School House 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 assessed all quality statements for this key question and found the practice was providing a responsive service. Leaders used people’s feedback and other evidence to improve access for people. Services were designed to make them accessible and timely for people, including those who were most likely to have difficulty accessing care. The practice had made significant changes to improve access to care, including utilising technology and increasing staff. They prioritised and allocated resources as needed to tackle inequalities and achieve equity of access. We recognise the pressure that practices are currently working under, and the efforts staff are making to maintain access for their patients.

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 found most people were positive about the experience of care and treatment they received at the practice within the last 12 months. The results of the most recent GP patient survey showed the responses were in line with national averages. This included how easy it was for someone to get through by phone, satisfaction with the appointment times, satisfaction with the appointment offered, and overall experience of making an appointment.

Staff told us about referral systems that ensured patients received consistent, coordinated, person-centred care when they moved between services. Leaders understood the needs of its local population and were developing services in response to those needs. They understood their challenges and were focused on continuing to make improvements.

Staff and leaders spoke positively about the patient population they served. They recognised their population was situated in an area of high deprivation. The practice had become a registered Safe Surgery, which is a GP practice who commits to taking steps to tackle the barriers faced by many migrants in accessing healthcare. They told us that a lack of identification, proof of address, or immigration status would not prevent patient registration. The practice told us they also provided care and treatment to residents of two nearby care homes. They told us this was an area of improvement for them and were aware of the challenges the care homes had faced. The practice explained they were improving access and carrying out quality improvement activity. For example, they completed a two-cycle audit of patient care and clinical records for their patients in care homes. As a result of the first audit in April 2023, they implemented a new policy and set specific standards to achieve. An audit in January 2024 identified improvements to clinical care and record keeping, with audit standards between 80-100% compliance. Further recommendations were made that would be monitored by the leadership team.

We received feedback from partners including the commissioners of the service, NHS Sussex integrated care board (ICB) and Healthwatch. They did not make any comments relating to this quality statement. We also asked the two care homes for feedback about the practice. One provided feedback that they frequently experience difficulty accessing care and treatment from the practice for their residents, noting that their weekly visits would sometimes be attended by paramedics instead of GPs as per their expectation. They also commented on poor communication with the practice, a lack of continuity of care, and prescription delays due to errors or lost requests.

There was developing flexibility, informed choice and continuity of care in the services provided. The practice could signpost patients to other services to support their wellbeing and social issues. The practice had maintained registers of different patient groups, including those with a learning disability, those with mental health concerns and those requiring palliative care. There was a home visiting service available through the primary care network.

Patient feedback indicated that information about their care and treatment was provided to them in ways which were easy to understand.

Staff and leaders told us they ensured practice information was kept up to date. Interpreting and translation services were used for patients whose first language was not English and for patients who used British Sign Language. Staff told us that patients were offered longer appointments as needed. Patients who had difficulty with reading, writing or using digital services were supported with accessible information.

Systems were in place to maintain accurate information. This included keeping the practice website up to date. Notice boards in the patient areas were maintained and provided appropriate information for patients and carers. The practice’s opening times were advertised, as was information on how to complain. Systems ensured sensitive and confidential information about patients met data protection legislation requirements. Patients were informed on how to access their health and care records and decide which personal information could be shared with other people, including their family or care staff.

We found most people were positive about the experience of care and treatment they received at the practice in the last 12 months. We did not receive any concerns or identify any specific feedback about the practice listening to and involving people.

The practice leaders told us they learned lessons from individual concerns or complaints, patient feedback, and from analysis of trends. They acted as a result to improve the quality of care. The practice discussed complaints in staff meetings and cascaded learning points in individual team meetings. Practice staff told us they could view patient feedback and results of surveys on the document management system.

The practice had a complaints protocol and leaflet, and we saw a poster in the waiting room about the process. We saw that all complaints were recorded on a log used to maintain oversight of complaints, monitor completion of actions, and to identify trends. This included informal complaints or concerns raised. We saw 9 complaints had been recorded in the last 12 months. We saw evidence that complaints were fully investigated, with transparency and openness. There were comprehensive responses from the practice. We saw that patients were signposted to the parliamentary and health service ombudsman, in case they were not satisfied with the resolution of their complaint in the practice.

Feedback provided by people using the service, both to the provider as well as to CQC, was mostly positive. Patients were positive about making an appointment, ability to book remote appointments, getting through by phone and appointments running to time. Additionally, the results of the most recent GP patient survey showed the responses were in line with national averages in relation to access.

The practice leaders told us they had made significant changes to improve access since taking over the practice. They explained they improved the use of technology, increased the number of doctors, had brought in a GP to remotely process referrals and correspondence and ensured all staff had protected time to catch up or complete admin. They had carried out their own patient survey and told us patient satisfaction about access to services had improved. In June 2024, 97% of the 92 responses said access was very good or good. They were aware that availability of nursing appointments was a concern due to staffing issues, however they had recently appointed a nurse as well as a locum nurse.

Patients could book an appointment in person, via the phone or online. Appointments were available face to face, by telephone, or as a home visit. Systems were in place to recall and invite patients to attend for childhood immunisations and cervical cancer screening. The practice had arrangements for prioritising patients. Staff had a care navigation tool which enabled them to book the right type of appointment, or to signpost to other services if appropriate. There were processes to regularly review telephone data to identify peak call times, and the practice took appropriate action where needed. For example, they added extra reception staff during busy periods to improve call response times. We saw call monitoring data for April and May 2024. This showed, on average, patients waited less than 5 minutes in the queue. The practice received an average of 577 calls per week of which 75% were answered. The practice was positive about this result, reflecting it had improved, but told us access continued to be a priority for them and they described plans to address this.

We found most people were positive about the experience of care and treatment they received at the practice in the last 12 months. We did not receive any concerns or identify specific feedback relating to equity in experiences or outcomes.

Staff understood the importance of providing an inclusive approach to care and made adjustments to support equity in people’s experience and outcomes. Alerts were used on the clinical system to identify those who may need reasonable adjustments so they could be accommodated. Staff provided examples of arrangements made to ensure patients received care in a way that suited their individual needs. Leaders told us they worked as part of a primary care network (PCN). PCNs are groups of GP practices collaborating with community, mental health, social care, pharmacy, hospital, and voluntary services in their areas to provide local services.

The practice complied with legal equality and human rights requirements. They had regard to the needs of people with different protected characteristics, and made reasonable adjustments to support equity in experience and outcomes. Staff used appropriate systems to capture and review feedback from people using the service, including those who did not speak English or have access to the internet.

We found most people were positive about the experience of care and treatment they received at the practice in the last 12 months. We did not receive any concerns or identify any specific feedback about planning for the future.

Staff and leaders had an awareness of systems to support patients requiring end of life care. There was a register of patients and multi-disciplinary meetings were held with relevant healthcare professionals.

Clinicians understood the requirements of legislation and guidance when considering consent and decision making. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were made in line with relevant legislation and were appropriate.