Cossington Park 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 looked for evidence that staff involved patients in decisions about their care and treatment and provided them with advice and support. Staff routinely reviewed patients care and worked with other services to achieve this.

At our previous comprehensive assessment, we rated this key question as Requires Improvement. At this assessment, we rated this key question as Good.

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.

The practice had systems and processes in place to identify patients’ needs and preferences during the registration process. The practice 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 patients’ health, care, and wellbeing needs during health reviews. Clinicians used templates when conducting reviews to support the assessment of patients’ wider health and wellbeing. Staff could refer patients with social needs, such as those experiencing social isolation or housing difficulties, to the Care Navigators who were able to signpost patients to appropriate services.

We discussed how clinicians identified and monitored patients at risk of developing a long-term condition. Clinicians explained they had systems and pathways established to follow. We undertook clinical record searches to review these systems. Clinical searches identified 6 patients as having a potential missed diagnosis of diabetes. We looked in detail at 5 patient records and found no issues with the care and treatment for these patients.

As part of our clinical searches, we also reviewed the care of patients with hypothyroidism (underactive thyroid). We identified 372 patients who were diagnosed with hypothyroidism. We found no issues with the thyroid function blood test monitoring for these patients.

The vast majority of feedback from patients using the service was positive. The National GP Patient Survey found 94% of patients felt their needs were met during their last general practice appointment.

There were systems in place to ensure staff were up to date with relevant legislation, evidence-based practice and required standards. Clinical meetings were in place to keep staff up to date. For clinicians who were unable to attend this meeting in person, these meetings were minuted and disseminated to all clinicians.

The remote clinical searches we undertook of the practice’s clinical records system included reviewing the monitoring of people with long-term conditions to assess if National Institute for Health and Care Excellence (NICE) recommendations were followed.

For example, we identified 26 out of 471 patients on the asthma register had been prescribed 2 or more courses of rescue steroids (Short-acting beta-2 agonist (SABA) inhalers - “reliever" inhalers used for quick relief from asthma symptoms like wheezing and breathlessness). We reviewed a sample of 5 patient records and found all 5 had received an adequate assessment at the time of the prescribing of rescue steroid. However, we found none of the 5 patients had been followed up to check their response to treatment in an appropriate timescale following the acute exacerbation of their asthma. National Institute for Health and Care Excellence (NICE) guidance recommends that patients receive a follow up within two working days. The practice took immediate action in response to our feedback in this area and all clinical staff were reminded of the NICE guidance and a new practice policy was developed.

As part of our clinical searches, we identified 59 patients with Chronic Kidney Disease Stages 4 or 5. We found no issues with the clinical monitoring of these patients.

As part of our clinical searches, we also identified 142 patients with diabetes whose last blood glucose reading was over 75. We reviewed a random sample of 5 patient records and found no issues with the care and treatment of these patients.

The practice worked well across teams and services to support patients. They made sure patients only needed to tell their story once by sharing their assessment of needs when people moved between different services. Staff had access to information they needed to assess, plan, and deliver patients’ care, treatment, and support. Systems were in place to share information about patients electronically with other services.

The practice worked with other services to ensure continuity of care and engaged in multi-disciplinary team (MDT) meetings. For example, for patients identified as approaching end of life, the practice referred to and worked closely with the community palliative care team. Home visits and care packages were implemented to ensure patients’ wishes were followed and carried out in their final stages of life.

The practice referred patients to the additional roles reimbursement scheme (ARRS) staff such as social prescribers and the ARRS pharmacists who provided both telephone and face to face appointments for patients for advice and support with their medicines management.

First contact practitioner (FCP) physiotherapy was also available for patients with musculoskeletal (joint, muscle, or nerve) pain to have appointments with a physiotherapist directly at the practice.

The practice supported patients to manage their health and wellbeing to maximise their independence, choice and control. The practice waiting area and practice website provided health information for patients.

Staff supported national priorities and initiatives to improve population health, including stopping smoking, diabetes prevention programme and tackling obesity.

For example, the practice signposted patients to the ‘Healthier You’ NHS diabetes prevention programme which identifies people at risk of developing type 2 diabetes and refers them onto a nine-month, evidence-based lifestyle change programme. This programme was available for patients to access either as a face-to-face group or as a digital service.

Staff also signposted patients to the ‘Better Health, Healthier Families’ NHS food scanner app designed to help people make better food choices and improve their health.

In addition to the NHS food scanner app, staff also promoted the ‘Joy App’ for patients which helps people to find activities, including local walking groups; and connect with local community groups and support services.

Leaders told us the practice was working towards achieving the Royal College of General Practitioners (RCGP) ‘Active Practice’ accreditation to demonstrate commitment to reducing sedentary behaviour in both patients and staff; increasing physical activity of both patients and staff; and partnering with a local physical activity provider.

The practice routinely monitored patients care and treatment to continuously improve it. Staff endeavoured to ensure that outcomes were positive and consistent, and that they met both the clinical expectations and the expectations of patients. The practice undertook regular clinical audits, and we were provided with evidence of two-cycle audits which demonstrated quality improvement. Staff focused on identifying risks to patients’ health, including those in the last 12 months of their lives and patients at risk of developing a long-term condition.

As part of our assessment, we reviewed the practice performance data for childhood immunisations. The World Health Organisation (WHO) recommends a rate of 95% for all routine childhood vaccinations. We found the practice was performing well for childhood immunisations.

Published national data showed the percentage of children aged 5 who had received immunisation for measles, mumps and rubella (two doses of MMR) was 94%.

The percentage of children aged 2 who had received immunisation for measles, mumps and rubella (one dose of MMR) was 95%.

The percentage of children aged 2 who had received their booster immunisation Pneumococcal infection was 95%.

The percentage of children aged 2 who have received their immunisation for Haemophilus influenza type b and Meningitis C was 95%.

The percentage of children aged 1 who had completed a primary course of immunisation for Diphtheria, Tetanus, Polio, Pertussis, Haemophilus influenza type b (Hib), and Hepatitis B (Hep B) was 94%.

In addition to childhood immunisation data, we reviewed published national data for the uptake of cervical screening. The practice had achieved 58%, which was significantly below the national target of 80%. The practice was working to improve the cervical screening uptake. Staff told us they made telephone calls to patients who failed to attend their appointments and arranged catch up clinics; and as part of the patient registration process, patients were asked when their last cervical screening test had been undertaken.

The practice told patients about their rights around consent and respected these when delivering person-centred care and treatment. A consent policy was in place to ensure appropriate consent was obtained from patients when receiving care and treatment. Staff understood the requirements of legislation and guidance when considering consent and decision making.

Patients were offered a chaperone for care and treatment when this was appropriate. Chaperone posters were on display at the practice to inform patients of this service and staff who provided this service had completed chaperone training.