Sunnybank Medical Centre Also known as Affinity Care

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

Overall, we found that the practice provided effective care and treatment. Following the last inspection of the service in December 2022 the provider was found requires improvement for effective care and treatment. Issues identified included concerns related to the review and management of patients with long-term conditions, lapses in staff appraisals and assessments, and low cervical screening performance. At this assessment we saw that steps had been taken to tackle these previous areas of concern. Long-term condition review and management processes had improved, staff appraisals had been regularly undertaken, and whilst cervical screening performance was similar to 2022 performance, we saw that measures such as increasing access opportunities to screening had been put in place.

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.

Patient feedback from the 2024 National GP Patient Survey indicated that patient satisfaction with how the practice worked with them to assess their needs was generally in line with local and national averages. For example, 88% of respondents reported that the healthcare professional they saw or spoke to was good at listening to them at their last general practice appointment compared to the local average of 86% and the national average of 87%. We heard from a patient who told us that they had their health needs met by the provider, and had been regularly called for reviews. They told us that they felt listened to and had never been rushed through a consultation.

Leaders, managers and staff told us that processes were in place to assess patient needs and used this to plan for their care and treatment. For example, they explained to us their processes for calling in patients who required specific monitoring if they were in receipt of high-risk medications. Staff told us that they had access to assessment tools, such as those for dementia and frailty. When we spoke with staff, they confirmed to us they were aware of how to deal with and escalate actions to support deteriorating patients. Actions included calling the available duty doctor. Clinicians told us that they had the equipment required to effectively monitor and assess a patient’s health needs, and this had been regularly serviced and calibrated when required.

The provider had processes and systems in place to assess patient needs. This included the use of care navigation by non-clinical staff, and the initial triage of patients when contacting for appointments. Clinical staff had access to assessment tools including those for long-term conditions and mental health conditions. To support patients who had greater needs the provider had developed complex care health teams which supported housebound and/or otherwise vulnerable patients. This included patients who were approaching end of life, or patients accommodated in residential care settings. These teams supported the delivery of ongoing and anticipatory care, and included planned reviews and monitoring, as well as direct care and treatment of acute needs. Patients that had additional requirements had these identified on their patient record. In addition to this, the provider held registers of patients with specific needs and used this for care planning. This included palliative care, learning disability patients, and those who were carers. For example, Sunnybank Medical Centre had identified 903 patients (around 6% of the practice population) as carers, and was able to use this to target additional support. The provider had systems to record and manage advanced care planning and end of life decisions, and we saw during our remote searches that Recommended Summary Plan for Emergency Care Treatment (ReSPECT) documentation had been completed in line with requirements.

We did not receive any feedback and saw no indication of any concern in this area.

Leaders told us that processes were in place which kept clinicians up to date with current evidence-based practice. Clinical leads within the Quality and Safety Group reviewed new NICE guidance. This was then cascaded by email to all clinicians and discussed at regular protected learning time sessions. We saw evidence that updates and changes to guidance were standing items for discussion. Personal staff development was also encouraged, and staff we spoke with told us they had access to learning opportunities which sought to improve patient care, and they also told us that they were able to raise requests to attend additional training directly with the provider. The provider told us that they used audits and checks made during clinical supervision to assess that care had been delivered in line with required standards.

The provider had systems and processes in place which kept clinicians up to date with current evidence-based practice. This included the review of updated or new published guidance, and the dissemination of this to staff either directly or at meetings and protected learning time events. We saw that clinical supervision and audit was used to assess compliance with standards, and when identified to drive improvement. Our review of the remote clinical searches of patient records showed that overall patients were effectively and safely managed in line with guidance. However, it was noted that patients who had experienced an exacerbation of asthma had not been followed up by the provider within 1 week of this happening as required by national guidance. After the inspection we were informed by the provider that they had updated their operating protocol to ensure that follow up contact was made with patients. In addition, we found that 1 patient had a missed diagnosis of diabetes and had not been suitably identified or followed up by the provider. After we discussed this with them, the provider examined this in further detail and informed us that assurance processes were now in place which ensured those now diagnosed as diabetic would be properly monitored and supported. Staff appraisals included discussions around training and update training needs. We saw that appraisals were up to date for staff at both sites.

We received positive feedback from a member of the patient participation group regarding how the practice engaged with them and kept them informed about their own care and treatment, and developments regarding the practice.

Feedback we received from leaders, managers and staff informed us of externally delivered services the practice worked in collaboration with. This included community and secondary care services, mental health services, social care, and voluntary sector organisations. For example, they told us that they worked closely with a local voluntary sector provider who offered a range of social prescribing services.

We received no feedback from partners and stakeholders regarding how staff, teams and services worked together.

The practice delivered or hosted various services in-house. For example, they delivered a young person’s contact service, this operated across all sites operated by the provider. The service aimed to support young patients aged 11 to 18 (up to 25 for those patients with a learning disability) who had been referred into it. The contact service used a multidisciplinary approach and brought together a wide group of health and care professionals including specialist nurses, and youth workers, and had additional support of Child and Adolescent Mental Health Services, drug and alcohol, and sexual health workers. It delivered care via face-to-face clinics and drop-in sessions. The provider had also developed a segmented model of care which included 2 complex heath care teams who undertook the management of care for some of the most vulnerable members of the practice population. Activities of these teams included home visits, and visits to residential care facilities, as well as coordinating care with other stakeholders.

A member of the patient participation group told us that they felt well supported by the practice. They had not been referred for any specific social prescribing support, but were aware of the opportunities to access it via the practice.

Leaders and staff we spoke with had a good understanding of their role in supporting people to live healthier lives. They explained how they worked with individuals and families to improve health and care outcomes via general practice health provision and through working with other partners and stakeholders. They told us that they hosted services which included alcohol and drug workers, district nurses, and community midwives. They also discussed with us how they worked to promote preventative services such as cervical screening and child immunisation programmes. Leaders and managers told us they had good working relationships with other organisations to deliver healthier lifestyle outcomes for patients via their Community Partnership. This was composed of all the Affinity Care practices, along with representatives from social care, community care and the voluntary sector.

There were processes in place to invite patients for relevant health checks and reviews. As examples; 1,054 patients had received an NHS health check in the last 12 months, from a total of 3,554 patients who were eligible, and 82 of 106 patients with a learning disability had received an annual review. We saw that learning disability reviews had been subject to an audit which showed that an additional 11 of these patients had either booked for a review, or had received a review at another practice within the previous 12 months. The provider was involved in a wide number of activities to support population health, and worked with other stakeholders as part of a Community Partnership which worked collaboratively to support healthier lives. Activities included community health checks. The provider also supported the delivery of collocated services, and we saw that services such as alcohol and drugs workers, district nurses, and community midwives were hosted within the practice.

Patient feedback from the 2024 National GP Patient Survey indicated that the majority of respondents were satisfied with how their needs were supported. For example, 68% reported that they have had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses. This matched the local and national averages of 68%. Feedback from a representative of the patient participation group said they felt that their individual care needs were being met by the provider, and that they had the opportunity to discuss their health, care and support requirements during consultations.

Leaders and staff told us that as a practice, and as part of the wider provider Affinity Care, they had a focus on improving outcomes for their patients. To support this aim, following our last Care Quality Commission inspection in late 2022, the provider had established a Quality and Safety Group which had oversight over key areas of performance. Senior leaders informed us that this quality management process helped them to track and monitor performance for service critical areas such as safeguarding, and learning events, and allowed them to plan and deliver improvements when these were required. For example, they told us that new processes had been put in place to increase the uptake of child vaccinations, and new members of the nursing team were in the process of being trained to undertake cervical screening to improve capacity in this area, and thereby increase participation in the cytology programme.

The provider had developed and adopted effective clinical governance and reporting procedures across all Affinity Care locations. They had established a Quality and Safety Group which was attended by clinical leaders and managers from the organisation, each of whom had responsibility for a key area of activity and the outcomes associated with these. Key performance areas included safeguarding, complaints, medication reviews, prescribing, long-term conditions, medicines monitoring and usage, cytology, and vaccinations and immunisations. Performance was monitored using a risk rated report. The group met quarterly and reported directly to the Board of Directors. September 2024 was the first month since June 2023 where all indicators were either rated green (low) or amber (medium). We saw that the provider had in place effective systems of recalling patients, undertaking reviews, and managing medicines and patient safety. As part of the assessment, we conducted a series of remote clinical searches to assess the management of patients with long-term conditions. We found overall that the management of patients with long-term conditions was good, although we identified an issue whereby patients who had experienced an exacerbation of asthma had not been followed up in line with national guidance, and an isolated incidence of a patient with diabetes who not had this effectively identified and supported. Following our feedback the provider had put in place measures to prevent a recurrence of these issues. The provider had sought to improve processes for encouraging patients to attend for cervical screening and childhood immunisations. This included offering appointments at a time to suit the patient/parent, appointing dedicated staff to engage with patients, and increasing nursing capacity to deliver these programmes.

Our review of the remote clinical searches of patient records showed the practice worked with patients to monitor and improve outcomes. We saw that overall regular medicines and long-term condition reviews had been undertaken in line with guidance and operating protocols. Only minor issues had been identified which the provider soon rectified when informed of them. If the provider identified that patients would benefit from additional support, they were able to refer or signpost patients to partner organisations for lifestyle advice such as stopping smoking, or reducing alcohol consumption. Registers of patients were held which ensured monitoring of specific groups such as palliative care patients were managed effectively. For example, the provider had identified 903 patients as being carers (around 6% of the patient population) and used this information to target support. Information published by Office for Health Improvement and Disparities showed the latest data (June 2023) for cervical screening uptake as 76%, this was below the national target of 80%. During this assessment the provider shared with us a report which indicated via unverified data, that they had achieved a screening rate of around 84%. This had been achieved through a combination of enhanced patient engagement, improved call and recall processes, and greater flexibility on accessing screening. Child immunisation data for the provider showed that it had achieved the national child immunisation minimum targets of 90%. Notwithstanding this the provider had put in place measures to improve take up. This included discussing with reticent parents the need for vaccinations, dedicating a telephone line to book vaccinations, and appointing a coordinator to manage child immunisations processes.

We did not receive feedback from patients and saw no indication of any concern in this area.

Staff we spoke with were able to give examples of how consent was assessed, sought and recorded (where appropriate). For example, consent for minor surgery was obtained in writing and recorded on the clinical system. Staff had knowledge to consider and discuss consent with those who were vulnerable and in need of additional support. Staff also told us that they obtained verbal consent prior to referring to other services such as to secondary care or voluntary sector organisations.

We saw that the provider had systems in place to manage consent processes. We saw that staff had received training regarding mental capacity, which enabled them to effectively assess the patient’s ability to give consent and were able to access interpretation services for those who required language support to understand their care, and when necessary, give their consent. The provider used inferred consent for most procedures, however they also required specific written consent when undertaking certain more complex, personal, or invasive treatments. As part of this assessment, we examined 5 Recommended Summary Plan for Emergency Care Treatment (ReSPECT) documents. We saw that these had been fully completed by staff, had been regularly reviewed, and included recording the input of patients and/or carers in decisions regarding their care and future treatment.