Dr C D Lenton & Partners Also known as Ashfield 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 carried out an announced assessment of 3 quality statements (Care provision, integration and continuity, Listening to and involving people and Equity of access), under the key question Responsive and found: Leaders used people’s feedback and other evidence to improve access for people. However, services were not always designed to make them accessible and timely for all people. The provider did not always prioritise and allocated resources and opportunities as needed to tackle inequalities and achieve equity of access.

This service scored 68 (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.

Staff told us they encouraged continuity in people’s care and treatment where possible. Clinical staff booked in follow-up appointments with their patients where they felt continuity in care would improve outcomes. Leaders told us that continuity of care for their patients was an important factor when they were re-designing systems to improve access. Leaders told us they worked with external organisations to support 40 asylum seekers when a local hotel was converted to house refugees.

Feedback from a local care home, where residents were registered with this GP practice, was positive about the practice in general and the staff. They felt they had a good relationship with the practice that supported coordinated care for the residents.

The practice had developed effective processes to communicate with a local care home to which they provided services to. This meant the practice staff were kept informed of which patients required support and processes allowed the residents access to effective and timely care and treatment. There were systems for social prescribers to feedback to leaders about interventions to support holistic care.

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

CQC had received feedback from 3 people that related to the management of their complaint to the practice. We found that one complaint was handled appropriately and practice staff had met with the person to discuss their concerns. The other feedback we received was negative and included that the person did not receive a response from the practice or that they were not able to speak with the manager to discuss their concerns. From the NHS UK website we found 23 reviews had been left by people between March 2023 and February 2024. While there was no feedback left about the management of complaints, we found that responses (positive or negative) were not always replied to in a timely manner. However, when the practice did reply they were open and honest with people. The practice website contained information on how to complain and at the time of the assessment there was no information displayed in the waiting area about the complaints process or what improvements had been taken following patient feedback. Leaders told us at the time of the assessment the practice with the support of the PPG was updating information in the practice waiting area, this included information for patients on the practice’s complaint process. The practice kept the Patient Participation Group (PPG) informed about improvements the practice was planning to improve the quality of services provided and the PPG had opportunities to share their feedback about what improvements they felt were needed.

Staff told us that when patients wanted to speak with staff about their complaint, relevant staff were not always available. This meant that patients had to submit their complaint in writing and could not verbally discuss their complaint and have it resolved in real time. Leaders told us a new staff role had been created, a complaints handler administrator, specifically to help deal with complaints and help resolve minor complaints in real time. Staff we spoke with were not aware of this role. Staff were not made aware of all complaints that came into the practice or any subsequent learning. Staff told us that communication could be improved at all levels to aid learning following complaints. Leaders told us they were aware they needed to improve communication within the practice and this was something they were working on. They intended to start whole practice meetings where a representative from each team would attend, and then they would feedback to their teams.

Patients could give feedback about their experiences of care in a range of ways. Leaders monitored patient feedback from a range of sources and took actions to improve. The practice had an appropriate complaints policy and written complaints we viewed were handled in line with the policy. The practice had effective processes to thoroughly investigate complaints and respond to patients in good time. The practice was open with patients if mistakes had occurred and if there was any learning for staff. However, we found the complaints policy had not been updated since August 2023 and did not include details of the complaints handler administrator role. The practice had created a new role of a complaints handler administrator to help resolve complaints in real time. However, this role was not embedded at the time of the assessment. The practice had received 16 complaints between April 2023 and April 2024. The practice had identified a trend in patients complaining about appointment access or availability and had acted to improve appointment access. Following concerns from patients and staff about travel vaccination, the practice had improved the travel vaccination policy to make it clearer to patients and staff about what the practice could offer and the expectations from patients. In individual complaint responses patients were kept informed about how their feedback was acted on. However, there was no information in the practice for patients to show what improvements the practice had made following their feedback. Processes to share learning from complaints and concerns needed improving. Not all staff we spoke with could give examples of how they incorporated learning into daily practice. Leaders were aware that communication within the practice needed to improve.

The 2023 GP patient survey data showed that while patient satisfaction with telephone and appointment access had improved in all 4 indicators from the previous year (2022), including improved satisfaction with the type of appointment offered and the appointment times available. Patient satisfaction with how easy people found it to access the practice by telephone remained poor. The 2023 survey showed a negative variation when compared with other GP practices with only 28% of people who responded to the survey, reporting that they found it easy to get through to the practice by phone. Feedback from 7 people to CQC was negative about accessing the practice by telephone or in making an appointment. The practice had received 23 reviews on the NHS website between March 2023 and February 2024. Of these reviews, 15 were negative about telephone and or appointments. The practice collected patient feedback using different methods, including the friends and family test. Between June 2023 and March 2024, 8889 patients had responded to the survey. Of those responding, 74% had commented that their overall experience was very good and 17% good. The practice had identified that when patient satisfaction was poor it was related to appointment availability and long waiting times, other people had expressed their dissatisfaction with getting a repeat prescription. The patient participation group (PPG) had carried out a survey in October 2023 which also identified areas for improvement including better telephone and appointment access. Patients we spoke with during this assessment told us that telephone and appointment access was not always easy and had always been a problem. The provider reviewed and responded to patient survey information and continued to make improvements to offer a more responsive service that met all patients’ needs.

Staff told us they understood the needs of its local population and had developed services in response to those needs. Patients could make appointments by telephone and by visiting the practice. The practice offered on the day and pre-bookable appointments and offered the choice of face to face or telephone appointments. The practice worked with local practices within their primary care network (PCN) to provide evening and weekend appointments. Patients had access to interpretation services. The practice was accessible to patients with mobility needs. Feedback from staff demonstrated people in vulnerable circumstances were able to register with the practice, including those with no fixed abode. Leaders demonstrated they were aware of the challenges to patient access and had acted to improve patient access. To improve access to the practice’s telephone lines, staff communicated with patients, shared results and links to information using text message. The practice had increased the number of receptionists available to answer the phone. The practice sent people links using text message so they could book their own appointment at a time that suited them for example for a blood test, a follow up appointment with the GP or for their mental health review appointment. Where appropriate, clinicians also had the ability to book follow up appointments, reducing the need for patients to contact the practice again. To improve availability and range of appointments, the practice offered appointments with a physiotherapist twice a week, a paramedic, pharmacists and a social prescriber. Further improvements were being discussed including the introduction of an electronic system to triage patient requests. At the time of the assessment, no final decision had been made.

The facilities and premises were appropriate for the services delivered. Reasonable adjustments were made so that people in vulnerable circumstances could access services. The practice had systems in place to monitor telephone and appointment access, including extended access appointments available through the PCN. The practice obtained feedback from a range of sources, including the GP patient survey, friends and family survey, PPG and complaints. This helped them identify further improvements. Leaders discussed information relating to access and patient satisfaction in business meetings. Feedback from a local care home, where residents were registered with this GP practice, was positive about the processes in place that allowed access to care and treatment in a timely manner. However, processes that promoted equity in access were not always effective or well embedded. For example, staff told us of incidents where new patient registration form papers had been misplaced and patients had to complete the forms again. These incidents had not been reported formally and registration processes had not been reviewed. Leaders told us they had developed processes to help non-clinical staff prioritise and respond to urgent patients and to support signposting; however, not all staff we spoke were aware of these processes. The processes for assigning appointments to the duty Dr and monitoring the appropriateness of these appointments required improvement. The system used to calculate capacity and demand was not effective. During the assessment, we reviewed the appointment system and found: There was little availability with the phlebotomist for 2 weeks and the next available appointment for a cytology (cervical cancer screening test) appointment was in 8 weeks’ time. This was after additional appointments had already been made available. The next children’s immunisations appointment was in 2 weeks’ time. There were no pre-bookable appointments with a GP for the next 6 weeks

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

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.