Upper Thames Medical - The Park Surgery and Lechlade Medical

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 quality statements in the effective key question. This is the first inspection of this service since its registration with CQC. At this assessment, we rated the key question as: Good. Staff involved people in the assessment of their needs, and support was provided where needed, to maximise their involvement. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving between services. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those individuals important to them in making decisions in people’s best interests where they did not have capacity.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt involved in the assessment of their needs and confident that staff understood their individual and cultural needs. Staff were aware of the needs of the local community. Digital flags on patients records highlighted additional support, such as the requirement for longer appointments or for a translator to be present. Care and treatment was regularly reviewed and updated. People were required to complete an online form to request an appointment. If people were not able to do this reception staff and care navigators would help with the completion of the form. GPs reviewed all online forms each day and advised the care navigators of what action to take e.g. book appointment within specified time frames. Care navigators could book urgent on the day appointments and routine appointments within a longer time frame. The duty GP did not have an allocated clinic but saw emergencies, triaged online forms and responded to external professionals’ queries. We reviewed the appointment diary and saw appointments were available to book the same day for urgent appointments and on the following few days for routine appointments with nurses. However, we observed the next available routine appointments for GPs was for 14 and 15 May, the receptionist confirmed that there had not been any patients who had said this was not soon enough. Our clinical searches identified 1550 people on the asthma register, 64 of those people had been prescribed 2 or more rescue steroids (treatment for severe asthma episodes) in the last 12 months. We reviewed 5 of these patient records and found 3 people had not been reviewed appropriately in line with national guidance, including an assessment at the time of prescribing and a timely follow up to check the response to treatment. Following our on-site visit, the service acted swiftly and implemented a new process to ensure people received the appropriate assessment and follow up.

Systems and processes were followed to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we reviewed demonstrated care was provided in line with current guidance.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The provider worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. People received consistent person-centred care when they moved between services.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff focused on identifying risks to people’s health, including those in the last 12 months of their lives, people at risk of developing a long-term condition and those with caring responsibilities. The practice website contained information and links to other sources of information to support people to make healthier choices and support their lifestyles.

There was a system and process to review health conditions such as diabetes and chronic kidney disease (CKD). However, our remote clinical searches identified some people had not been monitored appropriately. For example, our clinical searches identified 129 people with diabetes who had an HbA1c result of 75mmol/mol (a high average blood sugar level indicating increased risk of complications). We looked at a sample of 5 patient records, and 4 had not received the appropriate monitoring. Following this being identified, the practice provided evidence these people had been reviewed. Verified data for cervical screening available at the time of this assessment was from June 2023 and showed the practice was not meeting the national uptake target of 80%. However, unverified data shared by the practice showed they were achieving the national target. We also found the verified data for childhood immunisations, available at the time of this assessment, was from June 2023 and showed the practice was not meeting the national uptake target of 95%. However, unverified data shared by the practice showed they were achieving the national target. Our clinical searches identified 485 people diagnosed with hypothyroidism (a condition where the thyroid does not produce enough hormones). We identified 7 people who had not received the appropriate monitoring in the last 18 months. We reviewed 5 patient records and found 2 had not been reviewed in line with guidance. Following this being identified, the practice provided evidence these people had been reviewed.

Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. Staff had completed Mental Capacity Act Training. Policies, protocols and guidance followed supported people to make decisions and consent to care and treatment. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.