Birchwood 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

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this. This is the first inspection under our new methodology for this service. This key question has been rated as good.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. The national GP patient survey showed 81% of people who stated that the last time they had a GP appointment the healthcare professional was good or very good at listening to them. This was in line with national targets. The reception staff were aware of the needs of the local community. 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. Staff checked people’s health, care, and well-being needs during health reviews. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and well-being. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Clinical records we saw demonstrated care was not always provided in line with current guidance. For example, we reviewed the management of patients with asthma who had been prescribed two or more courses of rescue steroids within the last 12 months for exacerbations of asthma. Guidance from the National Institute for Health and Care Excellence (NICE) recommends patients should be reviewed within 48 hours of an acute asthma exacerbation to review the patient’s response to treatment. Our search identified 1,407 patients diagnosed with asthma, with 90 patients identified who were prescribed two or more courses of rescue steroids. We conducted a detailed review of five patients’ care records and saw these patients were not always followed up within a week of their exacerbation.

The processes for shared care agreements for teratogenic medicines (medicine that can cause foetal abnormalities in pregnancy) required strengthening. People prescribed these medicines should have 2 consultants to agree the use of this medicine and we identified this was not always happening.

Staff meetings were held weekly and all national guidelines were available on the practice internal computerised system used.

The service worked well across teams and services to support people. They shared their assessment of people’s needs when people moved between different services within secondary care. There were processes in place for the monitoring and auditing of patients who were referred to secondary care providers under a 2-week wait referral. The provider conducted practice meetings weekly and staff meeting minutes were provided to staff.

The service did not always support people in managing their health and well-being, so people could not always maximise their independence, choice, and control. The service did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. We identified 150 out of 1255 people diagnosed with diabetes who had not received the appropriate monitoring. A random sample of 5 records showed that 1 person had overdue blood testing required and 4 people out of the 5 sampled records had no up-to-date blood pressure reading. There was a risk of some deterioration or complication of diabetes which could be missed, or treatment may have been suboptimal. We asked the provider to review these people. Staff did support national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.

The service did not monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. For example, our clinical searches found that 5 out of 16 people diagnosed with hypothyroidism had not received appropriate monitoring. A random sample of 5 records identified all service users were overdue blood testing. People were at risk of being over-treated and having cardiac concerns or undertreated for hypothyroidism and at risk of lethargy. We told the provider to complete a review of all these patients immediately.

The service 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. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation. Our clinical searches reviewed peoples records and found no concerns with DNACPR processes for reviewing and documenting.