Tieve Tara Medical Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At the inspection in July 2023, the practice was rated requires improvement in the key question effective. Concerns included missed diagnosis of chronic kidney disease, patients with pre-existing conditions not being managed in line with evidence-based guidance, and some cancer screening outcomes being below national targets. At this assessment we found that overall, the practice provided effective care and treatment. A review of potential missed diagnosis of chronic kidney disease showed that patients were effectively managed. In addition, we found that the management of patients with some long-term conditions was appropriate. However, some patients diagnosed with hypothyroidism or asthma had not had the required monitoring or review. Breast cancer and cervical cancer screening outcomes remained below national targets despite efforts from the practice to encourage uptake. Staff had access to training and learning opportunities to support them in their role. The practice engaged with other services and supported patients to manage their health and wellbeing. Processes were in place to support patients to make informed decisions about their future, and to review patients at the end of their lives.

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.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. There was no feedback to indicate concern in this area.

We spoke with members of the management team who explained how patients requiring monitoring were supported and managed. This included inviting for annual health reviews and monitoring checks.

There was a care navigation process in place and staff received training for this. Patient’s accessibility and communication needs were taken into account and they were supported accordingly. Staff could refer people with specific needs, such as those experiencing poor mental health, to a social prescriber. The practice had a palliative care register with 36 patients and these patients were reviewed in monthly palliative care meetings and supported to make informed decisions about their future. There were dedicated staff to oversee and support at risk patients, including care home patients. A review of clinical records showed that the management of patients with some long-term conditions including chronic kidney disease (CKD) and diabetic retinopathy was effectively managed. However, we saw that 3 of 197 patients diagnosed with hypothyroidism had not had the required monitoring in the last 18 months. In addition, a review of patients on the practice’s asthma register identified that steroid card usage and bone protection assessments had not been carried out where appropriate. Furthermore, we reviewed potential missed diagnosis of CKD stage 3-5. For the 4 patients identified and reviewed, no significant issues were found.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. There was no feedback to indicate concern in this area.

Clinical staff told us they followed best practice guidance when carrying out their work. They also told us they had access to training and learning opportunities and were supported with their professional development.

The practice had systems and processes in place to keep clinical staff up to date with current evidence-based practice. We saw several examples of this, including staff undertaking apprenticeships and attending specialist training such as for spirometry. However, as part of our clinical searches we reviewed 4 patients prescribed methotrexate (a disease-modifying anti-rheumatic drug) and found that prescriptions did not specify the day of the week the medication was to be taken, in line with Medicines and Healthcare products Regulatory Agency (MHRA) guidance.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. There was no feedback to indicate concern in this area.

Staff and leaders told us how they managed information sharing with other providers, including out of hours teams. They also told us how they regularly engaged with members of the primary care network.

As part of the assessment process, we asked the NHS West Yorkshire Integrated Care Board to share their experience of the service. There was no feedback to indicate concern in this area.

Managers attended monthly meetings with members of the primary care network. Staff also attended diabetes peer support network meetings and a general practice improvement programme support meeting, to drive improvement within the practice.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. There was no feedback to indicate concern in this area

Staff told us about the ways in which they supported patients to manage their health and wellbeing, and to live healthier lives. This included referral to social prescribers and encouraging patients to attend health checks and reviews. Leaders were aware that the uptake rate for cervical screening was lower than local and national averages and were taking steps to improve this.

There were processes in place to invite patients for relevant health checks. In the last 12 months 258 patients were eligible for an NHS health check. Of these, 67 had been completed and 3 patients had declined. There were also systems in place to identify patients in need of extra support, for example those with a learning disability. The practice had 50 patients on their learning disability register. Of these, 29 had received a health check in the last 12 months, and 6 patients had declined. The practice had also identified 198 patients as carers. In-house social prescribers signposted patients to relevant services to support and improve their health and wellbeing. Information to support patients was also available on the practice website.

The GP Patient Survey for 2024 showed that 56% of patients felt they had enough support from local services or organisations to manage long-term conditions, compared to the national average of 68%.

Staff we spoke with could clearly outline the systems in place to recall and review patients and understood their role in this process. The practice told us they had plans to hold designated cervical screening clinics on Saturdays.

Our review of clinical records showed that patients with long-term conditions were largely well managed. The practice took steps to encourage patients to attend for cervical screening and childhood immunisations, for example by offering weekend appointments and information in other languages. Appropriate registers were held to ensure effective monitoring of specific groups such as those on palliative care.

The practice’s cervical screening uptake rate at June 2023 was at 70%, which was below the 80% national target. The practice had met the World Health Organisation (WHO) recommended uptake rate of 95% for all routine childhood vaccinations.

As part of the assessment process, we asked the practice to invite patients to share their experience of the service. There was no feedback to indicate concern in this area.

Staff told us how they dealt with consent and how they helped patients make decisions about their care, including the use of relevant guidelines and recording consent. Staff also told us how they worked with patients, and their carers, to support them to understand their options regarding Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) decisions.

There was a consent policy in place which covered areas such as capacity and the Accessible Information Standard. Carers and advocates were involved in consultation processes where required. Processes were in place to support patients to make informed decisions about their future, and to review patients at the end of their lives. We saw that DNACPR and Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms were completed in line with guidance and with the input of patients, and when necessary, their carers.