The Willow Tree 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

This means we looked for evidence people had the best possible outcomes because their needs were assessed and care and treatment were provided in line with up-to-date best practice.

At our last inspection with the previous provider, we rated this key question requires improvement. At this inspection, the rating has changed to good.

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 took decisions in people’s best interests where they did not have capacity.
 

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them. For example, reasonable adjustments and home visits were put in place based on people’s individual needs.

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, which included assessing the health and needs of people who were seeking asylum.

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

Our remote clinical searches identified 4 patients as having a potential missed diagnosis of diabetes. Staff provided evidence that they had addressed this during our assessment and confirmed that these patients were not diabetic.There was also a patient who had diabetes that we found had a high blood pressure result recorded on their record, but this had not been reviewed. During the assessment staff took steps to review the patient and provided assurances that the patient had carried out home blood pressure monitoring which showed that the person's blood pressure was in a healthy range.

During our remote clinical searches, we reviewed the practices processes for supporting people with a long-term condition. We saw that patients with asthma who had been prescribed 2 or more courses of rescue steroids in the last 12 months had been appropriately reviewed by a clinician.
Our searches also showed that patients with chronic kidney disease and hypothyroidism had been monitored.

Practice staff 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. Clinical records we saw demonstrated care was provided in line with current guidance.

Leaders provided opportunities for staff to keep up to date with current guidelines, and changes to evidence-based care and treatment. Staff had regular developmental training sessions and were given protected time for learning. Evidence-based information was also shared during regular clinical meetings.

Clinical records we saw through our searches showed practice staff provided care that was in line with current guidance. Staff described systems and processes in place to recall and review people with long-term conditions according to their requirements.

Results from the latest GP National Patient Survey showed 84% of respondents stated that during their last appointment they had confidence and trust in the healthcare professional they saw or spoke to. This was below the expected average of 93%. However, people we spoke with during our assessment gave positive feedback in relation to the clinical care and treatment they received.

Practice staff consistently worked well across teams and services to support people, which helped to prevent delays in treatment and provided people with continuity of care. Patients we spoke with told us that they had received person centred care when they moved between services.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. People had access to services provided by the primary care network (PCN), including physiotherapy, social prescribers, and extended access appointments.

Practice staff always engaged with the local community. For example, the practice hosted vaccination and complex wound dressing clinics and worked closely with local asylum hotels. The practice also participated in health promotion programmes such as Hepatitis C screening and access to a wellbeing bus. The wellbeing bus provided a convenient and safe place for people to receive health screening which aimed to reduce anxiety and stigma.

Referrals to other services were monitored to ensure that appointments were created for people in a timely manner. For example, the medical secretary regularly checked that people referred to suspected cancer services had received an appointment from the hospital. The practice regularly held multidisciplinary meetings to review vulnerable people’s holistic care and treatment.

Practice staff always supported people to manage their health and wellbeing to fully maximise their independence, choice, and control. The practice supported people to live healthier lives and where possible, reduce their future needs for care and support. For example, the service had introduced a wellbeing room where people could go to for a safe place of support.

During our visit to the practice, we saw an area in the waiting room where patients could use a self-testing blood pressure machine, weighing scales and height measurement device. This area was spacious and accessible. People were advised that their results would be uploaded into their medical record and clinical staff would be notified to review and act, when necessary.

Staff focused on identifying risks to patients’ health, including those in the last 12 months of their lives, patients 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. Leaders identified that there was a high number of smokers registered at the practice. As a result, the practice hosted a smoking cessation advisor at the premises to support people to stop smoking.

Results from the National GP Patient Survey showed that 56% of respondents answered positively to the overall experience of their GP practice. This is below the expected average of 75%. The practice recognised this, and staff had worked to build connections with patients and carers. People we spoke with during our visit gave positive feedback about being supported to manage their health.

The provider planned to redesign a garden space for patients to access a bright and calming area while waiting for their appointments.

The practice recognised that they had not always met national targets for national screening and immunisations. Practice staff were keen to make improvements. Leaders told us that vaccines were given opportunistically to try to improve uptake. The practice was below the national targets for cervical screening; however, they continued to improve the uptake by reviewing their recall system and ways to encourage attendance. For example, they engaged with local outreach services, such as a mobile cervical screening programme.

Practice staff 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. There was a system in place for completing a wide range of clinical audit cycles.

Patients aged between 40 and 74 are eligible for an NHS health check. The practice told us they had completed a health check with 115 patients out of the 1173 patients registered with the practice who could have one. The practice also offered patients with a learning disability a yearly health check, and the uptake of this was 75%. The practice was continuing to provide reasonable adjustments to encourage patients to attend for their reviews.

There were policies in place to support staff when obtaining consent from adults, children and people who lacked mental capacity. Staff told people 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 in patients’ clinical records.

Staff we spoke with had completed training on consent and the Mental Capacity Act and had a good understanding. Clinicians supported people to make decisions, and where appropriate, they involved relevant advocates to support them.

Chaperones were available upon request. This information was on display in the form of posters throughout the practice.

We looked at a sample of ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) decisions in patient records to ensure that decisions were made in consultation with the patient or, where appropriate, their family or carers. Appropriately completed documents were available, and DNACPR decisions were suitable and were made in line with relevant legislation. We saw evidence of detailed and compassionate conversations.