The Green 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 in June 2023, we rated this key question as good. At this assessment, the rating changed from good to requires improvement based on the concerns we found.

This service scored 58 (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 did not always make sure people’s care and treatment was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Feedback from people using the service was both positive and negative. Reception staff were aware of the needs of the local community. However, not all needs were correctly assessed for all the patients from our review of clinical records during the clinical searches.

Reception staff were aware of the system of triage to assign appointments to patients based on their needs and knew to quickly escalate concerns to the clinical team based on the guide provided by the practice management. Health check reviews for autistic people and people with learning disability were completed and care plans reviewed.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Our review of clinical records demonstrated that care was provided in line with current guidance. Systems were in place to ensure staff were up to date with evidence-based guidance and legislation, but this was not always followed.

The service worked well across teams and services to support people. Staff had access to the information they needed to appropriately assess, plan and deliver people’s care and treatment and support. Staff could refer people to relevant services where needed.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff focused 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.

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of the people. The service completed clinical audits regularly. The cervical screening data for women aged 50-64 and 25-49 available to CQC showed that the practice was below the national target. Screening for women aged 25 to 49 years old was below 70% minimum uptake (observed 55.8%; expected 80.0%). Screening for women aged 50-64 years old was below 70% minimum uptake (observed 68.5%; expected 80.0%).Childhood immunisations data showed the practice was below the national target. Following the site visit, the practice informed CQC that enhanced monitoring had been implemented but the impact on uptake was not yet known.

The service told people of 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 made in line with relevant legislation from our review of some records.