Eltham Palace Surgery

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 found the service was not providing responsive care because patients continued to report concerns with access to appointments. This was reflected in the national GP patient survey where 4 out of 4 indicators relating to access showed patient satisfaction below national averages. There was a complaints process; however, details of how to make a complaint were not available on the practice website.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At our previous inspection in May 2023, we found patients had concerns around access to appointments. At this assessment in April 2024, patients told us they found it difficult to access same day appointments and there were long waits for routine appointments. Review of the practice’s clinical appointment system reflected the concerns raised by patients. Patients also told us they would welcome different methods of making appointments, for example via an online system. At the time of our assessment, this option was not available to patients.

The provider sent us evidence of monitoring of the number of same day and routine appointments available to patients. The provider had also moved to a cloud-based telephone system which allowed for more options for monitoring of access via telephone. However, patients continued to report difficulty accessing appointments. One of the GP partners reported that extensive work had been conducted to monitor the demand versus the supply of same day appointments, and the practice stated they had made efforts to ensure that more appointments were made available to meet the practice population needs.

Patients in vulnerable circumstances, including those with no fixed abode, were able to register with the practice.

There were no concerns raised by partners regarding care provision, integration and continuity.

Patients could make requests for home visits. These requests were triaged by one of the GPs to determine whether a home visit was appropriate. Home visits were carried out by practice GPs or the Primary Care Network (PCN) home visiting team.

Patients told us information about their care and treatment was explained to them in ways that were easy to understand.

Staff told us that interpreter services were available to support patients who did not speak English. Patients were also able to bring somebody with them to their appointment to support their understanding, for example patients who used British Sign Language. Staff told us that patients who did not speak English as their first language were highlighted on the electronic clinical records system and were booked double appointment slots as standard.

There were processes to support patients with a learning disability to bring a carer or family member to appointments with them. We did not see that leaflets were available in Braille, large text or easy read format; however, staff at the practice told us information in these formats had been ordered.

Patients told us they knew how to make a complaint. Those who told us they had make a complaint spoke positively about the way this had been handled by the practice. However, at the time of our assessment, the link on the practice’s website to make a complaint did not work.

Staff told us there had been 13 complaints received in the last 12 months. We were told by staff that learning was shared in practice meetings. However, some staff members told us they did not know how to access meeting minutes where learning from complaints was discussed.

At our previous inspection in May 2023 we found that it was difficult to access the complaints form online. We found the same concerns at this assessment in April 2024. The practice website contained a link to the NHS reviews website; however, the complaints policy and a complaint form were not accessible via the practice website. A section of the website said that people could provide feedback online by completing the feedback and complaints triage. However, the link directed users to a page with an error message instead of the appropriate form.

The national GP patient survey in 2023 showed patient satisfaction with the 4 indicators relating to access was lower than national averages. The questions related to; satisfaction with the appointment offered; satisfaction with the GP practice appointment times; how easy it was to get through to someone at the practice via telephone; and the overall experience of making an appointment. Performance against these indicators had decreased overall since 2021, although had improved following the 2022 survey. Patients told us they could not always access appointments when they needed them. We were told there were difficulties getting through to the practice by telephone with long waits reported. Once people spoke to someone at the practice, they were not always able to get a same day appointment. When booking a routine appointment, we were told the wait was approximately 2-3 weeks. Feedback shared directly with CQC and reviews on the NHS website referenced difficulty accessing referrals, appointments and prescriptions.

The provider kept a log of the number of urgent appointments available each day along with the number of patients who had been unable to access an appointment. This log also included the number of days until the next available GP appointment. The provider shared this record with us from June to December 2023. We saw that each week there were a number of patients who were unable to access appointments. The provider had identified that increased capacity was required to meet patient demand. Whilst the provider told us they had made changes in an attempt to improve access, for example through a telephone system that allowed for more detailed monitoring, patients continued to raise concerns about access. We reviewed the practice’s appointment system on the day of our site visit (30 April 2024) and found the next available routine GP appointment was on 16 May 2024 and the next available nurse appointment was on 3 May 2024. Urgent appointments were available on 1 May 2024.

Patients could make appointments via the telephone or in person. Booking online was not currently available at this practice. Appointments were available with GPs, practice nurse, clinical pharmacist or physiotherapist. The practice was open from 8am to 8pm Monday and Friday, and 8am to 6.30pm Tuesday to Thursday. Out of hours services were provided by NHS 111 outside of the practice opening hours.

Patients told us they were not currently able to access bookings online. We heard this would be preferential to some patients rather than calling or attending the practice to make an appointment. Some patients told us they were able to access double appointments when necessary. We also heard from some patients they did not have sufficient time in their appointments to discuss all concerns.

There was a hearing loop in reception; however, staff were unsure how to use this. Staff told us a private room was available if patients requested a space for a private conversation with reception staff.

There were processes to ensure the practice could respond to changes in people’s preferred gender, name and title. Patients with a learning disability received an annual review and were able to attend appointments with a family member or carer. Home visits were also offered. Patients in vulnerable circumstances, including those with no fixed abode, were able to register with the practice. The layout of the practice was suitable for patients, staff and visitors who used wheelchairs, mobility scooters or pushchairs. There was a disabled toilet and automatic doors to the reception team.

Patient feedback did not raise any concerns regarding planning for the future.

There was a multidisciplinary team approach for discussing patients receiving care at the end of their life.

Do not attempt pulmonary resuscitation (DNACPR) decisions had been recorded where appropriate on patient records.