Headstone Lane Medical Centre

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

At our last assessment, we rated this key question as good. At this assessment, the rating has remained good. People’s immediate and ongoing needs were fully assessed. Where appropriate this included their clinical needs and their mental and physical wellbeing. People were advised what to do if their condition got worse and where to seek further help and support. People were involved in the assessment of their needs, and support was provided where needed to maximise their involvement. The needs of carers of people using services were assessed and met. Care planning with the involvement of multi-disciplinary teams enabled a person-centred approach to delivering care and treatment.

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.

Patients told us they had been assessed and received referral to hospital and were followed up appropriately. Patients told us they had received their chronic disease follow up in a timely way and the clinician communicated with them in a way that was easy to understand. Patient feedback was positive in respect of clinical teams meeting patients’ needs.

Staff told us they prioritised patients who were clinically vulnerable to ensure their needs were assessed and any immediate care and treatment was delivered.

Leaders and staff told us codes and alerts were added to patient records to ensure patients’ communication; disabilities and any impairment needs were highlighted for staff to tailor patient care. Staff told us, and we saw evidence in clinical records, of clear documentation to support clinicians’ decision making. Patients were made aware of seeking further help if their condition deteriorated. Staff told us they checked patient’s health, care, wellbeing, and communication needs during health reviews.

The systems in place ensured patients’ assessments were up-to-date and staff understood their current needs. Patients experienced appropriate referral pathways to make sure their needs were further assessed and addressed. The practice had systems to identify and prioritise care and treatment for its most vulnerable patients. For example, we saw that all patients with a learning disability were offered an annual health check. The practice held a register identifying patients with caring responsibilities and other registers for vulnerable patients including a mental health register and safeguarding register.

Patients told us clinicians involved them in their care and treatment. Patients also feedback they were able to access face to face consultations, telephone consultations and urgent appointments.

Staff told us that the leaders provided opportunities for them to keep up to date with the current guidelines and changes to evidence-based care and treatment. Staff told us they were able to attend meetings to discuss cases and new guidelines, and minutes of the meetings were available should they need them. Routine reviews and audits were undertaken to ensure staff were adhering to the most up to date guidelines.

The practice had systems and processes to keep clinicians up to date with and to monitor their use of current evidence-based practice. The minutes of clinical meetings evidence that discussing new guidelines was a standard item on their agenda.

We received feedback stating that the whole practice team delivered a positive experience.

Staff told us they were proud of the cohesive team working relationships they had to ensure all patients received high quality healthcare. They told us they were engaged with the leaders to be innovative and meet their patients’ needs. Staff gave examples of working with other services, so patients were referred, reviewed and supported appropriately.

We received positive feedback from partners about the way staff and services worked together.

Staff had all the information they needed to deliver safe care and treatment. There were clear policies and procedures in place, and these were easily available for staff to use. There were systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment. The processes in place enabled staff to liaise regularly with community teams such as community nurses, health visitors and mental health practitioners. Referrals to specialist services were documented, contained the required information and there was a system to monitor delays in referrals.

Patients we spoke with and received comments from gave examples of health checks and long-term condition checks they had received in the previous 12 months.

Staff told us they promoted and encouraged living healthier lives. The practice encouraged patients in other lifestyle choices, such as supporting those who wanted to stop smoking and those who need help and support to manage health eating.

The practice had systems and processes to ensure patients had access to appropriate health assessments and checks including NHS checks for patients aged 40 to 74. There were systems to allow appropriate and timely follow-up on the outcome of health assessments and checks where abnormalities or risk factors were identified. All patients with a learning disability were offered an annual health check. Patients with long-term conditions were offered an effective annual review to check their health and medicines needs were being met.

Patients spoke positively about proactive monitoring. For example, being offered regular reviews for long-term conditions.

Feedback received from staff and leaders was positive about monitoring and improving outcomes. The practice demonstrated a recall system for patients to ensure appropriate and timely monitoring. Staff told us the system in place enabled them to ensure every contact counted and reduced the number of times patients needed to attend the practice. They told us this approach to monitoring patients had improved outcomes for patients.

The practice had a comprehensive programme of quality improvement activity and reviewed the effectiveness and appropriateness of care provided.

The practice had undertaken detailed audits to ensure they had up-to-date information and had reviewed their processes. They had undertaken detailed reviews of the patients who had not attended and had contacted them. The practice offered a flexible approach to appointments for workers, parents/guardians to book appointments at times that were convenient to them. Clinical staff were proactive to encourage patients to attend their screening appointments and offered flexible booking of appointments.

The practice demonstrated they had a comprehensive approach to understanding the performance of the practice in respect of outcomes for patients.

As part of this assessment, we ran a suite of clinical searches. From these and the selection of records we reviewed we were assured that the practice prioritised and had a proactive approach to positive outcomes for patients.

We did not receive any concerns from patients we had feedback from or who we spoke with regarding consent.

Staff told us they always obtained consent from patients and offered a chaperone where appropriate. This was recorded on the clinical system. They told us for some procedures written consent was discussed with and obtained from the patient. Clinicians told us they understood these requirements when considering consent and decision making. Clinicians told us they supported patients to make decisions, and where appropriate, they assessed and recorded a patient’s mental capacity to make a decision.

The practice had systems and processes in place to obtained consent to care and treatment in line with legislation and guidance. We saw that consent including written consent for some procedures was documented. There were clear systems and processes in place for ensuring patients decisions in respect of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR), were made in line with relevant legislation and were appropriate. There was a process in place to ensure DNACPR forms were reviewed when the patient’s condition or circumstances changed.