Berrycroft Community Health 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

We assessed all the quality statements in the effective key question. We found that patient care was nearly always planned and delivered in line with national guidance. Consent was sought from patients and there were processes to support staff in protecting patients rights in regards to consent. Staff received supervision, support and training.

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.

From our extensive searches on the clinical records system, we identified patients were receiving the assessments, including tests, they required to ensure effective care planning. Diagnostics and consultations for long term condition care were undertaken to ensure effective care planning. We found a very small number of patients with potential undiagnosed diabetes and reported these findings to the practice. The practice took immediate action to review the patients on this search finding and ensure appropriate tests were undertaken.

Leaders and staff informed us the practice provided health screening and diagnostic appointments such as blood tests via their phlebotomists. The practices performance in performing cervical screening for eligible patients was below the national target. Practice leaders informed us staff review eligible patients throughout the year, and call them in for cervical screening and this also send an email invite if necessary. They informed us nursing staff check to see if a patient is overdue for screening and will advise them if necessary to book an appointment.

Patients were provided with treatment plans and information regarding their health conditions. For example, patients with asthma and diabetes were given educational information to assist them in planning and ensuring self-care. Nurses explained the practice assessed patients ongoing needs through routine checks and testing which was centrally organised by support staff. They were supported by healthcare assistants and GPs. There were assessment tools for reception and support staff to assess the appropriate clinician or appointment needed by a patient.

From our clinical searches we identified patients were delivered care in line with evidence based guidance. We found a small number of patients had received 2 or more courses of rescue steroids in the last 12 months where some required interventions had not taken place. The practice reviewed these patients immediately after the inspection.

The nursing team and support staff explained the processes they used to deliver evidence based long term conditions care. They were provided with updates to national clinical guidance and had clinical templates which were regularly reviewed to ensure they delivered up to date care to patients.

Clinicians were provided with local protocols for referring patients and delivering care within patient pathways which reflected national guidance. Patients with a learning disability were offered an annual health check. Data provided by the practice indicated that all the patients on this register had received a health-check. We were unable to verify this finding on the clinical records.

Patient feedback did not indicate significant concerns with the coordination of care within the practice or between the service and external providers.

Staff informed us there were processes for managing correspondence and referrals to external services. The nursing team informed us they worked closely as a team to deliver holistic care.

A local care home provided feedback that the GP practice shared information with care home residents, care home staff and coordinated peoples care effectively.

There were processes for managing correspondence and referrals to external services. The nursing team informed us they worked closely as a team to deliver holistic care.

Patients were provided with treatment plans and information regarding their health conditions. We saw information for patients regarding health and wellbeing was made available on the practice’s website and information boards in the practice building.

Nursing staff informed us they supported and advised patients on how to lead healthier lives and how to manage their long term conditions independently.

The clinical record system contained alerts and coding to assist clinicians in monitoring patients wellbeing over time.

Patient feedback did not include reference to the monitoring and improving outcomes of care.

Staff contributed to quality improvement activity and risk monitoring audits such as infection control, prescribing and premises audits. Nurses were involved in clinical audits.

We looked at the practice’s audit planner. This included a variety of clinical and non-clinical audits. There were prescribing audits which were used to monitor and identify improvements to the use of specific medicines and review the practices prescribing alongside national guidance. We asked to see examples of other clinical audits which identified improvements over time. There was an audit into the care of babies with cow’s milk allergies which had been repeated to continue reviewing the adherence to national guidance. The practice provided no other clinical quality improvement audits which had been repeated to identify whether improvements to clinical care were being made as a result of audit, other than those related to prescribing.

Patient outcomes regarding the care of long term conditions and prescribing of high risk medicines were overall positive. The practice was monitoring the recall systems used to ensure patients received timely interventions. The practice had identified ways to enhance the process for long term conditions reviews as part of their system of quality improvement. For example, diversifying the means by which the reviews could take place including combining partial or fully virtual long term condition reviews and combining them with medication reviews.

Feedback from the GP national survey in 2023 indicated people felt involved in their care and treatment decisions. There were no themes regarding consent from any other patient feedback.

Clinicians understood the requirements of legislation and guidance when considering consent and decision making.

There was guidance and training for staff in consent and related legislation such as the Mental Capacity Act (2005) and legal guidance such as the Gillick Competency (regarding consent for young people under 16 years of age).