The Village 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

There were processes in place to deliver care in a coordinated way which met people's needs. The practice listened to people's views and made improvements, for example, to the telephone system so that people were able to get through with minimal waiting times. There was a mix of face to face and telephone appointments with both urgent and pre-bookable slots available. There were arrangements in place to support people with additional needs. Policies were in place to support people near the end of their lives. However, we found systems could be improved to ensure due process was followed in relation to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) plans.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people we spoke with told us they were involved in their care. They told us their opinions were taken into account and they were asked for their views on the treatment plan. Most people told us it was a personalised experience and care was tailored to their needs. One comment had been posted on the NHS Choices webpage since our previous assessment. The person commented positively about a member of staff and how they went above and beyond to provide reassurance to a child during an appointment.

A member of staff shared an example of how they had supported a patient who attended for a long term condition review but shared other concerns, including choosing not to take their medicines, which was affecting their health. They provided time for the patient to discuss their concerns, sought advice from the GP, which results in a urgent referral to the appropriate health care team. They told us this patient had improved with the support provided.

A lead GP told us that the practice used special patient notes to communicate patient information with out of hours services. This supported the making of appropriate decisions regarding patient care and treatment. They told us that the home visiting team supported the practice in making home visits and visits to local care homes. Staff told us people were offered and could attend appointments at either site. They told us systems were in place to ensure people requiring regular monitoring for specific medicines were given their next appointment after each blood test. They carried out home visits for house bound patients requiring blood tests.

Care home staff told us the practice ensured continuity of care for people through the weekly visits by the same GP. Staff looking after people with a learning disability told us the practice staff were flexible and accommodated people’s needs and preferences when making appointments.

Processes were in place to deliver co-ordinated services. For example, multidisciplinary meetings to discuss the care and treatment for vulnerable patients and co-ordinated working with the home visiting team. Staff had received training in equality and diversity.

Data from the 2024 national GP patient survey (not verified by CQC) showed that the 94% of respondents felt the healthcare professional they saw had all the information they needed about them during their last general practice appointment, compared to a local and national average of 92%. 93% of respondents who stated that during their last GP appointment they were involved as much as they wanted to be in decisions about their care and treatment was good or very good at listening to them; this had improved from 68% in 2023. Some patients we spoke with during our on site assessment told us that test results were shared with them in a timely manner and if there was a problem the practice contacted the patient. One person told us that they felt staff were made aware of their hearing impairment as when clinicians spoke with her they spoke loudly and clearly so that she could hear and understand.

Staff told us they were able to access interpreters for patients whose first language was not English and British Sign Language users. They told they uses pictorial information to support and communicate with people with a learning disability. Staff made good use of specialist websites, for example Diabetes UK, for written information on understanding food labels. Staff told us they were able to access large print information for people as required.

There was a policy in place for recording, investigating and responding to complaints and patients had access to a complaints leaflet. The practice had identified complaints received often related to telephone access and the lack of doctors. The practice had recruited additional salaried doctors, enabling patients to have consistency with choice of doctor. The practice had introduced a new telephony system with a queueing and call back facility allowing patients to maintain their place in the queue. The system also provided data on call waiting and dropped calls. The practice told feedback from patients had been positive about these changes. We saw the complaints policy had been followed in the complaints we reviewed. Feedback and learning from complaints was shared with staff at team meeting.

The practice had analysed feedback from patients and identified that patients’ main concerns related to the need for more GPs, poor telephone access and the need for more available appointments. In response to this the practice recruited an additional 3 GPs, changed the telephone system and recruited more receptionists to answer the phones and extended the period of time patients could book appointments in advance. They shared these changes with patients though a You said, We Did board which was displayed at the entrance of the practice.

Leaders told us there was a lead within the practice who handled complaints received by the practice. There were time limits for responding to and investigating complaints and involving staff where required. Learning was shared with staff. The practice had identified that there was a trend in complaints regarding the attitude of some staff. In response to this, staff had been provided with additional training in customer service.

Minutes of meetings we reviewed showed that the practice worked with the Patient Participation Group (PPG) to listen to patients’ views and inform and involve them in decisions about the practice. For example, updates on staffing levels, support services and analysis of the national GP survey results. The practice had analysed the previous year’s National GP survey results and identified 3 areas they need to improve on. This included satisfaction with appointment times, ability to speak with a preferred GP and overall experience of the practice. They carried out their own survey based on these 3 areas and unverified data showed that most patients were now satisfied in these 3 areas following changes made by the practice. The practice had also gathered patient feedback through the Friends and Family test. In June 2024, 68 of the 75 comments received were positive.

Most people we spoke with told us that phone wait times had improved but there were reports of it being variable day-to-day. People told us they had good access to appointments, including those needing additional appointments for further tests. Data from the 2024 national GP patient survey (not verified by CQC) showed 58% of respondents responded positively to how easy it was to get through to someone at their GP practice on the phone. This was above the local average of 45% and national average of 50%. However, this had improved slightly from 54% in 2023. Data provided by the Integrated Care Board (ICB) showed that the rate of appointments per 1,000 patients was 397 which was lower than the local average of 506 and the national average of 476. The percentage of patients seen within 14 days of booking was 68% which was lower than the local average of 85% and the national average of 88%. However, 50% of patients saw a GP in comparison with the local average of 44% and the national average of 46%. The percentage of face to face appointments was 96% compared with the local average of 71% and the national average of 65%.

Leaders told us that the average waiting time to see a GP was 2 to 3 weeks however, protected appointments for more urgent issues were available to meet the needs of patients. A telephone triage system was provided by the on-call duty GP that ensured patients were seen within a timely manner dependent on need. Management told us they had recruited additional GPs and a second health care assistant who is able to take blood for blood tests to improve access to appointments. A new cloud-based phone system had been put in place which also offers a call back service. Practice nurses offered appointments from 8am until 6.15pm to support working aged patients to access services and there were extended access appointments 3 days a week between 6.30-8pm. There were systems in place to support patients of no fixed abode and migrants register with the practice. Receptionists we spoke with told us there were pre-bookable and on the day appointments. They told us most appointments were face to face however, if a patient requested a telephone appointment this was accommodated. They told us that most days they had enough appointments to meet the needs of patients. The receptionists checked the appointments system on the day of our onsite assessment and found that the next available pre-bookable GP appointment was 15 August 2024 however, the duty GP could add additional appointments if required. The next available practice nurse appointment was the next day. Requests for home visits were triaged and prioritised by the duty GP.

A policy was in place to support staff in the management of appointments. Patients could access appointments either by telephoning the practice or calling in person. Online services were suspended due to the different types of appointments available and issues with patients selecting incorrect appointment types. Appointments with GPs, nurses and health care support workers were available to book in advance or for more urgent issues they could be booked on the day. Consultations were either face to face or over the telephone, dependent of patient choice. Patients wishing to access services online completed a request form and were provided with a user name and password to access the system.

Data from the 2024 national GP patient survey (unverified by CQC) showed 71% of respondents describe their overall experience of this GP practice as good, compared to a local and national survey of 74%. We received 1 patient comment from Healthwatch regarding their experience. They told us that a receptionist had laughed at them and read out information from their records that other patients overheard.

A lead GP told us that patient experience had been enhanced by the recruitment of additional salaried GPs. They told us that patients with a disability, for example a visual impairment, had alerts added to their records to make staff aware of their needs so they could make reasonable adjustments to support them. They told us they had access to interpreters for patients whose first language was not English or for patients with a hearing impairment. Patients with a learning disability were offered double appointments to provide additional time to discuss their needs. An advanced nurse practitioner told us that there were systems in place to support patients with additional needs to access the service and understand their treatment and care options. For example, alerts were added to the records of patients with a disability to make alert staff of any support the patient may require. Alerts were also added to the records of patients whose first language was not English and the practice had access to interpreters to support this group of patients.

There were processes in place to support patients whose first language was not English. The practice had access to an interpretation service both for face to face and telephone consultations. They also had access to British Sing Language interpreters for patients with impaired hearing. Double appointments were provided when an interpreter was required and alerts were added to their records to make staff aware of these needs. Patients with a visual impairment could be provided with large print documents. There was easy read material for patients with a learning disability.

We reviewed the records of 5 patients who had a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) plan in place when we carried out our remote searches. A copy of the DNACPR plan was not available in 4 of the 5 records. A DNACPR plan was available in 1 record. However, it was not clear from the plan if a discussion had been held with the person or their representative to discuss the decision to put a plan in place.

We discussed with a lead GP the issue that DNACPR plans were not available in 4 of the 5 records we reviewed where it was coded a plan had been put in place. They told us that when the plans were put in place by the hospital and that they had not been sent a copy. They told us that the patients kept the original plan in the place where they lived. This meant that the practice did not have details of why the plans had been put in place and who had been involved in the decision. They could not be reassured that due process had been followed or that the patient was aware of this decision or continued to agree with the decision made.

A policy was in place to support staff in the management of care for patients near the end of their lives. This included the management of DNACPR plans and Recommended Summary Plans for Emergency Care and Treatment. There was a nominated GP lead within the practice for end of life care. We reviewed the minutes from the multidisciplinary palliative care clinical meetings. We found that systems were discussed to improve outcomes for patients. For example, a review of the provision of medicines for pain for patients nearing the end of their lives and changes to care and treatment provided to this group of patients.