Iridium Medical Practice

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

We carried out an assessment of 6 quality statements under the Effective key question.

We looked for evidence that staff involved patients in decisions about their care and treatment and provided them advice and support. We also looked for evidence of staff regularly reviewing patient’s care and working with other services to achieve this.

At our last assessment, we rated this key question as good. At this assessment, the rating has changed to requires improvement.

The provider could not demonstrate that patients were always involved in assessments of their needs. Care and treatment was not always based on latest evidence and good practice.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always make sure patient’s care and treatment were effective.

Feedback from patients using the service was mixed. Patients did not always feel involved in assessment of their needs or that their needs were fully considered.

All staff were aware of the needs of the local community. Staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for a translator to be present. We saw limited evidence of alerts being used to highlight other reasonable adjustments.

Our record reviews indicated that medicine reviews were not always comprehensive and they had not always fully considered patient’s needs. The provider told us they were in the process of developing a standard template for all clinicians to use.

The provider did not have effective systems to identify patients with previously undiagnosed conditions for example patients with a potential missed diagnosis of Chronic Kidney Disease stage 3, 4 or 5. Our search identified 56 patients with a possible missed diagnosis. The provider told us they ran this search once or twice a year, however, would review this process going forwards.

Our record reviews also showed that clinicians did not always clearly document their assessment and reasoning when prescribing medicines.

Clinical staff used templates when conducting care reviews to support the review of patients with long term conditions such as COPD. From the records we reviewed, we saw these were mostly completed well and did not identify any concerns.

Staff could refer patients with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

Care home staff were positive about the GP and told us that the GP held weekly ward rounds by telephone to assess patient’s needs. However, they told us there were often delays when the GP was required to carry out a home visit to assess a patient’s needs

We found that most patients who were prescribed high-risk medicines were monitored and reviewed in line with guidelines, except for patients on a medicine to treat high blood pressure. The provider took immediate action to contact all relevant patients and improve processes. The provider could not demonstrate that staff always planned and delivered patient’s care and treatment with them. For example, asthma care or self-care plans we viewed did not contain all relevant information. The provider told us due to issues with their clinical system, clinicians preferred to print out the template Asthma Plan and complete it manually in the presence of the patient, however, they could not evidence that this was being done. Systems were not in place to ensure all staff were up to date with evidence-based guidance and legislation. Clinical records we reviewed demonstrated care was not always provided in line with current guidance, for example reviews of asthma patients following an exacerbation were not carried out in line with guidelines. Action plans for patients with a learning disability were not always completed or did not contain sufficient detail to demonstrate that patients were involved or received an individualised health action plan. We saw that digital alerts on records were not updated to reflect changes in the patient’s circumstances. The provider was not meeting national targets for the uptake of childhood immunisations or cervical cancer screening. We discussed this with the provider who told us of the actions they were taking to improve this. Following the assessment, we reviewed more recently published data and saw that uptake for 2 out of 5 childhood immunisation targets had improved when compared to the previous year.

We also saw that uptake of bowel cancer screening (60% in 2023-2024) was lower than the national average of 71%. However, the uptake of breast cancer screening (67% in 2023-2024) was comparable to the national average of 70%.

Staff did not always have access to the information they needed to appropriately assess, plan, and deliver patient’s care, treatment, and support. For example, relevant staff could not access safeguarding registers and we found that alerts on care records for patients with learning disabilities had not been updated to reflect changes in their circumstances. For example, one patient’s alert referred to the patient as being a child, however, the patient was now an adult. Consultation entries and medicine reviews we viewed were not always detailed and did not contain all relevant information. The provider told us clinicians may record information within tasks or within the practice notes section of the patient’s record and not necessarily within the consultation notes. However, we did not see evidence of this in the records we reviewed. All relevant information should have been recorded within the consultation notes to ensure that all staff saw it. The practice provided GP services to 3 local care homes. Care home staff we spoke with told us they could contact the practice by telephone or email and had weekly ward rounds with a GP by telephone. They described a good relationship with the GP however did not always find it easy to raise concerns with the practice if something was not working well. They did not have regular meetings with the practice to help improve the care and treatment for their residents.

From our record reviews we identified that the service did not always support patients to manage their health and wellbeing, so patients could not always maximise their independence, choice and control.

Staff did not always identify risks to patients’ following commencement of new medicine or patients at risk of developing a long-term condition or those with caring responsibilities.

However, staff shared examples of how they supported other patients with living healthier lives. For example, the practice supported those patients in the last 12 months of their lives.

Staff referred patients to the social prescriber or health inequalities lead so that patients could get support with wider issues that may be impacting their health and wellbeing.

The practice worked with external partners to support adults with complex needs to improve their overall health and wellbeing and reduce their GP appointments and hospital admissions.

The health inequalities lead (employed by the PCN) had set up a 12 week pilot of occupational therapy clinics at the time of the assessment to improve patient’s access to aids and adaptations at home. The pilot was in it’s early stages and the impact of this pilot on patients’ experience had not yet been measured.

The health inequalities lead worked with external agencies to support patients who were off sick from work to help them get back to work where appropriate.

The practice supported exercise clinics and diabetes education sessions.

The practice held fortnightly sessions in the waiting room of the practice for carers.

The practice ran regular searches on their clinical system to monitor patient’s care and treatment. Where we identified that searches needed reviewing more frequently, the provider took immediate action to improve processes.

The practice was not meeting national targets for cervical cancer screening or children’s immunisations uptake, however, they told us of the action they were taking to improve this.

The practice had dedicated staff that monitored completion of annual reviews and had processes to re-call patients for their appointments. However, there was no evidence that quality of annual reviews were being monitored. We identified concerns with the quality of annual reviews for patients with learning disabilities during our assessment.

The health inequalities lead monitored the number of referrals made to the social prescribing service and provided a report to the provider each year, summarising the outcomes of each project. At the time of this assessment, some projects had not been evaluated and this was planned for later in the year. However, where patient feedback was available, it was positive.

The provider shared examples of quality improvement projects and audits they had carried out to improve care and treatment.

For example, the practice had acted to improve care and treatment delivered to patients with diabetes. They had implemented processes to prompt clinicians to take urgent action if adjustments to medicines were needed following blood test results.

The practice had reviewed and improved their processes for how they recorded and monitored information when making urgent gastroenterology referrals.

The practice had carried out an audit in September 2024 of asthma patients. This audit identified a number of processes that could be improved to reduce the number of patients who were unnecessarily prescribed medicines. We also found during this assessment, further work was needed to improve quality of care being delivered to patients with asthma.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment. Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.