the practice and that they would appreciate more involvement, including facilitating focus groups, which had previously worked well. Patient feedback from the national GP patient survey data was significantly lower than local and national averages. Only 50% of patients described their overall experience of this GP practice as good, compared to local average of 72% and the national average of 74%.

Leaders told us they were aware of patient feedback with regards to access from the national GP patient survey data, from on-line reviews and from complaints received into the practice. Staff described the various systems in place for how patients could raise suggestions, comments, compliments, feedback and complaints. Staff were aware of the named complaint lead. They told us that complaints were discussed as a regular meeting agenda item. Staff said that they recorded and flagged complaints for investigation. The majority but not all staff said they learnt the outcomes of complaints and of any actions arising and discussed any mitigations of risks for learning. Staff told us the latest national GP Survey results were described and discussed with the practice team, including improvement action plans. Staff told us of the new telephony system which had been well received by patients to date.

The practice had various systems in place for how patients could raise suggestions, comments, compliments, feedback and complaints. The practice had a designated complaint lead. Information about how to complain was readily available. There was evidence that complaints were used to drive continuous improvement. There was a policy in place for investigating and responding to complaints however, at the last assessment we found it had not always been adhered to or linked with significant events. During this assessment we found that improvements had been made. Systems were in place to record, monitor and review complaints for trends and themes.

All indicators from the latest GP national patient survey for access to appointments were below local and national averages. Patients who responded to the survey reported it was difficult to get through to the practice by phone or to book an appointment. Some patients chose to visit in person and queue to try to book an appointment. Patients had raised complaints on public websites and a few directly to the Care Quality Commission. The practice was aware of this and implemented significant changes for improvement. Since the changes the practice had seen a reduction in patient complaints and in patients being signposted to other services unless appropriate. Patients could make an appointment at the reception desk, electronically and also over the telephone.

Our last assessment highlighted poor access, specifically lengthy call wait times and difficulty in obtaining appointments. Leaders told us they had listened to patient feedback and implemented new systems and ways of working to facilitate improvement. Leaders told us they had since revamped their telephone system to enable queue numbers and optional callback. They reported they had received positive feedback from patients and were confident this would be reflected in their results in the next national GP patient survey. All staff reported that the changes implemented had enabled clear sight of the number of incoming calls, the time waiting if any, and the length of the calls. The practice staff had access to sight lines of this electronic dashboard at their desk areas and the lead managing partner via their electronic telephone application. Staff reported that this together with the changes made to the incoming calls and online access meant that patients could get through to staff more readily, in particular if their call was more urgent. The leaders could audit this dashboard, produce reports and provide feedback to patients and staff on the progress they were making in this area. All staff recognised that the National GP patient survey results would not reflect this until 2025. Leaders proactively sought ways to address any barriers to improving people’s experience and worked with local organisations, including within the voluntary sector, to address any 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.

Leaders had developed an improvement plan following our previous assessment. The improvement plan was actioned. The practice had implemented changes to patient access, however this change needed to time to be embedded to ensure improvement in patient satisfaction. 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 speak English or have access to the internet.

Feedback received by CQC, NHS website, practice complaints and from the national GP patient survey showed patients dissatisfaction with getting an appointment or getting through to the practice by telephone.

Reasonable adjustments were made for patients who experienced difficulties accessing services. For example, translation services were available for those who required them, and a hearing loop was available at reception for patients who were hard of hearing. Additionally, staff informed us that a private room was available upon request for patients who needed a confidential conversation with reception staff. A screen was available in the waiting area, highlighting useful information for patients, including an introduction to staff and their roles. Staff gave an example that a longer appointment would be offered to patients who may have a learning disability or where staff felt a longer appointment may better meet the needs of the patients for example if a translator was required.

Staff utilised alerts within the clinical system to identify patients needing reasonable adjustments. From the unverified data seen we noted that some improvements had been made in some areas such as cervical smear and childhood immunisation uptake.

We received no specific feedback from patients regarding their experiences of planning for the future.

Clinicians we spoke with demonstrated a clear understanding of the requirements of legislation and guidance when considering consent and decision making relating to end of life care. Staff told us they regularly attended multidisciplinary team (MDT) meetings where they discussed patients who received end-of-life care.

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) or ReSPECT form (personal plan used to record a person’s clinical care and treatment in a future emergency) in place. Some oversight was required where these forms had not been completed by staff at the practice to ensure the necessary detail was evidenced.