Wonersh Surgery

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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 reviewed 2 quality statement in the Responsive key question – Equity in experiences and outcomes and Equity in access. The scores for the other quality statements are based on the previous rating for this key question. The provider understood the needs of its population and tailored services in response to those needs. For example, extended opening hours, online services, and advanced booking of appointments. The practice was open daily from 8am until 6.30pm. There were also early morning appointments Monday to Friday 7.30am - 8am and the practice opened Saturday 9am -12.30pm Patients were able to book appointments in a number of ways. Patients could attend the practice and book at the reception desk, via telephone, or by completing a form on the website. Patients requesting an urgent on the day appointment were triaged by a clinician who assessed and prioritised the clinical need and acted accordingly. The results of the most recent GP Patient Survey in relation to the responsive key question, showed the provider performance was above the national averages. The provider had made reasonable adjustments when patients found it hard to access services. The practice actively sought out and listened to information about their patients who were most likely to experience inequality in experience or outcome. Interpretation services were available for patients who did not have English as a first language. The practice had recruited a care coordinator who liaised with local services and organisations available to help support patients with long term conditions.

This service scored 75 (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.

Staff we spoke with told us that they were aware of barriers to care for some patients and the actions to take ensure good care. This included booking interpreters, being able to book double appointments, having early morning appointments and different ways to book appointments. Patients could book appointments in person, online or by telephone. Pre-bookable appointments were available as well as a daily triage for patients. Face to face appointments could be requested by the patient or if the clinician felt this was necessary. Staff told us they were currently offering 50% of appointments as face to face and 50% as telephone appointments. Where appropriate routine home visits could be booked with the paramedic.

The leaders understood the challenges regarding patient access. The provider had taken action in response to patient comments made in the National GP Patient Survey. For example, the duty GP tried to call as close to the time slot given to the patient as possible. The new triage system allowed patients to state when they were available for calls and a confirmation message was sent to all patients who booked appointments. Adjustments were made to the service to support patients with any communication barriers or additional needs they may have. For example, longer appointments, interpreting services and home visits. Alerts were on patient records to identify vulnerability or any additional needs. People in vulnerable circumstances were easily able to register with the practice, including those with no fixed abode such as homeless people and Travellers. Leaders reviewed data and feedback and changes were made to ensure improvements would have a positive impact for their patients.

Results from the National GP Patient Survey showed positive results. Patient feedback from the National GP Patient Survey showed that 68% of patients were positive to the overall experience of making an appointment. The national average was 54%. The National GP Patient Survey showed 63% of patients responded positively to how easy it was to get through to someone at their GP practice on the phone. The national average was 49%. The National GP Patient Survey showed 64% of patients were very satisfied or fairly satisfied with their GP practice appointment times. The national average was 53%. The National GP Patient Survey showed 84% of patients responded they were satisfied with the appointment (or appointments) they were offered. The national average was 72%.

The provider actively sought out and listened to information about their patients who were most likely to experience inequality in experience or outcome. The names of patients who were carers were held on a register. The provider has recently started a trans-patient register which was reviewed every 3 months to ensure screening opportunities were not missed. The provider had started a piece of work to identify young carers so they could be supported further. The provider had recruited a care coordinator who kept up to date with local services and organisations available to help support patients with long term conditions. The provider had systems in place to ensure patients and staff feedback was received. The provider had also completed a staff survey. Patients could leave comments via the practice website or by writing to the practice. The provider investigated and reviewed complaints and comments by patients, including those left on digital platforms. The provider provided a number of different support mechanisms for patients where needed. Patient records were detailed and gave a good overview of patient's requirements. This included appointments in a downstairs room, interpretation services, or additional time needed.

We interviewed staff members including health care assistants (HCA), Nurses, paramedic, reception staff, and administrators, as well as the practice manager and GP's. Staff showed a clear understanding of potential barriers to care including patients with a hearing or visual impairment or patients who were homeless. We found there was an inclusive approach to patient care. The provider had assessed the demographics and prevalence of disease of their population to better understand the services needed for their patient population. They had made changes to their service in response to this. For example, the practice now ran a specific clinic for hypertension. The provider employed a care co-ordinator who worked closely with the carer’s community. If needed this member of staff could complete a home visit to see if any additional support was needed. The provider and patient participation group completed their own patient surveys and along with the results from the National GP Patient Survey had created action plans based on these. As a result of feedback, the provider had moved to a total triage system and had amended the timing of their extended access appointments.

The patient participation group (PPG) held a café event which was attended by 118 patients. Patients were able to talk openly about any negative and / or positive issues. The PPG was to present these to the provider, so they had a greater understanding of their population group. We saw notes taken from this meeting and saw that the meeting had been well received and mainly positive with an open dialogue. The National GP Patient Survey does not have questions specific to this question. We received 4 CQC Give Feedback on Care forms from patients. These were all positive about the provider, however, did not give specific details about this key question. The provider had a significantly older cohort of patients. This had increased in the last 13 years. In response to the needs of their elderly population the provider had employed a further practice nurse and health care assistant to support dressing clinics and blood monitoring.

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.