High Street Surgery

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

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 requires improvement. At this assessment, the rating is good. Improvements had been made to the monitoring of people’s health. This meant the effectiveness of people’s care, treatment and support was consistent and achieved good outcomes.

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 practice 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 who used the practice was generally positive. Care home representatives told us people’s needs were assessed well by clinicians. Clinical staff visited people living in care homes weekly, to assess and review care and treatment, as needed. Staff checked people’s health, care, and wellbeing needs during health reviews. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing.

Staff used digital flags within care records to highlight any individual communication or accessibility needs, such as the requirement for longer appointments or for an interpreter. This information was gathered at the point of registration and opportunistically.

The practice had systems to identify and prioritise care and treatment for people who were vulnerable. All people with a learning disability were offered an annual health assessment. The practice had an advanced nurse practitioner trained to complete these and reasonable adjustments were considered to support people’s attendance. This offered people with a learning disability continuity and familiarity to encourage engagement and promoted awareness of the needs of people with a learning disability. Systems were in place to identify people with caring responsibilities at registration, opportunistically, and through self-reporting. They held a carers’ register and were reviewing this to ensure the information was up to date. Carers received an information pack and offered support as appropriate. All staff had completed carer, and learning disability and autism awareness training relevant to their role.

The practice planned and delivered people’s care and treatment with them. There were systems to ensure staff were updated with evidence-based guidance and legislation. Our clinical searches found evidence-based care was delivered.

Improvements had been made, and effective systems were in place to manage and respond to safety alerts. Our clinical searches identified people prescribed medicine which, when taken by women of childbearing age, must have counselling and a documented pregnancy prevention plan (PPP) in place. At the site visit, the practice demonstrated these arrangements had been in place for the sample of 5 people we reviewed. The practice had also reviewed people on these types of medicines and added this search to their recall system and planned to implement a protocol to further strengthen this work.

Improvements had been made to the monitoring of people’s health since our last inspection. Systems were in place to effectively identify people with a potential missed diagnosis of diabetes. People with chronic kidney disease (stage 4 or 5) had received appropriate blood monitoring in the last 9 months. Our search identified that out of 533 people with hypothyroidism prescribed thyroxine in the last year, 3 had not received appropriate blood monitoring. These people had been followed up and appropriate action taken at the site visit. In response the provider submitted an updated monitoring protocol and a protocol for blood taking for people with severe learning difficulties. We reviewed people with asthma prescribed emergency steroids. An adequate assessment was undertaken at the time of prescribing, but the process of follow up was not always effective. The practice acted to ensure people were safe and submitted a revised policy. The practice monitored and improved people’s outcomes and undertook clinical audits. We reviewed a sample of completed 2 and 3 cycle clinical audits which confirmed recommendations had been acted on and improvement sustained.

The practice worked well across teams and services to support people. They shared assessments of people’s needs when they moved between different services.

Feedback we received from people and care home representatives was positive in relation to the knowledge of staff and support people received. This included support from services which practice staff worked in partnership with, for example at end of life.

Staff told us regular multi-disciplinary team meetings were held with external agencies where vulnerable people, or those receiving end of life care were discussed and actions recorded. Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. There were systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment. The processes in place enabled staff to liaise regularly with community teams such as community nurses, health visitors, social workers and palliative care nurses. The practice worked with other services to ensure continuity of care.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. The practice supported people to live healthier lives and where possible, reduce their future needs for care and support.

Representatives from care homes told us people received general and specific health checks and clinical staff visited to administer vaccinations. People who had newly registered at the practice were offered a face-to-face health check soon after they registered. A range of services were available to support people to improve their health and wellbeing. This included for example, a health and wellbeing coach who was available in the practice every weekday, and mental health practitioners, physiotherapists and a social prescriber, who were available on different days and times at the practice. Healthy living information was available on the digital information screen in the waiting room, around the practice and on the practice website. The practice had redesigned an area of the practice, so it was more private, so people could monitor their own health, for example by taking their own weight and blood pressure with the equipment provided. Results were written directly onto people’s records and alerts were in place if results needed further review.

Staff supported national priorities and initiatives to improve population health, which included stopping smoking and tackling obesity. Staff focused on identifying risks to people’s health, including those in the last 12 months of their lives and people at risk of developing a long-term condition. Staff gave examples of where people had been positively supported to live healthier lives, which included healthy eating, weight management and wellbeing walks. Arrangements were in place to offer people with a learning disability and people with a severe mental illness an annual health check.

The practice monitored people’s care and treatment to improve it. They ensured outcomes were positive and consistent, and met both clinical expectations and the expectations of people themselves.

People who used the practice and care home representatives told us they received long term condition checks and were monitored effectively. Our clinical searches showed effective care and monitoring of people with long term conditions. The practice had a structured system in place for inviting people in for their long-term condition annual review and arrangements were in place to follow up people who did not attend. The practice completed clinical audits to ensure the quality and safety of people’s treatment was monitored and improved.

Practice leaders were aware that some areas of their performance such as cervical cancer screening and some childhood immunisations were lower than the national targets. The practice had action plans to improve these areas and monitored and reviewed uptake. Arrangements were in place to follow up people when they did not respond to invitations or missed their appointment. People could book an appointment to discuss any concerns they had about childhood immunisation and cervical screening. The practice offered a flexible approach to appointments for people who worked and to parents/guardians to book appointments at times that were convenient to them. Saturday appointments were available for cervical screening at another practice in the Primary Care Network. Discussions were also held opportunistically. For missed childhood immunisation appointments, when necessary, the practice liaised with other agencies including health visitors and consulted their safeguarding procedures if required. Information was available in the practice sites and on the practice website to encourage uptake. The practice had received written compliments from people who had a cervical screening test about the gentle and efficient manner in which the test was completed.

The practice told people about their rights around consent and respected these when delivering person-centred care and treatment.

We did not receive any concerns from people which were related to consent to care and treatment. Care home representatives told us staff spoke with people, their relatives and carers and obtained consent taking into account the person’s choices and decisions.

The practice had systems and processes in place to obtain consent to care and treatment in line with legislation and guidance. We reviewed 2 minor surgery audits which found consent forms were obtained for all people having minor surgery. Staff had a good understanding of consent and had received appropriate training which included Mental Capacity Act training.

People were offered a chaperone, and posters were displayed in the practice informing people this was available to them. Staff who carried out chaperone duties were trained for the role and had received a disclosure and barring (DBS) check.