Caskgate 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

During our assessment of this key question, we found concerns around the lack of healthcare follow-up and monitoring of some patients with long-term health conditions. The practice had systems and processes to keep clinicians up to date with current evidence-based practice. We found that patients’ immediate and ongoing needs were assessed and these included interventions required to ensure effective care was delivered. We observed from the clinical searches we carried out that the service did not always deliver evidence-based care. Recording of risk advice and some monitoring processes required review. They monitored and improved outcomes for patients by carrying out clinical audits. Although we did not see any 2 cycled clinical audits, the provider had a plan to address this. The staff team worked in a positive way to improve patient outcomes. They worked with other care providers and the Primary Care network to support patients whose circumstances may make them vulnerable. Patients needs were assessed and staff would actively refer patients to social prescribing for support with their wellbeing and social issues. Patients with communication needs were supported. Patient consent was sought appropriately.

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 evidence we reviewed was very limited but the information we received from patients was negative about diabetes management.

Staff told us they placed importance in providing individualistic care to patients to ensure they were providing effective care. The leaders were passionate about ensuring patients care was reviewed and updated regularly to provide high level care. Leaders and staff told us staff would put an alert on the patient record to highlight people’s communication needs and any impairments and had access to interpretation services.

A remote review of the patient record system showed that most patients received appropriate long-term condition reviews except for Diabetes. Patients with most long-term conditions were offered an annual review to check their health and medicines needs were being met. For patients with the most complex needs, the GPs worked with other health and care professionals to deliver a coordinated package of care. The practice identified patients with caring responsibilities and had signposting and policies in place to support their needs. This information was available through new patient registration, notice boards and leaflets. The provider looked after 9 care homes. Patients had a care plan in place and the GP or Clinical Pharmacist would contact them or attend the home as required.

The feedback we received from patients identified concerns regarding their diabetes care and treatment, specifically relating to lack of annual reviews including diabetic foot checks.

Leaders were not aware that shortfalls existed within the clinical records and that patients had not always received appropriate healthcare checks. Staff told us that there were processes in place to recall and review people with long-term conditions according to monitoring requirements. However, our review of clinical records found that monitoring was not always within appropriate timeframes, for example, diabetes. Feedback from leaders showed they worked hard since the previous inspection to ensure all clinical correspondence and tasks were up to date. People had access to appropriate health checks and assessments, and they were directed to relevant services when they needed extra support. For example, patients assessed as at risk of developing a long-term condition.

People were encouraged to be involved in monitoring and managing their own health and were being referred, if appropriate to the social prescriber who worked with all member practices in the local PCN. The remote searches undertaken of the practice’s clinical patient records system showed that there was a lack of oversight of some long-term condition management to ensure safe care and treatment was given to patients. The monitoring of patients with some long-term conditions were not always followed in line with National Institute for Health and Care Excellence (NICE) recommendations. We found 12 patients with diabetes who had not had a follow-up within the recommended 2-12 weeks and coding issues on their patient records. We noted that 3 patients were not followed up after prescribing of steroids following exacerbation of asthma. We found 1 patient with a Hba1C over 75mmols had not received a follow-up after 3 months. We noted 2 patients with hypothyroidism had been reviewed but they had missing blood tests and the alert box had not been reviewed.

We did not receive specific examples from patients about how teams, staff and services worked together. However, we did receive feedback stating that the whole practice team delivered a positive experience.

Staff told us they were proud of how the team worked well together to ensure patients received high quality healthcare. They told us they were engaged with the leaders to be flexible and adaptable to meet their patient’s needs. For example, they had shown resilience in response to a number of major changes to their ways of working over recent months and supported each other to continue to deliver effective care and treatment.

We received positive feedback from partners in relation to the responsiveness and support offered by staff at the practice. The practice was part of a primary care network (PCN) of practices who shared staff for the benefit of patients. For example, pharmacy technicians.

When people receive care from a range of different staff, teams or services, it was co-ordinated effectively. All relevant staff, teams and services were involved in assessing, planning and delivering people's care and treatment and staff worked collaboratively to understand and meet people's needs. The practice held meetings with external colleagues such as school nurses, health visitors and midwives to discuss vulnerable patients. At our inspection in May 2023 under the previous registration there was no system in place to monitor delays in referrals. At this assessment we found that referrals to specialist services were documented, contained the required information and there was a system to monitor delays in referrals.

The feedback we received did not show any concerns about people’s experience regarding supporting people to live healthier lives.

Staff and leaders told us they included and encouraged patients to take an active approach in reviewing their own health and wellbeing. They told us they had identified improvements that could be made in various consultations and these patients were signposted to the social prescriber for additional support. They recognised that child immunisation was an area for improvement, and they had restructured the nursing team and a new member of staff was completing training in childhood immunisations in order to offer more appointments and improve uptake. They told us they were flexible in their approach to contacting patients and booking appointments for childhood immunisations.

During our clinical searches we found medicine reviews had taken place but some records we reviewed were not detailed and coding issues were identified. The practice staff were knowledgeable within their roles and often referred to specialist or the social prescriber when appropriate.

The evidence we reviewed did not show any concerns about people’s experience regarding monitoring and improving outcomes at this practice.

Staff and leaders demonstrated they had systems and processes in place to monitor and improve outcomes. Staff told us of incidents and complaints which had led to improvements from shared learning, the documentation we reviewed was informative and all staff had access to meeting minutes.

Staff carrying out long-term condition reviews had received appropriate training for the role.

Clinical searches were mostly positive and showed good care and appropriate monitoring of patients with long term conditions and those on high-risk medicines. There was a structured system in place for inviting patients in for their long-term condition annual reviews and there were designated administration staff who had oversight of this. We saw the practice had a system for reviewing patients test results in a timely manner. We observed there were no test results older than 1 day on the clinical system awaiting review. We observed referral letters to be actioned in a timely manner.

We did not receive any concerns from patients relating to consent to care and treatment.

Staff had a good understanding of consent and had received appropriate safeguarding training including mental capacity act and deprivation of liberties training. The practice did not carry out any minor surgical procedures that required written consent.

Patients were offered a chaperone when carrying out examinations, we saw posters displayed in the practice informing patients of this. Staff who carried out chaperone duties were trained for the role and had received a disclosure and barring (DBS) check.