High Street 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 looked for evidence that the practice met people’s needs, and that staff treated people equally and without discrimination. At our last assessment, we rated this key question as requires improvement. At this assessment, the rating is good. This meant people’s needs were met through good organisation and delivery, although improvements needed to be sustained in order to demonstrate improved outcomes for people regarding access.

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.

The practice made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People who provided feedback had no specific views or concerns in this area. Care home representatives told us care and treatment was based on people’s individual needs and preferences. People and where appropriate, family members and carers were involved in care and treatment decisions.

The practice had arrangements in place to support person centred care. People were booked into appointments with their named GP for continuity. People who were due a long-term condition review could book their appointment online or by telephone on a date and time to suit them. Clinical staff told us during consultations they discussed relevant information, listened to people’s concerns and expectations, identified peoples’ needs and preferences and agreed a plan of care together which suited the person. We saw examples of care plans which had been adapted to the specific needs of people. Care plans reflected physical, mental, emotional, and social needs of patients including those related to protected characteristics under the Equality Act. Our review of clinical records showed patients were supported to understand their condition, were involved in decisions about their care and treatment and were involved in planning for their care needs.

The practice had a care coordinator who contacted people who were hard to reach, for example, people who had not responded to a long-term condition appointment invitation, or practice requests for monitoring of medicines. People were contacted by telephone initially, then by text message and then by letter. If no response was received these people were raised with a clinician so a clinical judgement could be made on the next steps.

The practice understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Systems were in place to support continuity of care. Arrangements were in place to ensure continuity of clinician for people who lived in a care home. Weekly visits and calls were made, and people were assessed and reviewed as appropriate. We received positive feedback from partners in relation to how practice staff engaged which included their work with care homes. People were registered with an allocated GP who took responsibility for their results, referrals, home visits and end of life care. Appointments were booked with the person’s GP if a GP appointment was necessary. The duty doctor covered this work when the person’s GP was not available.

Leaders had a good understanding of the needs of the local population and provided a range of services at the practice. For example, a physiotherapist was available at the practice 2 days a week and on 3 days at other practices in the primary care network. A care coordinator and a health and wellbeing coach were available every weekday at the practice.

The practice had an open culture and worked together with other services to meet the needs of people registered at the practice. There were established mechanisms for engaging with the community healthcare provider. Information was available on a range of services people could access or self-refer to, which included for example, carer support, sexual health, drug and alcohol and mental health services.

The practice supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

We did not receive any concerns from people regarding not being able to access appropriate, accurate and up-to-date information in a way that suited their needs.

Staff told us some information was available to people in different formats, and it would be highlighted on the person’s record if they had any communication or accessibility needs. Staff gave examples of information they had provided to people to aid their understanding of a specific clinical condition and treatment options. We saw information was available in a range of different language in the practice waiting room. In the nursing area of the practice, there were photos of staff and information about their areas of work. Information provided by the practice met the Accessible Information Standard.

Interpreter services were available for those people whose first language was not English, and for people with a hearing impairment and some staff spoke other languages. Staff told us they were aware of the arrangements in place to book an interpreter. A hearing loop was available.

The practice made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Most people who provided feedback had no specific views or concerns in this area. Care home representatives told us they were appropriately involved and were listened to when they gave feedback. A Patient Participation Group (PPG) representative described how practice leaders listened to and had acted on feedback shared. For example, improvements had been made to the telephone system, with people being able to request a call back rather than wait in the queue.

Complaints information was available in the practice and on the practice website. The practice had a GP lead for complaints. The practice manager advised reasonable adjustments were made for people to complain and offered to speak to any person who was not happy, to discuss their concerns. The practice had received 51 complaints in 2024, with themes regarding access and repeat prescription management. We reviewed a sample of complaints and found they had been managed in line with the practice’s policy. Complaints had been acknowledged, investigated in a timely way, people were given an apology and actions taken in response were shared. People were advised of the contact details of the Parliamentary Health Service Ombudsman if they wanted to escalate their complaint. Learning from complaints was evident and staff were able to identify changes made as a result of feedback from people, which included complaints. For example, the room where childhood immunisations were undertaken was changed so there was more space to accommodate people attending with a baby or child who used a buggy. The practice also had a ‘patient feedback action log’ where changes made following people’s feedback were recorded. The practice also recorded and reviewed compliments.

The practice did not always make sure that people could access the care, support and treatment they needed when they needed it.

The majority of the negative feedback we received from people was in relation to difficulty accessing an appointment and accessing the practice by telephone. We reviewed indictors in the National GP patient survey, published in July 2024 which related to access. The practice was below the England average for ease of contacting the practice by phone access (27.8%) and overall experience of contacting the practice (48%).

As part of the improvement action plan following their previous inspection, the practice had worked to improve access. This included for example, a new telephone system which enabled people to request a call back, so they did not have to wait on the line for the call to be answered. In addition, a full appointment review with a new rota was implemented which increased face to face appointments which included additional GP capacity. The practice had also reviewed the 2024 National GP patient survey data and had identified actions for further improvement. For example, they had successfully recruited a paramedic and all staff, including the deputy manager and practice manager dealt with telephone calls at peak times. However, these improvements needed to be sustained in order to demonstrate improved outcomes for people regarding access.

The practice minimised the number of staff who were off work at any one time and some staff were multi-skilled and worked flexibly in response to peak times of demand from people using the service, and to minimise the impact of unexpected staff absence. There was a system for appointment triage that ensured people with immediate needs had access to services. Call audits were completed with staff who answered phone calls for assurance, to encourage staff reflection, to identify areas of positive work and areas for improvement.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

We received no specific feedback from people regarding their experiences for this quality statement. Care home representatives told us people received weekly visits with continuity of staff which had improved outcomes for people.

Leaders sought ways to address any barriers to improving people’s experience and worked with local organisations, including within the voluntary sector, to address any local health inequalities. All staff had completed learning disability and autism awareness training. Staff understood the importance of providing an inclusive approach to care and made adjustments to support equity in people’s experience and outcomes. There were processes to ensure people could register at the practice, including those in vulnerable circumstances such as asylum seekers and refugees. Arrangements were in place to support homeless people and temporary residents to register. Staff treated people equally and without discrimination.

Arrangements were in place for care coordinators to engage with people who are more likely to experience inequalities in health and outcomes. This was usually by telephone with escalation arrangements to a GP if repeated contact attempts were unsuccessful. The practice complied with legal equality and human rights requirements, which included avoiding discrimination and having regard for the needs of people with different protected characteristics. The practice had information available in alternative formats and equipment in place to support people who had a hearing impairment.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We received no specific feedback from people regarding their experiences for this quality statement. Care home representatives were satisfied with the support from the practice for people to plan for their future and in meeting people’s end of life care needs.

The practice had systems in place to support people with palliative care needs and people at the end of their life. There was a multi-disciplinary approach to meetings where people were discussed and reviewed with actions documented, implemented and followed up. The practice also offered home visits where appropriate.

There were processes in place for ensuring people’s decisions in respect of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) were made in line with relevant legislation and were appropriate. We reviewed the records of 5 people, which included 3 people who had a DNACPR and 2 people who had a ReSPECT (Recommended Summary Plan for Emergency Care and Treatment). These had been completed appropriately following national guidelines. The practice had completed an DNACPR/ReSPECT form audit in January 2025. Recommendations had been identified to improve the consistent use of coding and ensure forms were reviewed annually or as people’s condition changed.