Bellevue Medical 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 with 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 requires improvement due to inappropriate monitoring of some patients. At this assessment, the rating has changed to good.

This service scored 63 (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 by assessing and reviewing their health, care, wellbeing and communication needs with them.

Our clinical searches found that 22 out of 45 patients had not received a DEXA (Dual-Energy Xray Absorptiometry) scan when prescribed Bisphosphonates. Bisphosphonates are medications that strengthen bones and prevent fractures by inhibiting bone resorption (breakdown) by osteoclasts. They are commonly used for treating osteoporosis in post-menopausal women. This scan monitors the efficacy of these treatments. We reviewed five patient records and found all patients were overdue with their scan. However, the provider told us that some failed to attend appointments, and they were called regularly to mitigate risk. The provider had increased follow up of patients who had failed to attend and increased telephone and text contacts to achieve a better uptake. Although we did not identify evidence of harm at the time of inspection, the absence of timely follow‑up for these scans had the potential to place patients at risk.

Where patients with Asthma received steroids, we reviewed the records of five patients with asthma who were prescribed two or more courses of oral steroids in the past 12 months as part of the treatment. We saw these patients did not have a follow up appointment within 1 week of the steroids. Repeated requirements for oral steroids should a trigger review of the asthmatic patients to ensure their treatment is optimised. We discussed these findings with the management team who assured us that they would be reviewing all patients within these categories and provide timely follow up. We saw evidence that all patients have since been followed up and procedures put in place to ensure more contact is made to encourage people to attend follow up appointments.

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. We saw that reception staff used digital flags within the care records system to highlight any specific individual needs, such as highlighting unseen disabilities such as Autism or Learning Difficulties. 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. 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.

However, they did not always do this in line with current evidence-based good practice and standards.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. However, clinical records we saw did not always demonstrate care was provided in line with current guidance. For example, our searches showed that not all Asthmatic patients were effectively followed up.

Daily ‘huddle’ meetings were used to disseminate guidance and information broadly. These meetings including discussing patient concerns clinicians had and seeking advice from more experienced colleagues.

Audits and reviews were taking place within the GP practice. Audits identified areas for improvement and allowed the management team to address concerns. One example was that, following patient feedback,managers agreed that triage should be offered by telephone or in person for people who did not have access to internet‑connected devices

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 told us they had access to the information they needed to assess, plan and deliver people’s care and treatment. They explained that referral pathways were clear, and they received the necessary information and results back in a timely manner to support ongoing care.

There were systems and processes in place to enable information to be shared between the provider and services to ensure continuity of care. Regular meetings were held with multi-disciplinary teams to ensure care was coordinated effectively. For example, attendance to multi-disciplinary meetings such as Safeguarding meetings in the locality to discuss complex patients, palliative care and those requiring further support.

The practice is part of the Modality Partnership and is part of a large provider so staff have access to a wide range of services for advice, support and guidance

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 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 people themselves.

The service did not meet national targets for screening and immunisations. From the clinical searches we reviewed, we found that people who used the service did not always receive effective follow up contact for missed appointments for immunisation or that there were effective systems to support people to understand the importance of immunisations. The managers told us that they were working with staffing teams to improve take up of follow up appointments. This included administration and clinical staff calling and texting people to remind them. They were also working with the larger Modality management group to find effective ways of managing patients who were not attending follow up appointments.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

We found capacity and consent were clearly recorded in patients’ records and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were appropriate and made in line with relevant legislation. Appropriate discussions had been held with patients (and/or their carers) about DNACPR decisions, and the mental capacity of patients was considered. ReSPECT forms (Recommended Summary Plan for Emergency Care and Treatment) were also completed appropriately. Where appropriate, patients were offered a chaperone for care and treatment. During our site visit we saw chaperone posters were displayed to inform patients of this service. Staff providing this service had completed relevant training.