Ringmead Medical Group

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

During the assessment we reviewed evidence remotely, spoke with staff, completed remote clinical searches of the practice’s clinical system, and undertook observations while on site. We found the following: There was a complaints process, however, we found this did not always ensure that the entire complaint was addressed or that learning was taken from the complaint. This posed the risk the incident could be repeated. Results of the GP Patient Survey indicated the practice was below the national averages in all areas. We found the practice was aware of the results. Improvements had been made in response and audit and review had been used to monitor the effectiveness of the changes. The practice had identified groups of patients that may need additional support and shared evidence of the support offered to them. Staff we spoke with were aware of the support available. Data was used to understand the practices’ population and to project potential future demand. This information was used to inform decisions about planning and capacity and delivery of services. We received patient feedback that raised concerns about patients facing difficulties accessing care due to the increased use of technology. We found the practice was aware of the potential risk of inequalities and we confirmed patients could access services online, in person and via telephone and would be supported if they had specific needs. Patient feedback indicated there were delays obtaining repeat prescriptions, however, the practice shared evidence of steps they had taken to try to improve this process and patients’ experience. Feedback from the Patient Participation Group was that the practice listened to concerns and provided open and transparent responses. The practice supported patients and their families during end of life care. We saw evidence that staff were receiving training to help them support patients to plan their future.

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.

We received 35 pieces of feedback via our Give Feedback on Care process during the assessment period. Of this feedback 5 submissions referenced the fact the patient believed they had received good quality care which had supported them with their specific needs. However, 5 submissions provided negative feedback about patients’ personal experiences when receiving care and treatment from the practice. No themes or trends were evident. We also reviewed the relevant results of the GP Patient Survey and found 3 areas where the practices’ results were below the national average. 1 indicator recorded significant statistical negative variation and although 2 others were below, there was no variation

Through our discussions with staff and the evidence shared by the practice it was clear the practice understood how to support patients and had processes to identify patients that may be vulnerable or need additional support to help them plan their care. For example, patients with frailty, homeless patients, patients on the safeguarding register, pregnant women and patients with mental health needs. Our remote clinical searches identified 3 patient with a diagnosis of diabetes and we could not find evidence that they had been informed of the diagnosis. We highlighted this to the practice because it posed the risk that those patients would not be aware of deterioration in their condition and worsening symptoms. The practice explained their process for coding diagnosis in the patients’ record but accepted the feedback that there was a risk of patients being lost to follow-up.

Staff we spoke with all spoke of how they continually assessed the needs of patients and looked for opportunities to support patients’ preferences. As well as identifying veterans at registration, the practice told us that where appropriate, opportunistic opportunities were taken to identify patients’ health and care needs. For example, musculoskeletal or mental health concerns, could identify a patient was a veteran. The practice told us they had a high Nepalese population within the practice boundary and 1 of the GPs was of Nepali origin and took pride in serving this community. This included supporting the patients when there were language difficulties. Interpretation services were also available to patients.

We asked for feedback about the practice from partners, but they had no specific feedback to share about this area.

The practice received population data from the Integrated Care Board which was specific to their practice and Primary Care Network. The demographic data helped the practice to understand prevalent health conditions and community health trends within the local community and services could be planned as a result. For example, dementia screening, cancer screening campaigns and NHS health checks at the public library and fire station. An example of how the practices’ processes met the needs of the practice population was the accreditation as an Armed Forces Veterans Friendly Practice. At the point of registration, patients were asked if they were a veteran and when identified, their records were coded. The practice had a clinical lead for veteran’s health and details of the service and support the practice could offer was detailed on their website.

None of the feedback provided by patients directly to the Care Quality Commission during the assessment related to this quality statement. However, of the patient feedback shared by partners, 2 pieces of feedback referred to concerns about the use of digital services to access the practice. One piece of feedback was shared by a relative who was concerned for a patient that was not digitally confident. The other piece of feedback was shared directly by the patient themselves and shared concerns about how accessible the digital systems were and how their experience of using these had not been simple or effective for their needs.

Staff we spoke with knew of the interpretation and translation service available for patients. The practice explained flags were placed on patients’ records to alert all staff to their communication needs. An example provided was where a patient preferred the practice to send a text message requesting they call the practice rather than being called by the practice. During the assessment we confirmed with staff that patients could book appointments in person, online or via the telephone to support the rights and choices of all patients. Staff we spoke with also explained how they would send information via text message after a consultation, for example safety netting information.

We found the practice website could be translated into different languages. This option was on the front page of the website and easily accessible for patients. The practice had access to interpretation and translation services for patients with communication needs. The practice used easy-read letters, text messages and annotated invitations to support patients with their communication needs.

We spoke with a member of the patient participation group (PPG) to understand how the practice worked with the PPG. They told us they found the practice to be open and transparent with PPG and when feedback was provided, the practice listened, considered what could be done and always gave an explanation about what was or was not possible and the reasons for this. Of the 35 pieces of feedback we received via our Give Feedback on Care process, none related to patient’s experiences of making complaints or providing feedback. Five of the submissions detailed patients’ dissatisfaction with their own personal experience but they did not identify direct concerns with the complaints process. We reviewed the patient feedback provided by partners about their experience of the practice and found 1 patient had reported they felt the complaints process was not accessible for patients that were not digitally confident or enabled.

We spoke with the practice about the complaints process, and it was explained that after the merger the practice had received a lot of complaints. The practice had reviewed these and the complaints process and had created a new process which included providing feedback. The reason for doing this was because leadership felt that some complaints were feedback rather than formal complaints. The practice also noticed patients were providing positive feedback about certain staff and wanted to capture this and share it with the staff member. It was confirmed that if a patient was complaining formally, the complaints process would be followed. However, our review of a sample of complaints found this process was not effective at identifying all the learning contained in a complaint and addressing all the points raised. When we spoke with staff we were not assured they understood the process or the importance of using complaints to identify learning or of responding to the whole complaint.

The practice operated the NHS Friends and Family Test to gather feedback from patients. Evidence of the results between September to December 2023 was shared. This was used to identify trends and the practice had acted in response to make improvements which included recruitment of more staff in both clinical and non-clinical roles. The practice also shared other examples of feedback they had gathered from patients. However, although this showed free text responses had been captured, the data did not include analysis or any actions in response to the points raised to demonstrate changes or improvements that had been made. The practice monitored multiple sources of feedback which included the GP Patient Survey, the practice website and the NHS website and patient feedback forms. Oher sources were monitored as well. We reviewed the practice’s complaints process and found there was a complaints policy and a log to record complaints received. The practice website directed patients to contact the Practice manager for details about how to complain. We reviewed the practice’s complaints log and found 46 complaints had been made in the last 12 months. We reviewed a sample of 4 complaints and found in 2, the practice had not responded to all the elements of the complaint. This posed the risk that the complaint had not been fully investigated and the concern or incident that led to the complaint could be repeated. Overall we were not assured there was a fully embedded process to gather feedback from patients or that learning from complaints and concerns was always seen as an opportunity for improvement by the practice.

The responses we received via our Give Feedback on Care process about patients’ experiences of accessing the service were mixed. We received 11 pieces of positive feedback about access which included themes such as patients had been able to access appointments easily, patients had been triaged and allocated appointments quickly and the practice was responsive to needs for urgent care. We also received 6 pieces of negative feedback which related to access. The themes within the negative feedback included difficulties accessing the practice by telephone and delays in getting an appointment. We reviewed the NHS website and found the practice had received 3 reviews from patients. These had all been made in the 12 months preceding the assessment. One review gave the practice 1 star and both the remaining reviews gave the practice 5 stars. The negative feedback documented the patient had needed to wait over 2 weeks for an appointment, but the positive feedback reported the patient felt they had received prompt treatment and the other review did not specifically reference access to the practice. The results of the GP patient survey in relation to accessing the practice showed 1 indicator with significant negative variation when compared to the national average. 1 indicator showed data was trending towards negative variation and 2 indicators had not variation. However, all were below the national average. The indicator with significant variation related to how easy it was to get through to the practice on the telephone.

The practice provided information that in response to the results of the GP Patient Survey, telephone access was identified as a priority. The practice reported this was already a known issue before the results were issued. In response, the practice changed telephony systems to a cloud based system which included call back facilities and dedicated numbers for teams. The practice gave information that before the merger the call waiting time had been reduced to 6 minutes through the recruitment of additional staff in the patient services team, however the information provided did not include the starting point to demonstrate the full impact of the improvement achieved. The practice also explained they had changed to a new online consultation system. After changing, the practice identified the request form could be improved and worked with the supplier of the system to achieve this improvement. The practice shared they had surveyed patients on the improvement and 84% of the responses were good or very good. The practice told us of plans for the Patient Participation Group to operate a help desk within the practice which would help patients to navigate and access services and offer more opportunities to patients to provide feedback.

We found the practice had commissioned an external contractor to review the demand and capacity within the practice. This provided the practice with information about the most frequent types of conditions being treated and the types of demand the practice needed to meet. We saw evidence the practice reviewed existing processes, for example, the practice had reviewed how the consultation request system was used. In September 2022 when the new system was introduced there was an equal split between online and telephone requests. However, in March 2023 69% of requests were online versus 31% via telephone. The review also included the demand hour by hour. This helped the practice plan staffing and capacity. We also saw evidence that the practice had analysed demand pre- and post-merger with another practice. This showed that while the patient list had grown by almost 50% and the number of requests had increased, demand had not changed significantly by type of request or team requested. At the time of the assessment we found the practice had begun the NHS England General Practice Improvement Programme which would support the practice to identify areas where further improvements to access could be made. We saw evidence of a log of actions to implement changes into the practice.

We received 35 pieces of feedback from patients via our Give Feedback on Care process. None of the feedback received related to this quality statement. In the 12 months preceding the assessment we received feedback from a patient who expressed they had asked for all appointments to be face to face as a reasonable adjustment to support their needs. They told us that initially this had been refused but once they complained and explained their needs, the adjustments required were put in place. During the assessment our findings were that some patients were concerned about the need to travel to sites that were a long way from their home. The concern was due to length, complexity and the cost of travel.

We found examples of how the practice tailored supported for patients that may experience inequality in experience or outcomes. For example, the practice offered a bypass number to patients that were homeless to ensure they could easily access care and treatment. Our assessment confirmed that all patients could request appointments via their preferred method of consultation, for example, telephone, remote consultation, or face to face. The request could be made in person, via the telephone or online. This supported patients to achieve equal outcomes from care and treatment provided by the practice. Due to the concern we heard that patients were worried about needing to travel to a site a long way from their home, we asked the practice about this process. It was confirmed that patients could attend all the sites within the practice boundary, and this was to ensure they could receive care and treatment at the earliest opportunity because an appointment may be available sooner at a site further away from their home. However, if their preference was to wait for an appointment at a particular site or with a certain clinician, they could.

The practice provided evidence of how vulnerable patients or those that may require additional support were identified. This included several patient groups such as homeless patients, patients that did not speak English as a first language, patients on the safeguarding registers and other patient groups. The practice provided evidence of the number of patients in each group and the criteria used to identify the patients.

We asked the provider to share details of our Give Feedback on Care process on their website and although we received 35 pieces of feedback, none were specific to this area

We heard that a member of staff was receiving training to support them to have conversations with service users about planning for the future

We reviewed the practice’s end of life policy which detailed how the practice would support patients’ and their families at the end of their lives. The policy referenced guidance which was used within the practice and the policy and also confirmed the clinical assessment tools which should be used to identify patients that may be approaching the end of their lives. The policy explained the practice used templates to aid discussion with patients when making future plans. The policy also confirmed an end of life register was maintained by the practice. The practice offered patient and their families a bypass number to support them to access the service. Upon becoming aware that a patient had died the practice had clear process to follow which included contacting the bereaved family to offer support. We reviewed the practice’s skills matrix and found a member of staff was being trained in anticipatory care and 2 staff had completed training.