St Georges Medical Practice

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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. Staff regularly reviewed people’s care and worked with other services to achieve this. At our last assessment, we rated this key question as good. At this assessment, the rating remains the same. People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff made sure people understood their care and treatment to enable them to give informed consent.

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. The service had recently introduced the use of templates for clinical staff when conducting care reviews to promote consistency and 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 service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance.

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

Staff were positive about how the service worked well across teams and services to support people. There was evidence of working with the wider health care teams though Multi-disciplinary teams (MDT) meetings. People had access to services provided by the Primary Care Network (PCN), including physiotherapy, social prescribers and extended access. Support and learning was shared across the PCN. The service had worked with their Patient Forum to make improvements to the service.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. There were systems in place to ensure that people with long-term conditions were reviewed regularly and following an exacerbation of their condition. Feedback received by the Care Quality Commission from people who used the service and our clinical searches confirmed the systems were effective.

National data showed that all 5 indicators for childhood immunisations had achieved the minimum 90% uptake target, with 3 of the 5 having achieved the 95% World Health Organisation based target for uptake and had been consistent over time. National data showed the uptake of cervical screening had been consistent over time close to or above the national target of 80%. The service had undertaken quality improvement activity to identify potential barriers to the uptake of cervical screening and action to address these. As a consequence, the invitation process was reviewed and amended to make it more inclusive. People were informed about the availability of evening and weekend appointments; staff contacted people whose first language was not English with the support of an interpreter and provided written information in people’s preferred language. The service made reasonable adjustments for those who were nervous about attending, and proactively contacted people new to the country to discuss their general health needs and screening programmes available to them. These changes resulted in an increase in uptake of cervical screening.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. There was a formal system in place for obtaining written consent for minor surgery procedures. A recent audit demonstrated written consent had been obtained for those people who had attended the service for minor surgery.

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.

There were a number of issues with DNACPRs, including 2 not being available in people’s notes. We saw the provider was working through the search results and was already aware of the issues we identified. The provider had already identified issues and areas for learning, and although the audit had not been written up, an immediate action was to request DNACPRs when people were discharged from hospital.