The Parkshot Medical Practice

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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

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 remains the same.

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.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. Feedback received by the Care Quality Commission (CQC) through the online “Give Feedback on Care” forms was generally positive. Patients reported that they were “made to feel at ease, listened to, and had information explained clearly,” and that staff “answered all my questions and ensured I understood my care.” Reception staff were aware of the needs of the local community. They 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 explained that the reviews went beyond clinical checks to look at each person’s wider wellbeing, making the discussions meaningful and personalised. The provider had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, 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.

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. The practice established a Diabetes working group focusing on patients with poorly controlled HbA1c levels (a test that measures the average level of blood sugar over time), as well as those who were more vulnerable or experienced difficulties accessing care. Clinical data was used to proactively identify and monitor these patients, enabling tailored interventions to improve outcomes. We saw that all patients had timely reviews, with HbA1c blood tests carried out in line with national guidelines.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. Staff told us they had attended multidisciplinary meetings, such as Proactive Anticipatory Care (PAC), which were designed to prevent crises, reduce hospital admissions, and help people remain independent at home.

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 those in the last 12 months of their lives, patients at risk of developing a long-term condition and those with caring responsibilities. Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.

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.The practice had not met national targets for screening and immunisations, but was performing similarly to local averages, and was involved with a local project to improve uptake. To improve uptake of childhood immunisations, the practice offered flexible appointment times to increase access and convenience for families. Following a risk assessment, the practice reviewed its vaccination uptake and recall processes and reassigned responsibility for invitations and recalls for children aged 12 months and over from the nursing team to administrative coding staff. The escalation process for non-attendance and vaccine declinations was also revised to ensure earlier GP review of potential safeguarding concerns and to support informed, patient-centred discussions with vaccine-hesitant parents.To address the uptake of cervical screening, the provider took part in “Improving Cervical Screening Uptake Across Richmond Primary Care Network” Identifying a community need in April 2024. Care coordinators contacted eligible patients to discuss screening, address concerns, provide education, and support appointment booking. The initiative focused on patients aged 25–59 who had never attended screening and those aged 60–65 who had not attended for seven years or more. This personalised approach improved informed decision-making, increased participation, and supported earlier identification of patients requiring further investigation and treatment. As a result, the practice reported that the screening uptake improved across all age groups. The provider also joined a Human Papillomavirus (HPV) self-testing pilot, and identified around 800 eligible patients, trained clinical staff, and risk-stratified patients to prioritise invitations for those most overdue for screening.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.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.