Church 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 assessed 6 quality statements from this key question. We have combined the scores for this area with scores based on the rating from the last inspection, which was good. Our rating for this key question remains good. We found 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. Staff supported people to live healthy lives and provided them with support and information on their care and treatment. Leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of everyday work.

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.

People told us they felt their individual needs were appropriately and regularly assessed; and fully understood. They felt involved in the assessment of their needs.

Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or texting patients instead of phoning them. Staff checked people’s health, care and wellbeing needs during health and medicine reviews. They were also proactive (for example, offering vaccinations, cervical screening and blood pressure checks) when patients attended for other reasons.

Clinical staff used templates when conducting care reviews 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 to a social prescriber. Patients were being monitored appropriately and this guided decisions about further care and treatment (for example we saw that the frequency of medication reviews and blood tests was in line with national guidance).

People spoke positively about how clinicians highlighted current good practice that was relevant to their care. For example, advising discontinuation of certain medications based on good practice.

Staff and leaders were encouraged to learn about new and innovative approaches that evidence showed could improve the way the practice delivered care. For example, clinical staff members had recently attended an online seminar chaired by a diabetes consultant.

The provider’s systems ensured that staff were up to date with national legislation, evidence-based good practice and required standards. Consequently, people received care, treatment and support that was evidence-based and in line with good practice standards.

People told us that referrals considered their individual needs, circumstances and ongoing care arrangements. We also heard that when people received care from different services, it was effectively co-ordinated.

Staff spoke positively about good working relationships: both between the practice’s administrative and clinical teams; and also with local community based services.

The district nursing team spoke positively about how the practice worked effectively across teams and services to support people. For example, they highlighted regular multi-disciplinary meetings where information was shared between teams and services to ensure continuity of care.

Staff had access to the information they need to appropriately assess, plan and deliver people’s care, treatment and support. Information was shared between teams and services to ensure continuity of care, for example when clinical tasks were delegated or when people were referred between services. We noted that the practice routinely undertook audits to ensure that referrals and other tasks were appropriately acted upon in a timely manner.

People told us they were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. They were involved in regularly monitoring their health, including health assessments and checks where appropriate and necessary.

Staff told us that the provider focused on encouraging and supporting people to make healthier choices to help promote and maintain their health and wellbeing. This included opportunistic approaches such as offering cervical screening, blood pressure checks and advising about smoking or drinking habits when the patient attends for other reasons.

Systems were in place to focus on identifying risks to people’s health and wellbeing early and on how to support people to prevent deterioration. For example, proactive appointment recall processes for patients with long term conditions.

People spoke positively about effective approaches to monitoring their care, treatment and outcomes. For example, proactive medications reviews and blood tests for people with long term conditions.

Staff told us that there were effective approaches to monitor people’s care and treatment and their outcomes. For example, nursing and reception teams explained arrangements for encouraging attendance for child immunisations and cervical screening.

There are effective processes to monitor people’s care and treatment and improve outcomes. For example, the provider routinely undertakes clinical audits: initially identifying improvement areas, undertaking improvement activity and then re-assessing for evidence of improved outcomes. We noted the GP was also routinely quality assuring nurses’ patient record keeping.

We noted that a recent clinical audit had sought to reduce prescribing of a chronic pain relief medication (due to the increased risk of dependency). Patients had been contacted to advise of the risks and we noted that the follow up audit saw a reduction in prescribing levels.

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.

Staff understood the importance of ensuring that people fully understand what they were consenting to and the importance of obtaining consent before they delivered care or treatment (for example regarding minor surgery). They had received training on the requirements of the Mental Capacity Act 2005, including for example the duty to consult others such as carers, families and/or advocates, where appropriate.

There were systems and practices to support clinicians in determining the patient’s ability to consent to any proposed treatment, medication or referral and which ensured that people understood the care and treatment being offered or recommended.