The University Health Centre

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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

At our last assessment, we rated this key question as requires improvement and issued a breach of Regulation 12 (Safe care and treatment) as there were gaps in the management of some patients with long-term conditions. At this assessment, we found the practice had made improvements and is now rated good. We found patients 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 patients’ care for the best outcomes and smooth transitions when moving services. Staff made sure patients understood their care and treatment to enable them to give informed consent.

This service scored 71 (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 made sure patients’ care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. 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. From a selection of patient records reviewed, we saw that overall patient consultations contained appropriate information and demonstrated that care and treatment was being delivered in a safe way.

The practice planned and delivered patients’ care and treatment in line with legislation and current evidence-based good practice and standards. Clinical guidance and updates were discussed in clinical meetings and in practice protected time.

As part of our assessment, a CQC GP specialist advisor (SpA) conducted a series of remote clinical searches of patient records to assess the practice’s procedures around the management of patients with long-term conditions. For example, asthma, chronic kidney disease, diabetes and hypothyroidism. We found the practice had good management of these patients and from a selection of patient records reviewed, we saw that overall patient consultations contained appropriate information and demonstrated that care and treatment was being delivered in a safe way. There were no patients with a potential missed diagnosis of diabetes or chronic kidney disease.

The practice worked well across teams and services to support patients. Staff had access to the information they needed to appropriately assess, plan, and deliver care, treatment, and support. We saw there were systems and processes in place to ensure care was delivered and reviewed in a coordinated way which included those with a learning disability. There were regular documented multi-disciplinary team meetings.

The practice supported patients to manage their health and wellbeing to maximise their independence, choice and control. Staff told us they were committed to promoting and encouraging patients to live heathier lives. They told us they used consultations to opportunistically discuss health choices and provide supporting information. This included encouraging patients to attend health checks and reviews and signposting to support groups and self-help advice. Staff told us they supported national health priorities, initiatives and screening programmes to improve the population’s health, for example, breast and bowel screening. Patients had access to a social prescriber, which helped them improve their health, wellbeing and social welfare by connecting them to community services. We saw the practice website had links to health and wellbeing information. The practice included health events and promotion on noticeboards in their waiting area. The practice signposted patients to the NHS Community Pharmacist Service, where appropriate.

The practice routinely monitored patient care and treatment to continuously improve it. We saw that the practice had a programme of quality improvement, including clinical and non-clinical audits, to drive improvements in care and treatment. There were patient registers in place, for example, those with a long-term condition and those with a learning disability. The practice operated a recall system to ensure patients were offered appropriate health assessments and checks.

Since our last inspection the practice had continued to focus on their childhood immunisation outcomes, and we saw that the practice had made improvements. For example, the percentage of children aged 1 who had completed a primary course of immunisation for Diphtheria, Tetanus, Polio, Pertussis, Haemophilus influenza type b (Hib), Hepatitis B (Hep B) was 93.8% (last inspection 90.3%); the percentage of children aged 2 who had received immunisation for measles, mumps and rubella was 93.1% (last inspection 76.9%); the percentage of children aged 2 who had received their immunisation for Haemophilus influenza type b (Hib) and Meningitis C (MenC) was 97.5% (last inspection 76.9%), the percentage of children aged 2 who had received their booster immunisation for pneumococcal infection was 97.5% (last inspection 78.2%) and the percentage of children aged 5 who had received immunisation for measles, mumps and rubella was 81.8% (last inspection 74.4%).

At our last inspection, the percentage of persons eligible for cervical cancer screening who were screened adequately within a specified period (within 3.5 years for persons aged 25 to 49, and within 5.5 years for persons aged 50 to 64) was 37.5%. The practice recognised that this continued to be a challenging area as a university practice, as there was a significant international population and a large turnover of patients every year. The practice continued to promote cancer screening at the registration process and actively and opportunistically encouraged eligible patients to have cervical screening during consultations. The practice had a cancer champion and demonstrated a systematic recall process. At this assessment we found for the age group 25 to 49 years old that the uptake was 35.7% and for the age group 50 to 64 years old the uptake was 70.6%.

Clinicians understood the requirements of legislation and guidance around people’s consent to care and treatment, including the assessment of a person’s mental capacity to make a decision. When needed, clinicians supported patients and involved their families, carers and other professionals to make decisions in the person’s best interests, including decisions about Do Not Attempt Cardio- Pulmonary Resuscitation (DNACPR). We reviewed 2 patient records and saw evidence of the patient and their relatives being involved in end-of-life care discussions. We saw Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) care plans were used to record patient wishes regarding care and resuscitation and these were stored in the clinical records. Records showed that staff had undertaken Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training. Staff were aware of the need to request consent to share records in line with General Data Protection Regulation (GDPR) principles. There was a formal consent form in place for invasive procedures, such as minor surgery.