Albany Surgery

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 looked for evidence that 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.

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

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 service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs.

Staff were aware of the needs of the local community. 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. 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. For example, our clinical searches identified 25 people with a potential missed diagnosis of diabetes. We reviewed 5 of these records and found all 5 had been managed appropriately.We discussed with the service why our searches had identified these people, and it was found to be a coding error. The service followed this up with its clinical system provider to ensure codes were recorded in a timelier manner’.

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

The service had a nominated ‘carers champion’ who ensured the needs of carers of people using services were also assessed and met. This supported their health and well-being in their carer roles and helped them to provide safe and effective care to the people they support.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation.

Staff told us they had protected time to complete continuous professional development, The service supported and encouraged staff to pursue further training in their specific areas of interest as this enabled them to keep up to date with current guidance to provide effective care and treatment.

Clinical records we reviewed as part of this assessment demonstrated care was provided in line with current guidance.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service carried out weekly ward rounds providing care and treatment to people residing in 4 local care homes. Feedback from the care homes was consistently positive about the service. Staff at the care homes told us they had a dedicated telephone number to contact the service therefore bypassing any queues. They told us the service always showed commitment to people’s wellbeing and safety.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support.

The service worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff focussed on identifying risks to people’s health, including those in the last 12 months of their lives, at risk of developing a long-term condition and those with caring responsibilities. Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.

The service website contained information and links to other sources of information to support people to make healthier choices and support their lifestyles.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Childhood immunisations data from April 2023 to March 2024 showed the service had exceeded the national target of 90% for 4 out of 5 of the childhood immunisation indicators.

Cervical screening data from June 2024 showed the service had not met the national target of 80%. However, unverified data shared by the service showed they had met the 80% target as of November 2025. This indicator enables a service to monitor coverage and thus implement interventions to increase uptake where appropriate. For example the service had recently offered appointments during the evenings and at weekends which had helped increase the uptake of cervical screening appointments.

From the clinical notes we reviewed, we noted people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

Our clinical searches identified 76 people diagnosed with asthma who have had 2 or more courses of rescue steroids in the last 12 months (treatment for severe asthma episodes). We reviewed 5 of these records and found 2 people had not received a follow-up review following an acute exacerbation (sudden, severe worsening of a chronic disease's symptoms) in line with best practice guidance. The service immediately contacted the people involved and arranged a review of their condition. The service also updated their current processes to be in line with the National Institute for Health and Care Excellence guidance (NICE).

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Policies, protocols, and guidance were followed to support people to consent to care and treatment. All staff had completed Mental Capacity Act training. Staff understood and applied legislation relating to consent.

We reviewed 5 patient records which showed capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.