Castle Healthcare Practice

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.

At our last assessment, we rated this key question as Good. At this assessment, the rating remained the same.

This service scored 79 (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. 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 wellbeing needs during health reviews. Where patients were prone to not attending for regular tests, staff used flags to inform the team to use appointments opportunistically to offer additional services such as vaccinations or cervical screening.

Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The provider had effective systems to identify people with previously undiagnosed conditions. Patients had access to a blood pressure monitor, which they were invited to use to help identify possible hypertension. The practice offered regular health checks for at risk groups of patients.

Our review of patient records showed that medication reviews were always comprehensive, and they had always involved patients and fully considered their needs.

Staff referred people with additional or social needs, such as those experiencing social isolation or wanting access to additional support such as weight management, to a social prescriber.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People were involved in decisions about their care, including what was important and mattered to them, including, end of life care.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance. For example, we reviewed medical records for five people with diabetes. All patients being managed appropriately.

Staff had access to local and national guidelines which could be accessed easily through online platforms with links to guidance also available through their clinical system. Updates to guidance were shared with all relevant staff at meetings whose minutes were circulated to ensure all staff were aware.

Staff we spoke with told us they held clinics to support people with long term conditions such as asthma, diabetes and chronic heart disease. They told us they used local and national guidelines and kept up to date through training and updates were circulated within the practice.

Clinical audits were conducted to ensure care was delivered in line with legislation and recommended guidelines. For example, the practice carried out regular audits of women of childbearing age receiving topiramate (a medicine used to treat epilepsy and bipolar disorder which if taken during pregnancy, can cause birth defects). Women identified were contacted and consulted regarding contraception advice or medication changes if they wanted to get pregnant.

The service worked well across teams and services to support people. They shared their assessment of needs when people moved between different services. Staff told us they informed services of additional needs including the need for interpreters and longer appointments when making referrals to other services.

Referrals to other services were audited to ensure that appointments were created for people in a timely manner, for example, when people were referred for suspected cancers.

The practice held monthly multidisciplinary meetings with community nurses, palliative care nurses and specialist nurses, to review vulnerable people’s holistic care and treatment, including people with a cancer diagnosis. The practice held weekly lunch and learn sessions every Friday where they invited guests into the practice to share information about new medication or community initiatives.

All staff told us they felt the team worked well together at the practice for the benefit of patients. They felt communication clear and consistent and there were various systems in place where could get information, including daily briefing meetings, staff WhatsApp groups including a cascade feature and internal notification systems.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff focussed on identifying risks to patients’ health, including patients at risk of developing a long-term condition and those with caring responsibilities. The practice had a carers’ lead in place and initiatives including the codes to identify carers on clinical records and offering services such as vaccinations and options to have joint appointments. For example, mothers of newborn babies were often offered a joint appointment for their post birth check at the same time as their baby’s immunisations to prevent them having to attend the practice twice.

Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity. Patients were offered health checks and given advice on stopping smoking and where required sign posted to the social prescriber for additional support. The reception and waiting area had leaflets on numerous conditions and services including losing weight, exercise, stopping drinking and mental health support.

The practice had an active social media page where they advertised local events and health initiatives.

The practice through the support of their PPG ran campaigns and themed notice boards including a recent campaign on diabetes. This notice board consisted of leaflets in different languages to suit the populations needs.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

From national data in June 2024 we found the uptake for cervical screening for 25- to 49-year-olds was 78.6% and, 83.8% for women aged 50- to 64-year-olds. The uptake for women aged 50 to 64 met the national target of 80% but the uptake for 25- to 49-year-olds did not meet this target. Staff told us they put additional systems in place to encourage patients attend screening including sending out letters on pink paper to help draw attention to it and putting additional notes on patient records to inform colleagues to encourage screening if patients attended appointments for other reasons opportunistically.

National data for the period 01 April 2023 and 31 March 2024 showed 4 of the 5 indicators for childhood immunisations had achieved the 90% minimum target however, the uptake of children aged 5 who had received immunisation for measles, mumps and rubella was at 86.8%, which was below the 90% minimum target. There were effective systems in place to follow up people who failed to attend for these appointments. Systems included the lead nurse contacting parents and guardians, informing them of the benefits of immunisations and risks of not having them. There was also a system in place to offer vaccines once children had reached the age to consent to their care and treatment.

The service provided flexibility for people to book appointments for childhood immunisations and cervical cytology screening at early morning appointments and evenings.

From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. The practice had effective processes for recording consent within the medical record.

The staff had good knowledge of gaining and assessing consent options allowing the delivery of person-centred care and treatment which was in the person’s best interest. This included young people and people who did not have capacity to consent to care and treatment.

Staff understood and applied legislation relating to consent. We saw examples where capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and made and reviewed in line with relevant legislation. We saw effective review processes in place where these decisions were discussed and reviewed with patients.