Danbury Medical Centre

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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 5 quality statements from this key question. We have combined the score for this area with scores based on the rating from the last inspection, which was requires improvement. Our rating for this key question remains requires improvement. We found that patients were not able to effectively access the practice to ensure their health and treatment needs were met. The practice were aware of this and had taken steps to address it, however this had not had time to embed and demonstrate sustained improvement.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The national GP patient survey carried out from January to March 2024 found patients were concerned about access to the practice. The practice had recognised this and was looking at solutions to improve. CQC received 8 complaints in the last 6 months. Access to appointments was indicated in 5 of these. The practice submitted their friends and family test responses for April 2024. Out of 820 patient’s responses 755 stated their experience of the practice was either very good or good.

Leaders told us that there were aware that access to the practice was a key issue and had taken action to start to address this. Each specialist area within the practice now had its own manager helping to ensure specialist knowledge with meetings held to share this. Leaders told us they worked with the Integrated Care System to inform and plan delivery of care appropriate to local health provision.

Leaders and staff told us they tailored care and treatment to the health and social care needs of the local community. They participated in and developed health inequalities projects. Leaders also told us they had initiated a fast track dementia diagnosis process and utilised a complex care team to support the most vulnerable patients.

Partner services were contacted for feedback regarding the practice. The Integrated Care System told us there had been a number of complaints regarding access to the practice approximately 6 months ago but nothing further. Healthwatch had received 1 piece of feedback regarding the practice. The practice supported one care home for older people, the manager confirmed that staff attended the home weekly, responded promptly to their requests, and they had good lines of communication with the practice. An external stakeholder for the area had raised a number of concerns regarding patient access to and satisfaction with the practice.

Leaders told us they had regular multi-disciplinary meetings to review their most vulnerable patients. Flags or alerts were used to identify those people who had a learning disability and/or were autistic to enable a longer appointment where required. Staff referred to the complex care team as a source of support regarding non-attendance for childhood immunisations. Leaders told us that all staff had completed dementia training to support their dementia diagnosis pathway. Training in learning disability and autism had been undertaken by some of the staff team and training for other staff was planned. Leaders told us they had taken action to improve access to the practice including the separation of routine and urgent appointments; introduced the use of a form-based online consultation process for contacting the practice to make a routine appointment with the intention of making the phoneline more accessible for urgent appointments; established a duty hub of allied healthcare professionals overseen by a duty doctor to triage appointments and determine timescales for appointments.

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

78% of respondents to the GPPS stated the healthcare professional they saw at the practice was good at listening to them. In complaints received to CQC, some people who use the service told us that their concerns and complaints were not always acknowledged or responded to. Friends and family feedback for April 2024 was mainly positive about the practice.

Leaders told us a new complaints manager had been recruited in May 2024. We found responses to complaints did not contain advice for patients to escalate their concerns. The practice took action to address this during the assessment. Staff told us they were not aware of learning from complaints, however, new governance structures had been introduced, where complaints and learning were identified as agenda items.

There were processes for people to feedback on the service and care they received. For example, patients could raise a complaint or leave a score/comment on friends and family. We reviewed complaint records for May 2024 and found that the majority of these had been updated in a timely and appropriate manner. There was no established method to disseminate learning from complaints, however, the practice had recently recruited a designated complaints manager and the newly established patient safety meetings included an agenda item on learning from complaints. The practice had a patient participation group which was also attended by a partner and the practice manager. Minutes reviewed showed a discussion of the new appointment system. The practice had a whistleblowing policy which did not have a review date. This did not include details of the freedom to speak up guardian, as required.

Patients were not satisfied with the arrangement for getting through to the practice by phone or with their experience of obtaining an appointment. This was reflected in complaints made to CQC. The national GP patient survey carried out from January to March 2024 found patients were concerned about access to the practice. 21% of respondents stated it was easy to access the practice by telephone. This was an upward trend as in 2023 only 13% of respondents were positive. 24% of respondents found it easy to contact the practice via their website, compared to the England average of 48%. 20% of respondents found it easy to access the practice via the NHS app, compared to an England average of 45%. 49% of respondents were satisfied with the overall experience of the practice. Compared to the England average of 74%.

Leaders told us they had to recognise that they had significant access difficulties across all sites and patients could not always get an appointment. They have been taking action to address access concerns since 2023. They recently introduced an online consultation system to address access offering both telephone and face to face appointments. All on the day appointment requests were sent to the duty hub where they were triaged by allied healthcare professionals under supervision of a duty doctor. This was for all 3 sites run by this provider. Routine appointments could be booked via the online consultation process. For patients who were not able to use technology, the reception team would complete the online form for them over the phone. 140 online consultation forms were available each day and once these are completed patients had to wait until the following day. Leaders told us they want the system to be open when the practices are open but currently there is a cap due to capacity. The actions taken help the practice know how many GP appointments they need each week and when they need locum support.

During the assessment process, the provider highlighted the actions they have taken to make improvements to the responsiveness of the service for their patient population. This included the introduction of an online consultation system for routine appointments. The practice had a clinician led triage system which was accessible to other staff for advice on the day. The new systems had not had sufficient time to embed. The website had clear information for patients about how to book an appointment. Leaders told us, a review of telephone calls into the practice found that in January 2023 there were 15711 calls into the practice, not including abandoned calls, with 11750 of these calls answered which was 74%. In January 2024, the call volume had decreased to 11140 excluding abandoned calls and 9129 of these were answered, which translates to 81%. Leaders also told us the call waiting time had decreased from 11 mins 25 seconds in January 2023 to 3 minutes 2 seconds in January 2024. The practice offered extended hours appointments. Text and telephone call reminders were sent to patients to reduce non-attendance rates and arrangements were in place for prioritising patients.

People reported dissatisfaction with the experience of making an appointment via the telephone. However, the practice had introduced a new appointment system intended to increase accessibility for all patients, including those that were not able to use technology. The new system had not had a sufficient period to embed for patient feedback to reflect whether there were significant improvements, however access by phone had improved in the GPPS by 8% in a 12 month period.

Leaders told us they had participated in the Integrated Care System led inequalities project and had established a process for allied healthcare professional to support the uptake of reviews for people with serious mental illness. Staff had completed training in dementia care and considered how they provided support and treatment to meet patient needs.

The practice had proactively sought out ways to address barriers to patient’s accessing care and treatment and had acted on information about people's experiences and outcomes to help achieve equity. For example, they had implemented a dementia care pathway to reduce waiting times for diagnosis, had an inhouse complex needs team comprised of a number of healthcare professionals and overseen by the safeguarding lead, to identify and support vulnerable patients. The practice had a human rights and equality policy last reviewed 29 January 2024 which detailed how they would approach their commitment to protect the human rights of patients. The practice has an accessible information standard policy last reviewed 11 April 2024. There were alerts on the practice system to indicate if a patient had a recorded communication need and longer appointments were available where required, as well as appointments at quieter times of the day.

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.