168 Medical Group

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

The practice provided primary care services that were accessible to all patients, including those with complex needs and those who needed the support of a carer.

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.

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

The practice had a focus on patients living with complex needs.. When patients did not respond to telephone calls or letters, staff arranged a home visit to check on their wellbeing. This was a collaborative process with other services and meant patients with a reluctance to engage received access to care. Staff arranged events in the community to improve access to care and health promotion knowledge amongst patients and their loved ones. The team planned events to address specific unmet needs or to engage hard-to-reach patient groups. This had included a sexual health event that aimed to improve the health knowledge of peri-menopausal women. Staff improved access and equity as a result of learning from incidents For example, the team updated cervical smear screening guidance for transgender patients after 1 individual was not screened in over 7 years. As a result, the practice implemented a new annual recall process for transgender patients. The practice was working towards fulfilling national requirements for learning disability and autism training amongst the team. At the time of our assessment, 27% of staff had completed training. The training improved access for patients and carers living with learning disabilities or autism by enabling staff to communicate more effectively. All staff completed training that enabled them to become Dementia Friends, which meant people living with the condition were assured of improved communication and longer appointments.

The practice maintained a record of the details of carers who provided support for patients with reduced mental capacity. Staff worked with patients and carers to improve access by supporting them to use digital app-based communication channels where this was easier than telephone calls. Staff used a personal list system, which meant each patient had a usual, named GP. This helped build therapeutic relationships and long-term understanding of needs for patients and their relatives. Staff had established comprehensive social prescribing and community support relationships with a regional wellbeing hub. Through a link worker this service meant staff could refer patients to community services to support them with non-medical needs. For example, this system helped patients access support for housing problems, debt management, and employment benefits. A team of patient coordinators worked with receptionists and the clinical team to prioritise the care of patients who disclosed needs that raised concerns, such as potential sepsis, meningitis, or shingles. Coordinators underwent specialist training for this role and ensured the practice met individual needs by arranging care for each patient with the most appropriate clinical member of staff. They arranged double-length appointments for patients with specific needs such as for frailty or where the patient needed language translation. Staff used a real-time capacity monitoring system that predicted demand, allocated patients to the most appropriate member of staff, and intercepted emergency needs before patients arrived at the surgery. This system enabled staff to respond to increases in demand and helped maintain waiting time for routine appointments to an average of 5 working days. This was significantly better than the national average of 10 working days.

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.