Askern Medical 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

At our previous inspection, the practice was rated Good for providing a responsive service. At this assessment we have rated the practice as requires improvement for providing a responsive service. Data from the National GP Patient Survey showed that patients had problems accessing the practice by telephone. Feedback to us before and after the assessment from patients, partners and staff told us this. Telephone data from the practice showed this. Patients and staff told us that complaints had either not been dealt with or there had been delays in receiving a response. We found that the practice were not following their own policy on complaints, they said this was due to staff shortages.

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.

Feedback from staff was mixed, some said they felt they worked well together as a team to provide good care, some said that they struggled due to not having enough staff and access to appointments for patients was poor. Leaders told us that consent was taken from patients for minor surgery.

We discussed with the staff the care given to patients. The clinical lead gave us a presentation on the day of our site visit explaining that the level of GP provision at the practice was the highest in the area. Staff told us they felt that there was enough GP provision. The practice had a higher level of patients registered from the Traveller community compared to other practices and had worked with them over the years to improve their health care outcomes.

We sought feedback from a care home where the practice had patients who were resident there. They told us that the practice had not responded and were not quick to respond to requests for home visits. They couldn’t get through on the telephone and recently a member of staff had to go to the surgery in person as they could not get through on the telephone, this had happened 4 times in the last 6 months. The manager of the care home had tried to engage with the clinical lead at the practice by email but they did not respond to them or acknowledge the emails.

From our remote searches of clinical records we saw that the results were generally positive. We did not identify any major concerns with medication reviews or how the practice managed long term medical conditions. The practice was open at both sites Monday and Friday 8am to 6pm. Tuesday to Thursday the practice was open 8am to 8pm, every other Saturday morning, providing extended access appointments. On Tuesday and Wednesday telephone appointments were available from 7.30am. Appointments were available at all times during the day. They provided a range of appointment types including book on the day, telephone consultations and advance appointments. Out of hours services were provided by via the NHS 111 service.

The remote searches of clinical records as part of our assessment did not raise any concerns with regards to communication with patients regarding their care. We did not receive any information from patients regarding this directly.

The provider shared with us information about how they communicated with patients regarding their needs. The practice had a system for summarising care records. They were able to share information with staff and other agencies to deliver safe care and treatment. Referrals to specialist services were documented, contained the required information and there was a system to monitor delays in referrals.

There was a documented approach and appropriate clinical oversight of test results, including when reviewed by non-clinical staff. Staff communicated with patients in a way that helped them to understand their care, treatment and condition, and any advice given. They helped patients and their carers find further information and access community and advocacy services. They had systems in place to access translation services

Prior to our assessment we had received information of concern from staff and 12 complaints from patients both of which told us that complaints were not being dealt with effectively and when patients asked staff about how to complain they would not help them. The care home where the practice had patients as residents told us that they had contacted the lead GP and they had not acknowledged their email or responded to them.

Staff told us via our questionnaires and further whistleblowing that there had been high levels of complaints to the practice. Whistleblowers told us that many of these had not been answered and some had been either shredded, not answered or deleted. At our site visit the leaders at the practice told us that some of the processes for complaints had not been followed due to staff shortages at management level over several months and that they were now being dealt with effectively. Following high level feedback to the practice by us after our assessment, leaders told us that they did not give us all of the complaint’s information at our site visit. They then provided us with a list of 4 complaints for the whole of their group (of which some complaints did not cover the two sites in this assessment).

We asked staff about complaints on the day of our site visit. We saw a copy of their complaints policy, which was not being followed, this sets out acknowledgement times, investigation, and that an annual review of complaints would be undertaken and any learning points identified, from the complaints we saw this was not happening. Staff were unclear how many complaints had been received in the last 12 months. They acknowledged that there was no clear process in relation to complaints, due to staff shortages these had been managed by different members of staff. Any complaints waiting had now been acknowledged and there had been delays. We looked at 4 examples of complaints at our site visit, which we were provided with, from which we confirmed 2 had been answered. It was difficult to tell what process had been followed for the other 2 complaints. Following our site visit we asked the practice to provide us with the number of complaints they had received in the last 12 months, this overall number was not supplied. They sent to us 4 further examples of complaints. In all of the complaints we saw only 2 appeared to have any attempt to identify learning from them, one of the complaints mentioned not receiving any response from the practice. We were not assured that all complaints received were recorded, investigated or responded to and the practice were not following their complaints policy. There was no identification of patterns or trends to the complaints.

We reviewed the practice's results in the National GP Patient Survey (01/01/2023 to 30/04/2023) All results were below the national average and had been consistently below the national average since 2019. For example Patients who responded positively to how easy it was to get through to someone at their GP practice on the phone was 19.4% - the national average 49.6%. Patients who were very satisfied or fairly satisfied with their GP practice appointment times was 38.1% – the national average 52.8%. We received 10 complaints and whistle blower information which specifically told us access to the surgery was poor. We were told there was insufficient time to see patients, several patients said they couldn’t get through on the telephone or were unable to obtain an appointment for several weeks. Three reviews on NHS choices website said there were problems with telephone access. We sent out a link to the practice to share with patients to give us feedback. We received 10 items of feedback, three of which were from staff who wished to remain anonymous. Three items of feedback were positive stating good care was given. Of the 10, three items of feedback specifically said that patients could not obtain an appointment and that there were not enough staff to answer the telephones. We contacted two members of the patient participation group. On feedback on access, one person told us there were problems with telephone access and the other that it was difficult to get through on the telephone. The practice told us from their own patient surveys that they had identified that 15% of patients who completed the survey were dissatisfied with waiting for their call to be answered, however 30% were not aware of their online booking functionality. The care home where the practice had patients who were resident there told us they couldn’t get through on the telephone and recently a member of staff had to go to the surgery in person, this had happened 4 times in the last 6 months.

Staff and leaders told us that they were understaffed and were recruiting for 2 more call handlers. Some staff told us that the telephone hub could sometimes not be manned and reception staff would have to answer the telephones and speak with patients on reception the same time as managing face to face patients. Staff told us sometimes patients told them they were waiting for 3 hours to get through on the telephone. We gave high level feedback to the practice regarding access. They said they were unhappy with the sample number of patients who completed the GP National Survey. Their own survey from 1600 patients over 18 months gave an 87% satisfaction rate. Other newspaper articles showed that the national satisfaction rate (for GP practices) was low, example given 24%, they believed their patient satisfaction survey was much higher than national averages.

The practice had a telephone hub where calls from patients were answered The hub served 3 other GP practice sites which the provider had This meant the hub was answering calls for a patient list size of 13,000 patients On the day of our assessment there were 2 members of staff in the hub answering calls Some staff sometimes hot desked at other sites to assist with the call handling The average wait time on the day for the call to be answered was 6 minutes This was a cloud-based system however there was no option for patients to be called back when they reached the front of the queue The electronic wallboard showed on the day of our assessment that 163 calls had been made to the practice (close to midday), 26 of these calls had been unanswered meaning that 16% of calls weren’t answered on that morning We fed back to the practice that this was a high number especially that the practice had already stated a lack of uptake for using online methods to contact the practice We were told by staff that the practice could obtain a telephone report, with call data from the telephone provider We asked the practice to provide us with a years’ worth of monthly reports, showing this information, following our assessment The practice sent us a weeks’ worth of telephone data for the week of our assessment, 18 March 2024, for the five days there were 1111 calls, of which 763 were answered (68.12%) 348 (31.88%) were missed Following our assessment the practice told us that at anytime there was a bigger pool of staff to answer telephones other than just in the hub They provided us with information from the telephone company which said there were 3 phones in the hub and 4 handsets across the providers 4 practices on a morning, therefore 7 lines being answered The information stated that after 1 minute and 57 seconds the patients can request a call back, the telephone company stated that as far as they could see patients who requested a call back were receiving one

Feedback from people reporting into CQC and from the National GP Patient Survey showed patients dissatisfaction with getting an appointment or getting through to the practice by telephone. Whilst the provider told us they worked closely with the Traveller community we did not receive any feedback from this group.

The lead GP told us the practice offered same day appointments for children, housebound and palliative patients. They have a register of patients who are frail. They worked closely with the Traveller community to support them in their care and treatment. The practice held a register of patients living in vulnerable circumstances including patients with a learning disability, offering longer appointments when needed. The practice had carers identified via their register, 5.8% of the practice population were carers (436 of 7500). On alternate Saturday mornings they offer extended access appointments for carers.

Interpretation services were available for patients who did not have English as a first language. Patient information leaflets and notices were available in the patient waiting area which told patients how to access support groups and organisations. Information leaflets were available in other languages and in easy read format. Information about support groups was available on the practice website.

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.