Holyhead Primary Healthcare Centre

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 all 7 quality statements under the responsive key question. We found that staff treated people equally and without discrimination. The provider complied with legal equality and human rights requirements. People were encouraged to give feedback which leaders used along with other evidence to improve access for people. Services were designed to make them accessible and timely for everyone. The provider prioritised and allocated resources and opportunities as needed to tackle inequalities and achieve equity of access however some people still had difficulty accessing services. People and communities were always at the centre of how care was planned and delivered. Care, support and treatment were easily accessible, including physical access. People could access care in ways that met their personal circumstances and protected equality characteristics. Patients, carers, and staff could easily access information and advice. There was partnership working to make sure that care and treatment met the diverse needs of communities.

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.

People received care and support that was co-ordinated, and everyone worked well together and with the patient. People were supported to plan ahead. Patients we spoke to did not express any concerns in this regard. Patients who responded to the 2024 National GP patient survey were asked if, after they had contacted the surgery, they knew what the next steps would be in dealing with their request and 81% said yes which is slightly below the national average of 83%.

Leaders and staff understood both the needs of the local population and the individual needs of their patients. They were able to demonstrate a thorough understanding of the practice demographics and the challenges they faced and planned services accordingly. Referral systems ensured patients received consistent, coordinated, person-centred care when they moved between services. All staff we spoke with endeavoured to provide high quality services that were centred on patient’s needs. Staff worked well together, with external organisation and with patients to ensure that care was coordinated and patient centred. Patients were supported to plan for important changes in their life that they could anticipate.

Staff told us they encouraged continuity in care and treatment wherever 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. We saw that there was effective teamworking and communication with members of the wider community multidisciplinary team for example with health visitors. The practice provided a range of basic health-checks and health promotion work in community settings.

Feedback received from partner organisations working with the practice to deliver care was positive. We found no concerns and the practice was able to provide examples of systems that facilitated work with multidisciplinary teams, the practice's PCN and the local ICB. We saw positive feedback from the PCN regarding the practice’s achievements with smoking cessation, safeguarding and learning disability health checks.

Patients could access extended opening hours on an evening and weekend and had access to out of hours services provided by Badger. Each GP had an allocation of follow-up appointments they could book if they felt this was needed to ensure continuity of care. All reception staff had training in how to appropriately signpost patients to other NHS services such as the Pharmacy First scheme (an NHS scheme where patients can consult with a community pharmacist for specific minor ailments). There were comprehensive processes in place to contact and encourage patients to attend national breast and bowel cancer screening programmes. Leaders used patient feedback and other data to help them monitor how responsive their service was and make further improvements as needed.

Patients were provided with timely, accurate and up-to-date information. Staff provided clear explanations about treatment and support available. Patients we spoke to found the on-site interpreters very useful. In the 2024 GP national survey 22% of patients said they were provided with information on how to manage their condition at home, the last time they saw their doctor. This was above the national average of 20%.

Leaders told us their community had large populations of Asian and Romanian people. The practice provided on-site interpreters to improve information sharing. The practice ran 3 separate language-based patient participation groups which also included a health education component and these were well attended. Of the staff we spoke to many were multilingual helping them to ensure that patients could access and understand their health information. Leaders had decided to move to 15-minute appointment slots because interpreters were so frequently involved in consultations. Staff had access to British Sign Language interpreters.

Information was accessible in a variety of ways, including electronically and on paper. Large print and easy-read versions of information were available on request. The waiting room displayed a lot of information relating to the surgery as well as community groups and services. We saw information on chaperoning, bereavement, mental health and carer support as well as national screening programmes, housing and immigration advice. Television screens within the waiting room provided a varied selection of health messaging. Posters in Romanian advertised the interpreter services. The practice leaflet and leaflets about cancer screening programmes were available in several languages. Carer information packs were available. Staff used the in-house interpreters on the phone when booking appointments or relaying information to patients verbally. The practice website provided links to a range of health and social care related topics such as diabetes management, domestic violence and talking therapies.

Feedback from patients and their carers was encouraged. Patients we spoke to reported that they had not needed to complain, but were confident their complaint would be investigated if they did. Information from CQC’s Feedback on Care forms we reviewed, showed that a patient who had complained was invited to a face-to-face meeting to discuss the issues and received an apology. The practice has PPG / PEG meetings 2 monthly (as they run 3 language-based groups). A representative of the PPG we spoke to said they were well attended, constructive and people's views were sought. The practice ran a monthly ‘afternoon tea’ event to encourage patients to visit the practice for social well-being but also as a chance for engagement and open conversation about the practice and its services. In the 2024 National GP patient survey 86% of respondents said their healthcare professional was good at listening to them, which was the same as the national average.

Leaders at the practice understood the diverse needs of their population and worked hard to capture the patient voice. They were able to demonstrate how they had used this information to help decide the future direction of services at the practice, for example they had recently employed a pharmacist partly because this was something patients said they wanted. The leadership team managed complaints in a sensitive, open and transparent way. They provided feedback to the complainant at the end of their investigation and were quick to offer an apology when it was necessary. Leaders met annually to review the complaints from the past 12 months and discuss any specific themes arising. This information was shared with staff.

The practice had a range of policies and procedures which allowed patients to provide feedback or complain if something was not right. Information on how to complain was on the website and displayed in the practice. The practice kept a log of complaints and their outcome, there had been 8 complaints between 1 April 2023 and 31 March 2024. Complaints we reviewed at random had been investigated and responded to in a prompt and appropriate manner.

Patient feedback about accessing the service was mixed. Patients we spoke with during the onsite visit reported they were able to access the practice in a variety of ways. Appointments could be booked by phone, on-line using the practice website or NHS app or in person. No one told us they had problems physically accessing the building. In the 2024 National GP patient survey 47% of patients who responded said they had used online services to book an appointment in the last 12 months. 55% of those that responded to the survey said that it was easy to contact their doctor using the NHS app. When asked how easy it was to contact the practice by phone, 56% of respondents said it was easy which was above the national average of 50%. Feedback CQC received through feedback on care forms indicated that people struggled to get an appointment. There were 7 reviews on the Birmingham Healthwatch website (since 01/04/2023 when the the current provider took over the practice) scoring an average of 4.14 stars. Where reviewers mentioned accessing appointments, there were 3 positive comments and 2 negative ones. The practice provided us with unverified data from their own patient survey of 984 patients between April and September 2024 which gave telephone access a rating of 3.71 out of 5 and 3.75 out of 5 for electronic access.

Leaders told us that although they felt access was reasonable at the practice in comparison with local and national data, work was ongoing to improve it. For example, they were doing engagement and education work to encourage patients to use the website or NHS app to book appointments. Reception staff told us they showed patients how to use the app and also how to change the language on the practice website. Leaders had access to live telephony data which helped them to manage peaks in demand. They had also begun collecting data from electronic booking requests. 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, a mental health nurse practitioner and social prescribers.

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. Appointments were available face to face, by telephone, video call or as a home visit. Reception staff had been trained to prioritise patients and we reviewed the supporting information with which they were provided to do this, which was clear and comprehensive. Clinical staff were always available if a receptionist needed further advice about how urgent the booking was. Some staff were trained in care navigation which enabled them to signpost to other services for example, Pharmacy First. The practice opening times were 8am to 6.30pm Monday to Friday. In addition, extended access appointments were available to 8pm Monday to Friday and on Saturday (provided by the PCN). Leaders had recently contracted an external company to undertake a capacity and demand assessment to better understand how their appointment system was working. This showed that 99.90% of appointments were booked. The average unmet need rate (appointments that were requested but not able to be booked due to lack of capacity) was 8.1% this equated to 155 appointments requested but not offered out of a total of 1914 appointments offered in a month. A random review of appointment availability when we visited the practice showed that an urgent GP or routine nurse appointment was available the following day, a routine doctor’s appointment was available within 2 days.

People told us they felt empowered by staff to give their views and felt the practice supported their rights to equality and human rights. People told us they felt any cases of discrimination or inequality would be listened to and acted on to improve care. None of the patients we spoke with raised concerns relating to equity in experiences or outcomes.

Leaders told us how they took a proactive approach to support those that may struggle to access appointments. Alerts were used on the clinical system to identify those who may need reasonable adjustments so that they could be accommodated. Staff demonstrated an awareness of patients who may be at risk of digital exclusion and took steps to support them. Leaders proactively sought ways to address any barriers to improving people’s experience and worked with local organisations, including within the voluntary sector such as Ygam (a gambling and gaming addiction service), to address any local health inequalities. Staff understood the importance of an inclusive approach to care provision to ensure equitable experiences for everyone. Staff shared examples where they had worked with patients who had complex needs, so they could be supported in a way that met their requirements.

Leaders and staff were alert to discrimination and inequality, whether from wider society, organisational processes and culture or from individuals that could disadvantage certain people or groups using their services. Staff at the practice complied with Human rights Act and Equality Act by avoiding discrimination and met the needs of those with protected characteristics The practice was a Safe Surgery. This meant the practice offered a welcoming space for everyone and they would ensure that a lack of identification, proof of address, or immigration status would not prevent patient registration. At the time of this assessment, the practice had registered 20 homeless people. They were a veteran friendly practice this meant that, as part of the health commitments of the Armed Forces Covenant, the practice had a dedicated clinician who had a specialist knowledge of military related health conditions and veteran specific health services. The practice was IRIS accredited. This is a specialist domestic violence and abuse training, support and referral programme for General Practice. Staff had attended in-house training and all staff had completed online Autism and Learning disability training.

We could not collect evidence from patient feedback to score this evidence category. Our observations raised no concerns. The evidence we did review did not show any concerns about people’s experience regarding planning for the future.

Staff and leaders understood the systems and processes to support patients requiring end of life care. They advised us that there was a register of patients and that multidisciplinary meetings were held with relevant healthcare professionals to ensure the best possible care was available.

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. As part of our assessment, we reviewed a random selection of 5 DNACPR decisions made within the last 12 months and saw that they were all detailed and comprehensive. We identified that decision forms had been retained and signed by an appropriate clinician. Care notes outlined how the decision had been discussed with patients, and how an assessment of the patient’s mental capacity had been undertaken.