Fir Tree Medical Centre

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment in January 2023, we rated this key question as requires improvement. At this assessment the rating has changed to good. A review of patients clinical records found a small number of patients with a potential missed diagnosis of diabetes had not been followed up appropriately. An action plan was submitted by the provider immediately following the assessment.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from people that used the service was positive. People felt involved in any assessment of their needs and confident that staff understood their individual and cultural needs. The results of the national GP patient survey showed that positive results were received from people who used the service. For example, patients felt that during their last appointment they were involved as much as they wanted to be in decisions about their care and treatment. Patients also gave positive responses indicating that during their last appointment, they had confidence and trust in the healthcare professional they saw or spoke to.

People who used the service were given the opportunity to provide feedback to CQC via a link sent to patients as a text message. We received feedback from 27 people and 22 were positive about how the service was meeting and had met their needs.

Our clinical searches identified that that people’s care and treatment was regularly reviewed and updated. Records reviewed demonstrated appropriate care planning, for example, for people with a long-term condition, mental health conditions, a learning disability or those receiving palliative care. People who were at risk of developing a long-term condition were identified and monitored.

There were systems to ensure staff were up to date with relevant legislation, evidence-based practice and required standards. Our clinical searches indicated that people received care, treatment and support that was evidenced based and was in line with good practice standards. Overall, appropriate monitoring and reviews were in place for people with long term conditions, for example, people with, diabetes, hypothyroidism, asthma and chronic kidney disease. However, there were some shortfalls. We looked at five patient clinical records for patients who had a potential missed diagnosis of diabetes. A delayed diagnosis can cause diabetes-related complications, meaning these patients were at risk of harm. We found that two patients had not been followed up effectively. Issues related included patients not having their conditions appropriately diagnosed or coded and therefore potentially they had missed out on monitoring, treatment, screening and follow up. Following assessment, the service submitted an action plan to demonstrate appropriate actions was taken in response to the results.

Staff had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. When people moved between services, all necessary staff, teams and services were involved in assessing their needs to maintain continuity of care. Information was shared between teams and services to ensure continuity of care, including when people were referred between services or when clinical tasks were delegated. For example, the service had a protocol for patients who had a new cancer diagnosis to ensure their needs were met.

People were supported to manage their own health, care and wellbeing needs, and make healthier choices. Staff focused on identifying risks to people’s health and wellbeing, for example, people in the last 12 months of their lives and people at risk of developing a long-term condition. The service supported national priorities and initiatives to improve the population’s health, including stop smoking and tackling obesity campaigns.Patients were encouraged to attend cancer screening and take up vaccinations offered as part of national programmes. A central vaccination team was in place to increase the uptake of children’s vaccinations. The service was just below target for the percentage of persons eligible for cervical cancer screening who were screened adequately within 3.5 years for persons aged 25 to 49, and within 5.5 years for persons aged 50 to 64. The service told us they were working to increase uptake of cervical screening across the relevant patient population. Patients were being contacted proactively to encourage them to attend, and specific cervical screening clinics were being scheduled.

The provider had effective approaches to monitoring people’s care and treatment, and their outcomes. Clinical and non-clinical audits were carried out to improve outcomes for patients. Patients who required monitoring underwent regular checks on their health. The service was in line with other services within the locality and nationally for outcomes for patients. Regular searches of patient’s medicines were undertaken by the service pharmacists to monitor patients. Depending on the results this included providing extra help to manage long-term conditions, advice for those on multiple medicines and better access to health checks.

Staff understood the importance of ensuring that people fully understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment. People received information about care and treatment in a way they could understand and had appropriate support and time to make decisions.

There was a system in place to record people’s consent appropriately. People’s capacity and ability to consent was considered. People, or persons lawfully acting on their behalf were involved in planning, managing and reviewing their care and treatment.

We sampled a small number of patient records with a Do not attempt cardiopulmonary resuscitation (DNACPR) decision. Of these, most contained the majority of the information expected, however 3 appeared to need further consideration. Our review indicated records did not always have clear and full documentation of the decisions about DNACPR, the reasons for this and the discussions which had taken place.