Akerman 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

At the last rated inspection, this key question was rated requires improvement. At this assessment the provider demonstrated that improvements have been made. Our rating for this key question is good. We assessed all quality statements for this key question and found that the service was providing effective services. The provider assessed patient needs in line with best practice guidance, and ensured all staff were aware of the service’s protocols and procedures. The service had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided. Staff worked together and worked well with other organisations to deliver effective care and treatment. The service obtained consent to care and treatment in line with legislation and guidance. However, at this assessment we found that the provider had continued to perform below the national target for all key indicators relating to childhood immunisations and cervical screening.

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 utilised local and national guidance to determine how patient needs should be addressed. We undertook a review of patient records at the service and found that these guidelines were being followed in the large majority of cases. Patients’ immediate and ongoing needs were fully assessed. Where appropriate this included their clinical needs and their mental and physical wellbeing.

As part of our assessment, a CQC GP Specialist Advisor (SPA) conducted a series of remote clinical searches of patient records to assess the practice’s procedures around the management of patients with long term conditions, which included asthma, chronic kidney disease, diabetes and hypothyroidism. We found that long-term conditions were managed in line with local and national guidelines in most cases. However, we found that 2 out of 5 patients with asthma did not receive a follow up after being prescribed rescue steroids, and the follow up for 1 patient was inconsistent. There is a risk of these patients deteriorating due their asthma and not being seen on time.

Leaders at the service demonstrated clear communication with staff at the service, including where changes to operational and clinical protocols were implemented. Leaders at the service detailed clear examples of follow ups of patients. For example, the service was below national guidelines for delivering both childhood vaccinations and cervical screening. We saw that the service had information available to provide to patients in multiple languages, and risk were clearly discussed. After three follow ups the service asked if patients wished to formally decline. Despite the fact that risks had been described, some patients still decided to refuse, which in the case of cervical screening was approximately 500 of 2,000 patients. This represented 25% of eligible patients.

We found the practice had systems and processes in place to keep clinical staff up to date with current evidence-based practice. The practice held registers for patients with a learning disability and provided annual health checks. There was register of those patients on end-of-life care who were regularly reviewed and supported to make informed decisions about their future.

Staff were aware of the need to complete accurate and full records, such that information did not need to be repeated by patients. Patients received coordinated and person-centred care. This included when they moved between services, when they were referred, or after they were discharged from hospital. Care and treatment for patients in vulnerable circumstances was coordinated with other services. There were established pathways for staff to follow to ensure patients’ needs were met.

We saw there were systems and processes in place to ensure care was delivered and reviewed in a coordinated way which included people receiving end-of-life care and those with a learning disability. We invited feedback from the NHS South East London Integrated Care Board ahead of this assessment. From the feedback we received from them there was no indication of concern in this area.

Leaders at the service told us that where appropriate, they gave people advice so they could self-care. Where patients needs could not be met by the service, staff redirected them to the appropriate service for their needs.

The practice had named care coordinators for patients with learning disabilities and nominated leads for palliative care to support patients and staff. Patients had access to a social prescriber, which helped them improve their health, wellbeing and social welfare by connecting them to community services. We saw the practice website had links to health and wellbeing information. The practice also shared information in their patient newsletter, including reminders for patients to book immunisations.

Leaders described how they monitored the uptake of patient monitoring for long term health conditions at regular clinical meetings and compared their results with other practices in their primary care network and in the wider area. Leaders told us that audits were discussed at clinical meetings, which were minuted.

The practice had a comprehensive programme of quality improvement and used information about care and treatment to make improvements. The practice conducted audits including prescribing data. We saw evidence that the practice actively followed up on overdue immunisations and screening and recorded when these services were declined.

We found no concerns regarding outcomes showing that the service was monitoring and improving patient outcomes.

Clinicians understood the requirements of legislation and guidance when considering consent and decision making. We saw that consent was documented in most cases. Clinicians supported patients to make decisions. Leaders at the service provided details of comprehensive follow up measures for patients who were due tests such as cervical screening. Comprehensive information was provided to the patients, who were able to opt out where clear discussion of risks was documented.

Relevant staff had been provided with training in the Mental Capacity Act. The provider monitored the process for seeking consent appropriately. We reviewed 5 patients’ Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions and found they were made in line with relevant legislation and were appropriate.