Preston Hill Surgery

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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 found that the service was providing effective services because people’s needs were assessed in line with good practice guidance and all staff were aware of relevant protocols and procedures. The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided. Leaders and 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. The clinicians worked proactively and in partnership with people to improve health and wellbeing.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were positive about how their immediate and ongoing needs were assessed and managed. This included their mental and physical wellbeing.

The leaders were passionate about ensuring patient care was reviewed and updated regularly to provide high level care. Staff checked people’s health, care, and wellbeing needs during health reviews. The provider submitted examples of audit and case review demonstrating the positive impact of tailoring care to meet people’s individual needs. For example, the GP and health and wellbeing coach had designed educational courses about diabetes to meet people’s individual communication needs with positive health outcomes. The whole practice team responded immediately when people needed urgent attention, for example, when people had attended the practice with symptoms of potential sepsis. The practice was exploring themes to improve well-being and the social aspects of care for patients. For example, they planned to introduce a gardening club as a well-being activity, and group events to support patients affected by the cost-of-living crisis.

Clinical staff used templates when conducting care reviews to support the consistent 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 the social prescriber who was allocated to the practice through the primary care network.

The evidence we reviewed did not indicates any concerns about people’s experience in relation to evidence-based care and treatment at this practice.

The lead GP provided many examples showing how evidence-based clinical guidelines and training messages had been collated and summarised into practical summaries for easy reference for the clinical team for specific conditions or therapies. Clinical staff described this approach as one of the strengths of the practice.

The provider used clinical audit extensively to ensure the team were delivering evidence-based care. We saw examples showing how the practice had audited various aspects of care in line with the latest guidelines. These examples also showed that the practice involved people and families (in the case of children) in discussion about recommended changes to care or medicines as a result of audit findings.

People described the service as professional and efficient, with staff working well as a team to provide effective care.

Staff informed us they had protected time for learning and development. They had the skills, knowledge, and experience to deliver effective care, support, and treatment.

Partners we spoke with described a positive working relationship with the practice. We were given examples of how the practice had achieved better outcomes for people due to taking a more flexible and patient-centred approach.

Clinicians worked with other health and care professionals, for example to carry out care planning reviews, to deliver a coordinated package of care for people with the most complex needs.

People told us the practice was proactive in promoting their physical and mental well-being. They described how the practice kept them informed about general health updates, reminders for check-ups and health promotion campaigns.

Staff told us that patients had access to appropriate health assessments and checks. Staff were consistent and proactive in helping patients to live healthier lives. For example, signposting patients to support services and updating them on public health campaigns. The practice also ran a ‘carer’s club’ whereby patients could register as a carer and be invited to events which outlined the support available to them. The clinicians provided examples of audit to improve the support provided to patients to live healthier lives. For example, the practice had audited its referral rate of patients at risk of developing diabetes to a recognised educational course. Patients attending this course provided positive feedback and had reduced their risk of developing diabetes. The practice referred 55 people in the first year with a high rate of attendance. Referrals were successfully increased in the second year of the audit (95 eligible people). The cohort of people who completed the educational programme achieved, on average, an 18.27 mmol/l reduction in measured blood sugar levels (HbA1C test).

The practice had launched a weekly walking group aimed at promoting health and well-being for patients and staff. This was prominently advertised in the practice and on the website. The practice planned activity it could take in relation to national public health campaigns to improve impact. For example, it had reviewed its capacity to provide appointments to teach people about breast examination during breast cancer screening awareness week and had sourced relevant information in a range of languages and easy read format.

Some people we spoke with commented that they had personally experienced good health outcomes which they directly attributed to the professionalism and attentiveness of the practice team.

The practice had identified bowel cancer screening uptake as an area for improvement and liaised with the local NHS leads on tackling barriers to participation. Following this, the lead GP had attended a local care home to raise awareness of the bowel cancer screening programme, the test process, provide test kits and answer any questions. Participation in the screening programme subsequently increased in this group.

The practice was in the process of restarting a regular forum meeting for patients with diabetes which had run successfully prior to the COVID-19 pandemic. The meetings were being set up with participation from the local community diabetes specialist nurse and were designed around specific topics and included on-the-spot health checks, such as, blood pressure readings. The practice was not meeting the national target for cervical screening coverage. It had implemented a strategy to improve the uptake of cancer screening. This included external training for the practice team about how to talk with people about cervical screening and the provider had expanded access so there was a qualified smear-taker available at the practice every weekday and ad hoc weekend screening sessions. The strategy included consideration of the needs of transgender males who were likely to be missed by the national screening programme.

The practice was not meeting the World Health Organisation target (95%) on childhood immunisation coverage. The practice provided evidence to show coverage for all cohorts had improved in 2023/24. For example, 80% of one year olds had received their childhood immunisations according to the UK schedule at the time of the inspection compared to 73% in 2022/23. The practice had implemented a strategy to improve uptake based on published research findings about barriers to uptake and local population factors. Actions included increasing the number and flexibility of appointments; greater use of interpreters; providing consultations with a health professional about the benefits of immunisation; and referral to a home visiting immunisation team. The practice had actively participated in a national scheme to offer catch-up immunisations to older children and young adults who had missed immunisation.

People told us they received information about care and treatment in a way they could understand and had appropriate support and time to make decisions. One person told us it was helpful that the practice team included members who were representative of the local community so family members were able to talk with their GP in their first language.

Staff were able to explain how they involved people to obtain consent to specific decisions. For example, the nurse obtained (and recorded) verbal consent from the parent or guardian in relation to childhood immunisations.

The provider had produced relevant internal guideline summaries, for example about mental capacity and the importance of providing people with the support they needed to make informed decisions about their care.