Nexus Health Group

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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 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.

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.

We found no concerns regarding people’s experience of assessing needs.

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 most cases. However, we noted that patients with asthma who had been prescribed rescue steroids were not always followed up within one week. Patients’ immediate and ongoing needs were fully assessed. Where appropriate this included their clinical needs and their mental and physical wellbeing.

The service had policies and protocols in place to ensure that patient needs were assessed and followed national and local guidelines where required. As part of the assessment a number of set clinical record searches were undertaken by a CQC GP specialist advisor, and we found that in the large majority of cases, patient needs were assessed.

We found no concerns regarding people’s experience of the delivery of evidence-based care and treatment.

Leaders at the service demonstrated clear communication with staff at the service, including where changes to operational and clinical protocols were implemented. As part of our inspection a number of set clinical record searches were undertaken by a CQC GP specialist advisor. These searches were visible to the practice. Leaders at the service detailed clear examples of follow ups of patients. For example, we saw that the service had clear action plans to improve uptake of cervical screening, childhood immunisation, and of cancer screening, all of which were lower than the national average at the last assessment. The service had improved uptake of cervical screening from 65% to 80% in the past two years, using a comprehensive program of patient and staff education. For childhood immunisations, the practice had appointed a new co-ordinator to focus on this area. Leaders at the service reported that there were still a high number of parents who refused vaccinations, but that they continued to provide information in multiple languages and meet with community groups in an attempt to increase uptake.

Clinical staff had access to relevant national and local guidelines and used this information to help ensure that people's needs were met. The provider monitored that these guidelines were followed. Care and treatment were delivered in a coordinated way which considered the needs of those whose circumstances may make them vulnerable.

Patients’ needs were fully assessed in many cases. This included their clinical needs and their mental and physical wellbeing. In the clinical searches of patients with long term conditions, we saw that evidence-based care and treatment was being provided. For example, we reviewed patients with chronic kidney disease (CKD) stage 4 and 5 who had not had urea and electrolyte monitoring in the last 9 months. Only 14 of a total of 286 patients had not been monitored, and we saw in a sample of 5 of these 14 records that there was clear documentation of attempted or actual follow up. Similarly, we reviewed patients with hypothyroidism who had not had thyroid function tests in the past 18 months. Only 36 of 1,523 patients had not received this monitoring. The service had again followed up these patients.

We found no concerns regarding people’s experience of the delivery of how staff and teams work together.

We invited feedback from the NHS South East London Integrated Care Board ahead of this assessment. We received no concerns from partners about the delivery of how staff and teams work together.

Staff were aware of the need to complete accurate and full records, such that information did not need to be repeated by patients. We spoke to a selection of 12 staff across a variety of roles who were not managers at the service. All of them detailed clear governance systems in place to ensure effective work between teams.

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.

The service ensured that care was delivered in a coordinated way and took into account the needs of different patients, including those who may be vulnerable because of their circumstances.

There were clear and effective arrangements for booking appointments and transfers to other services.

We found no concerns regarding people’s experience of supporting people to live healthier lives.

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. Staff who we spoke with were all aware of how to refer patients to support services if required.

We found no concerns regarding processes to help support people to live healthier lives.

We found no concerns regarding people’s experience of monitoring and improving outcomes.

Leaders described how they monitored the uptake of patient monitoring for long term health conditions monthly at clinical meetings and compared their results with other practices in their local area. Leaders and staff told us that audits were discussed at clinical meetings. Staff and leaders provided details of an extensive audit programme.

The provider submitted clinical and management audits, these covered medicines and health condition monitoring, which they had carried out to improve outcomes for patients. Leaders held regular clinical and all staff meetings which monitored patients’ outcomes, where the findings were shared with the local integrated care system.

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

We found no concerns regarding people’s experience of consent to care and treatment.

Clinicians understood the requirements of legislation and guidance when considering consent and decision making. We saw that consent was documented where required. Clinicians supported patients to make decisions.

As part of our inspection, we reviewed five records where do not attempt resuscitation agreements were in place. In each case we saw that the service had undertaken correct consent procedures with the patient.