Hodge Hill Family 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.

This is the first inspection for this service since its registration with CQC. This key question has been rated as good.

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. 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 wellbeing needs during health reviews. 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. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber. The practice had developed a triage sheet to support reception staff to navigate patients effectively to the right clinician or emergency services.

Our remote clinical searches identified 1 patient as having a potential missed diagnosis of diabetes. Staff provided evidence that they had addressed this during our assessment and confirmed that this patient was booked in for a blood test.

During our remote clinical searches, we reviewed the practices processes for supporting people with a long-term condition. We saw that patients with asthma who had been prescribed 2 or more courses of rescue steroids in the last 12 months had been appropriately reviewed by a clinician.

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. Staff we spoke to were knowledgeable in their role and demonstrated how they kept up to date with standards through notifications, individual and group learning.

Results from the latest GP National Patient Survey showed 82% of respondents stated that during their last appointment they had confidence and trust in the healthcare professional they saw or spoke to. This was below the expected average of 93%. However, people we spoke with during our assessment gave positive feedback in relation to the clinical care and treatment they received.

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.

Referrals to other services were monitored to ensure that appointments were created for people in a timely manner. For example, the medical secretary regularly checked that people referred to cancer services had received an appointment from the hospital. The practice regularly held multidisciplinary meetings to review vulnerable people’s holistic care and treatment.

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 practice also offered diabetic eye screening and community mental health support appointment within the practice, so patients felt comfortable in the environment they know.

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 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 practice were slightly below national targets for screening and immunisations. The practice offered set appointments for immunisations and cervical screening but were also flexible to meet the needs of their population, they were able to do this through offering extended access appointments. The practice was aware of their patient demographic and offered educational sessions for their patients. They also offered literature in a variety of languages to support the uptake of screening and immunisations. The practice had a quality improvement programme involving repeat audits, which helped deliver effective care and support staff with additional learning needs.

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. Through our access to the clinical system, we reviewed Do not attempt cardiopulmonary resuscitation (DNACPR) and found decisions were appropriate and were made in line with relevant legislation.