Wellington Medical Practice

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question as requires improvement. At this assessment the rating has changed to good. We found improvements in their systems for identifying patients with long term conditions and we found that patients' treatment and care were monitored to ensure they received effective care. Childhood immunisation and cervical cytology uptake was below national averages. The practice had implemented action plans to improve screening uptake and childhood immunisations. Systems were in place to monitor and manage completed Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form information. Some forms, not completed by the practice clinical staff, lacked detail and required a review. Practice leaders agreed to audit and review the ReSPECT forms held and action where appropriate.

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.

The latest GP National Patient Survey data showed that 79% of respondents felt they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment compared to local and national average of 91%.

Leaders told us they had a system for the management and assessment of patients with long-term conditions. Patients were called for an assessment in their birth month and monthly searches were undertaken by a dedicated team of staff to monitor this. Staff told us there were systems in place to support and assess patients experiencing poor mental health. Staff told us digital flags were used on patient clinical records to highlight patients who required extra support and those with specific individual needs. Communication needs were assessed, and information requested and electronically documented at the point of the patient registering at the practice. Should the patients’ communication needs change these were updated. There was an interpretation service that staff told us they could access.

Clinical staff used electronic templates when conducting care reviews to support the review of people’s wider health and wellbeing. There were systems in place to identify people with previously undiagnosed conditions. The practice identified patients living with moderate or severe frailty. They maintained registers of vulnerable patients including, adult safeguarding, learning disability and autism, palliative care and severe mental health. Practice electronic register audits were maintained in order to monitor, review and improve care and treatment. Pathology and results pathways were established with guidance in place for staff.

We did not receive any feedback about people’s experiences in relation to this quality statement.

Leaders and staff told us the service followed best practice guidance and standards. They told us that evidence based clinical templates were updated regularly to support the care and treatment of patients. Staff told us there was a range of systems, meetings and training events in place to keep them up to date. This informed their clinical practice to ensure that care and treatment was delivered following evidence-based guidelines.

Audits were completed to improve the effectiveness of the service provided to patients. The practice reviewed and maintained its processes to ensure there was no discrimination when making care and treatment decisions. Systems were in place to act upon Medicines and Healthcare products Regulatory Agency (MHRA) alerts and other safety alerts. However, we found further action was required in respect of patients on a medicine used to treat epilepsy in those of childbearing age. Leaders agreed to action these findings.

We did not receive any feedback about people’s experiences in relation to this quality statement.

Staff told us that receptionists were provided with standard operating procedures to support them to signpost patients to the most appropriate clinician. There were clear guidelines for the types of ailments the advanced care practitioners could and could not see to ensure they worked within their scope of practice.

We received no specific information from partners relating to this quality statement.

The practice was part of a primary care network (PCN) of practices who shared staff and services for the benefit of patients. Two of the partners were clinical directors for this PCN. There were processes in place to work effectively across teams and services to support patients. The practice also worked with other professionals that offered services such as social care, physiotherapy, occupational therapy and mental health support. Referral policy and procedures were in place, which included information on shared care arrangements. We saw evidence that a daily check was undertaken of the urgent suspected cancer 2 referrals to ensure all referrals had been made and followed up as required. There was a range of policies and processes in place to reduce the risk of discrimination when making care and treatment decisions.

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 available within the practice and the practice website. This was provided in various formats such as screening and vaccination programmes as well as during face-to-face consultations.

Leaders and staff told us they had plans in place to raise the importance of childhood immunisation and cervical screening within their local communities. Staff told us that they used medicine searches and quality improvement benchmarks to promote health improvements. They signposted patients to services within the community, such as weight loss and smoking cessation programmes.

There were systems in place to support patients to live healthier lives. The practice had systems in place that enabled staff to signpost patients to tertiary services and carer groups support. Patients were also signposted to community services as well as self-help groups and advocacy services.

We received no specific information from patients relating to this quality statement.

Clinicians could demonstrate how they identified patients with commonly undiagnosed conditions, for example diabetes, chronic obstructive pulmonary disease (COPD), atrial fibrillation and hypertension. Leaders and staff told us the lower uptake of cervical screening had been discussed and action plans implemented.

The practice had completed several clinical audits and had taken action to improve outcomes for patients. There was a structured system in place for inviting patients for their long-term condition annual reviews.

During our clinical searches, we found that patients' treatment and care were monitored to ensure they received effective care. Since the last assessment, the practice had strengthened their systems. For example, patients with a potential diagnosis of diabetes had received care and treatment. Our clinical searches found patients with a potential diagnosis of diabetes had received care and treatment in line with best practice guidance. The practice had implemented action plans to improve screening uptake and childhood immunisations.

We received no specific feedback from patients regarding their experiences of their consent to care and treatment practice.

Leaders told us they documented consent within the patient records, and this was included within some of clinical electronic templates. All staff had received training in learning disability and autism which further informed their understanding and 2 staff had completed enhanced training in this area. Staff spoken with had a clear understanding of mental capacity, and consent and told us they had access to policies and procedures to support best practice.

There were policies in place to support staff when obtaining consent from adults, children and patients that lacked mental capacity. The practice maintained a consent policy. There were systems in place to monitor and manage completed ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) forms. We saw evidence within ReSPECTs forms completed by the practice that discussions, decisions and preferences regarding advanced end of life had been recorded including patients, families and multi-disciplinary outcomes. However, some ReSPECT forms that had been completed externally, lacked detail and required a review. Following our feedback leaders agreed to audit and review the ReSPECT forms held and action where appropriate.