Trent View 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

We assessed 2 quality statements from this key question. We have combined the score for this area with scores based on the rating from the last inspection, which was good. Our rating for this key question remains good. Whilst patient feedback was mixed, we found the provider had continued to try to improve patient satisfaction by making significant changes to the way calls into the service were handled and triaged and they had increased the availability of clinicians at each site. We found staff treated people equally and without discrimination.

This service scored 71 (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 look at Person-centred Care during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The National GP Survey results for 2023 showed below average patient satisfaction. Results from 2024 GP survey data, which were not available to CQC at the time of the assessment but were provided by the practice, showed no improvement in patient satisfaction in this area and was significantly below local and national results for contacting the practice. Patient feedback during the site visit was mixed. One person told us that there were long waits when trying to access the practice by telephone, so they visited the surgery to make an appointment. Another patient told us they had had a long wait for an emergency appointment; however, they told us they had spoken to the urgent care nurse practitioner on the same day and had been booked an appointment to see a GP although they felt the 10-day wait was too long. Two other patients were happy with the appointments they had been offered one being an on the day urgent appointment and the other a non-urgent appointment within 48 hours. Patients told us they were asked if they were able and happy to travel to different sites for an appointment and told us they were sent text message reminders about their appointments. Of the patients who contacted CQC in the 12 months prior to this assessment we received 3 concerns about access in April 2024 and 2 concerns about access in July 2024. The concerns included contacting the practice to make an appointment, the practice cancelling appointments and a long wait for non-urgent appts. We also received one concern about lack of flexibility in appointments to enable them to book a regular monthly treatment around their other care needs.

Staff told us there was not always sufficient clinical staff cover to ensure a clinical member of staff on duty at each site each day. Leaders told us they had continued to make changes to try to improve patient satisfaction with access and were disappointed the changes had had minimal impact so far. There had been significant changes to the telephone system and teams answering the incoming calls. Changes to the way the way the nurse rotas had been managed had not been successful due to complexities of differing nurse competencies and available clinical rooms at each site. They had reviewed this and changed the way the rota would be managed in future to address the issues raised. They had recruited three new GPs to work across the organisation to support increased access for patients. A new clinical rota had been developed to ensure a prescribing clinician at each site daily. The provider had worked alongside their local primary care network to develop and implement their access recovery plan.

The provider had implemented several improvements to try to improve access for patients. This had included employment of additional clinical staff and rota management changes, a new telephone system and centralised call handling and urgent care teams. We observed good practice within the call handling team and urgent care teams. Staff were knowledgeable and supportive, and patients were appropriately signposted and triaged. The new telephone system had a call back facility, so patients did not have to wait in a queue. The system also enabled staff to monitor calls waiting and missed calls and the provider was investigating, with the telephone system provider, the number of missed calls and reason for this. Patients were asked if they thought their call was urgent or not and were put on an urgent care list for triage or made a non-urgent appointment. The urgent care team, made up of advanced care practitioners and a duty GP, called patients back where an urgent appointment had been requested and completed a telephone consultation. There was a clear system, based on clinical need and age of patient, for triaging patients on the call back list. Patients were given a face-to-face appointment where required and daily emergency appointments were available at all three sites. There was also an online triage system for patients to access. This system flagged urgent requests. The system was available 24 hours per day and patients were informed, by the system, that it was monitored by staff from 8am to 4pm. There was an opportunistic approach to try and get patients booked in for specific appointments. For example, a diabetic patient who was seen for urgent appointment was then booked in for diabetic review. We reviewed GP rotas and found minimal sessions when GPs were not available at a site. Where GPs were not available patients were able to access services at another site. A clinical prescriber provided cover when a GP was not available at a site.

We received mixed feedback about the care provided. Some patients told us they had had negative experiences as the GP had not listened to them. We also received one concern about lack of flexibility in appointments to enable them to book a regular monthly treatment around their other care needs.

Leaders sought ways to address any barriers to improving people’s experience. For example, all Trent View sites have a hearing loop in situ to support patients that have difficulties with hearing and wear hearing aids. This is advertised by posters at each reception site. However, not all reception staff were aware of or how to use the hearing loop system. All sites had access to language line, this service was used for patients whose first language was not English. The language line could be used via video call or a face-to-face meeting. An online consultation system could be found on the Trent View Medical practice website with a guide on how to complete this.

Systems were in place to support patients who had a disability, such as hearing loss, or whose first language was not English. The practice had veteran friendly accreditation. 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. They had taken action to improve, for example, regarding access but these improvements had not been reflected in recent patient experience feedback.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.