Archived: Little Lever Health Centre-2

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 this key question.

Not all clinicians kept up to date with current evidence-based practice. Systems were not in place to ensure staff were up to date with national legislation and required standards. Approaches to monitor and improve people’s outcomes were not effective. The practice team did not work well together. The provider did not have a full understanding of legislation around consent.

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

This service scored 33 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from people using the service was mostly positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. However, patients had complained about assessments by the provider, and also about having long waiting times for their appointments.

Staff told us people often had to wait a long time past their appointment time to be seen by the provider. They said this caused difficulties, especially for young children. The provider told us they were unaware of some monitoring requirements for patients. Staff and leaders were aware of the needs of the local community. Staff checked people’s health, care, and wellbeing needs during health reviews.

The systems and processes to keep clinicians up to date with current evidence-based practice were not effective, so people’s ongoing needs were not always met. As part of the assessment a number of set clinical record searches were undertaken by a CQC GP specialist advisor. Several issues were highlighted. People prescribed anti-coagulant medicines had not all had the required safety monitoring. The provider told us they were not aware the monitoring was required. We looked at people with a potentially missed diagnosis of Chronic Kidney Disease. There were issues with 2 of the 5 people we checked, and the provider told us they were not aware that specific action should have been taken. Older people prescribed non-steroidal anti-inflammatory drugs (NSAIDs) or anti-platelet medicines were not routinely also prescribed proton pump inhibitors (PPIs) to decrease stomach acid. The provider told us they were unaware of this requirement.

Staff usually gave people information and advice about their health, care and support and how they can be as well as possible. However, we saw some people felt the information was not appropriate.

Discussion with the provider showed there was limited knowledge of up to date evidence based care and treatment. Clinical and non-clinical staff told us low staffing levels was a barrier to maintaining the quality of care provided.

The provider did not have robust systems to ensure staff were up to date with national legislation, evidence-based good practice and required standards. The provider did not have 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.

People received care that was coordinated, and everyone worked well together and with people.

Staff and managers told us they did not always feel listened to. They had raised concerns about aspects of the practice, and these had not been actioned. Some felt unable to raise concerns. Practice meetings were infrequent, but staff felt managers kept them updated.

We received limited feedback from partners. However, we heard the provider did not always work effectively with the practice team.

The practice had processes in place, so information was shared between teams and services to ensure continuity of care, for example when people are referred between services or learning was shared. The practice did not have regular meetings to ensure all staff, teams and services worked well together.

Staff provided care and support that enabled people to live as they want to, seeing them as a unique person with skills, strengths and goals.

Staff identified people who may need extra support and directed them to relevant services. This included people in the last 12 months of their lives and carers.

People were told when they needed to seek further help and what to do if their condition deteriorated. There was an established social prescribing team for adults and children to support people in a holistic way.

People we spoke with felt that their health was monitored appropriately and explained to them. However, our review of evidence showed us this was not always the case.

Leaders told us how they monitored people’s health and carried out a programme of audits to monitor improvements made. We were provided with examples of audits and projects taking place within the practice. Despite being advised an audit had taken place, we saw no evidence of learning or improvement in this area. The audits were usually carried out by a locum GP, and they were not routinely discussed in meetings.

As part of the inspection a number of set clinical record searches were undertaken by a CQC GP specialist advisor. The results from the searches demonstrated that there were some gaps in the monitoring of people which could impact on continuous improvements being made. The processes in place were not effective.

There were some positive results from the clinical searches undertaken. However, other results demonstrated approaches to monitor and improve people’s outcomes were not effective. People with asthma who had been prescribed 2 or more courses of rescue steroids were not routinely followed up after an exacerbation of their asthma, and the provider was unaware of the need for this.

Most people received information about care and treatment in a way they could understand and had appropriate support and time to make decisions. Do Not Attempt Cardiopulmonary Resuscitation decisions were documented and showed people were involved in these decisions. However, the consent of younger people was not always considered.

The provider did not have a good understanding of consent. We saw a particular example of a person not being involved in decisions about their care. We saw a family member was acting on their behalf and had had discussions with the provider about their relative’s care and treatment. The provider told us consent was not required in this case. They confirmed that the person had the mental capacity to act for themselves.

Although there were systems and practices to ensure that people understood the care and treatment being offered or recommended, the provider did not always follow them. The provider’s consent policy stated, “Everyone aged 16 or more is presumed to be competent to give consent for themselves,”, and “Young people aged 16 and 17, and legally ‘competent’ younger children, may therefore consent to their own treatment”. The provider told us that although a patient over the age of 16 had capacity, they did not need consent from them to discuss medical issues and treatment options with family members if they were under the age of 18.