Werrington Village Surgery

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• 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

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. However, our remote searches identified a lack of oversight of some long-term condition management to ensure evidence-based care and treatment was given to patients within appropriate timeframes. Staff worked with other services to achieve this. However, there were gaps in their administration around responding to alerts. At our last assessment, we rated this key question as Good. At this assessment, the rating remains the same.

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 service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs.

Reception staff were aware of the needs of the local community. Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff checked people’s health, care, and wellbeing needs during health reviews. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The provider had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The provider assessed the needs of its patients and offered health and care in line with these.

We did not receive any feedback about people’s experiences in relation to this quality statement. The GP patient survey demonstrated that 87% of patients felt they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment and 90% had confidence and trust in the healthcare professional they saw or spoke to during their last general practice appointment.

Staff told us they were provided opportunities to keep up to date with current guidelines and changes to evidence-based care and treatment. However, our remote searches identified a lack of oversight of some long-term condition management to ensure evidence-based care and treatment was given to patients within appropriate timeframes.

The remote searches undertaken of the practice’s clinical patient records system identified monitoring of patients with some long-term conditions were not always followed in line with current legislation, standards and evidence-based guidance including from the National Institute for Health and Care Excellence (NICE), referred to as NICE guidance. For example, searches identified 50 patients as having a potential missed diagnosis of chronic kidney disease 3, 4 or 5. We reviewed 5 of these patients and found 1 appeared to have had a missed diagnosis and had not been followed up. Searches also identified 634 patients were on the asthma register, of the 634, 49 patients (7.7%) had been prescribed 2 or more courses of rescue steroids in the last 12 months. We reviewed 5 of these patients in detail and identified 4 had not been followed up to check their response to treatment following exacerbation of their asthma within a week (as required by NICE guidance) and three had not had an annual asthma review in the last 12 months.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.

Partners had oversight of the clinical workload and ensured there was a duty doctor available to support other clinicians throughout surgery opening hours.

Processes were in place to ensure staff and services worked together. For example, there were systems and processes in place to enable information to be shared between the provider and services to ensure continuity of care.

We received no specific feedback from patients regarding their experiences of how staff supported people to live healthier lives. Patients had access to health promotion and education to support them to live healthier lives. This was provided in various formats such as screening and vaccination programmes as well as during face-to-face consultations. NHS health checks were offered to patients over 40. Eligible patients had access to community pharmacy services as well as self-help groups/advocacy services.

Staff focused on identifying risks to patients’ health, including those in the last 12 months of their lives, patients at risk of developing a long-term condition and those with caring responsibilities. Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.

The practice had systems in place that enabled staff to signpost and support people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support. The practice patients were signposted to community services as well as self-help groups and advocacy services.

We received no specific feedback from patients regarding their experiences of how the practice monitored and improved outcomes. However, The GP patient survey demonstrated that 76% of patients said they have had enough support from local services or organisations in the last 12 months to help manage their long-term condition(s).

Clinicians could demonstrate how they identified patients with commonly undiagnosed conditions, for example diabetes, chronic obstructive pulmonary disease (COPD), atrial fibrillation and hypertension.

The practice had systems to ensure that those patients requiring medicine reviews and ongoing monitoring were being reviewed and recalled. However, we found these processes were not always effective and some patients had not always received timely review of their care and treatment including monitoring of their medicines when needed. The practice responded promptly to our feedback and took action to strengthen processes further.

The practice had systems to ensure that those patients requiring medicine reviews and ongoing monitoring were being reviewed and recalled. We were able to evidence that clinical audits were being carried out to monitor and improve outcomes for patients. Data we reviewed showed that of patients eligible for cervical cancer screening who were screened adequately was 77.7%, which was just below the target of 80%. The practice had met the 90% target for childhood immunisations, achieving 95%.

We received no specific feedback from patients regarding their experiences of their consent to care and treatment practice. However, The GP survey demonstrated that 87% of patients were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment.

Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.

Relevant staff had been provided with training in the Mental Capacity Act. Where patients had specific communication needs, arrangements were then made for appropriate support such as interpreting services or written information in a format accessible to the patient. The practice had a chaperone policy in place and patients were offered a chaperone when carrying out examinations.