Bousfield 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

At our last assessment we rated this question as requires improvement. At this assessment the rating has changed to good. We assessed all quality statements within this key question. People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people and took decisions in people’s best interests where they did not have capacity.

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 was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. All staff we spoke with were aware of the needs of the local community and had been trained to support their patient population. However, there were areas where a small number of non-clinical staff had not undertaken formal training for example in sepsis and mental capacity awareness as well as some support services available to patients around domestic violence. The health care assistant (HCA) was the infection control lead and did not have any specific training for that role. The practice manager was receptive to implementing improvements in this area. Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff checked people’s health, care, and wellbeing needs during health reviews. However, reception staff were not formally trained in triage and care navigation which was something that had been recently discussed during a learning event for improvement. Formal training was underway and flow charts had been introduced but the improvements were not yet embedded. 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 or housing difficulties, to a social prescriber.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. Systems such as policies and procedures, clinical and non-clinical templates were in place to ensure staff were up to date with national guidance, evidence-based good practice and required standards. Staff consulted and followed NICE guidance and British National Formularies (BNF) when making decisions about care and treatment. They attended meetings and received appraisal and supervision. Clinical staff had time factored into their days to deal with administrative tasks and non-medical staff had support from GPs in the building daily. Staff we spoke with provided examples where guidance had been followed to improve outcomes, for example when undertaking medicine reviews and reviews of patients with long-term conditions. The practice was performing in line or above local and national averages for most required indicators in relation to patient feedback.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. All staff within the organisation were trained to do all tasks such as workflow, scanning, referrals, repeat prescribing and patient registration to ensure adequate cover for planned or unplanned leave. The practice worked with other services to ensure continuity of care. Leaders and staff worked closely with colleagues in the local PCN to meet the needs of the patient population.

Multi-disciplinary team meetings were held on a regular basis so that when people received care from a range of different staff, teams, or services, such as those receiving treatment from secondary services or shared care, this was co-ordinated. Shared care agreements were in place to ensure that prescribing arrangements between primary and secondary care were well managed. Staff worked closely with all agencies involved in a person’s care to ensure the best outcomes and smooth transitions when people moved between services.

At our last inspection in July 2023 recommendations were made to the provider to monitor and take action to improve the uptake for cervical cancer screening and childhood immunisations. At this assessment the scores for cervical screening were 65% and 68% which were still lower than the required 70% uptake. In addition, the percentage of children receiving required immunisations were between 73% and 77% which was below the 80% expected uptake. However, staff were able to evidence how they continued to monitor and encourage attendance in these areas by using opportunistic discussion and education. Saturday morning out of hours appointments were also available. The practice also provided plans for continual improvement moving forward.

Staff supported local and national priorities and initiatives to improve population health, including smoking cessation and weight loss. People living with long-term health conditions underwent regular monitoring. Staff referred or signposted them to local support services for information, education, advice and support linked to their needs. People were also encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing and prevent deterioration.

The service routinely monitored people’s care and treatment to continuously improve it. They sought assurance through a series of key performance indicators and quality improvement activity. The practice was able to demonstrate improvements through audits which they shared during the assessment. Positive outcomes were demonstrated through patient experience and GP practice indicators. Leaders demonstrated that monitoring and improving outcomes for patients was important to them and they used information and data to drive improvement. There was evidence of clinical, non-clinical and medicines audits carried out to improve outcomes for patients.

People who used the service felt they could make an informed decision about their care and treatment because they had been provided with the information needed to support them to do so. The National GP patient survey results showed that 91% of respondents, compared to 92% locally and 91% nationally, felt the health professional they saw had all the information they needed and 95%, compared to 92% locally and 91% nationally, felt involved as much as they wanted to be in decisions about their care and treatment.

Staff we spoke with demonstrated the importance of ensuring that people understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment. Clinical staff had received training in the Mental Capacity Act. Mental capacity awareness was not something that non-clinical staff had been trained in, however since the assessment the practice manager has added this to mandatory training. We looked at a sample of ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) decisions in patient records. Appropriately completed documents were available, and alerts had been added to the patient record system. Relevant information was demonstrated in the care records of patients who did not have capacity to make decisions.