Earl's Court Surgery

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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. The service now documented detailed planning around end-of-life care including regular reviews of ‘do not attempt cardiopulmonary resuscitation’ decisions with people and their families. We also noted improvement in the achieved coverage of childhood immunisations and cervical screening although these areas remain below target.

At our last inspection, we rated this key question as requires improvement. At this inspection, the rating has changed to good.

This service scored 71 (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.

The team was aware of the needs of the local community. The service used digital flags in the care records system to highlight any specific individual needs, such as the requirement for longer appointments. Staff checked people’s health, care, and wellbeing needs during health reviews. The service had access to a social prescriber who could signpost people to other resources, for example, sources of advice on social care and benefits.

The service planned and delivered people’s care and treatment with 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.

Our clinical searches showed that the service was managing care appropriately for those aspects of management we reviewed in relation to asthma, diabetes and chronic kidney disease.

The service worked well across teams and services to support people. They shared necessary information about 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 service worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. The service maintained registers of people with more complex needs. They had a register of people assessed as experiencing frailty who were at risk of deterioration. One of the GP partners participated in a weekly meeting to review the needs of people on the frailty register alongside other healthcare professionals, for example the community nursing team and a geriatrician.

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 focused on identifying risks to people’s health, including those in the last 12 months of their lives, people 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. People identified as at risk of diabetes were referred to a preventive programme covering diet and lifestyle.

The service monitored people’s care and treatment but the service was not achieving national targets in relation to childhood immunisations and cervical screening coverage.

The service was not meeting national targets for immunisations (90%). For example, the service was achieving 72% of 5-year-olds completing both measles, mumps and rubella (MMR) booster immunisations. The service actively followed up families not attending for immunisations by telephone with one of the GP partners. The service had a small population of eligible children (fewer than 20 in each age cohort) and when some families refused immunisation or did not provide evidence of immunisations received abroad, this had a sizable impact on measured performance.

Cervical screening uptake remained markedly below target. The service had increased the number of cervical screening appointments available along with other services in the primary care network and used technology to enable people to self-book to available sessions. The service followed-up people who did not respond to the initial screening invitation by text and telephone.

The clinical team had a focus on ensuring that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance. The service carried out some clinical audit to monitor clinical management and outcomes.

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. The clinical team meetings included a review of a sample of live DNACPR forms to ensure these were up to date.