Siam 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

This key question has been rated as good. We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support.

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving between services. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people took decisions in people’s best interests where they did not have capacity.

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.

Practice staff made sure people’s care and treatment was effective by assessing their health, care, wellbeing and communication needs with them.

People gave positive feedback in relation to how their needs were assessed and reviewed by clinicians. Care home representatives told us people were involved in any assessment of their needs, which included their carers, as appropriate. Systems were in place to identify people with caring responsibilities at registration, opportunistically, and through self-reporting. They held a carers’ registerand 3.7% of the practice population were registered as carers, which included young carers. The practice regularly reviewed their register and continued work to identify carers.

Staff used digital flags within people’s care records to highlight any reasonable adjustments needed for health and care access. This information was gathered at the point of registration and opportunistically. Staff shared examples, such as the requirement for an interpreter. 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 practice had systems to identify and prioritise care and treatment for people who were vulnerable. For example, all people with a learning disability had been invited for a learning disability health check and 83% had received a check in the previous 12 months. Reasonable adjustments were in place to support people’s attendance. Arrangements were in place to invite and complete NHS health checks for people who were eligible, and health checks for people aged over 75 years were also available.

Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

Practice staff 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. Clinical records we saw demonstrated care was provided in line with current guidance.

Staff told us that the leaders provided opportunities for them to keep up to date with current guidelines, and changes to evidence-based care and treatment, for example through training days and clinical meetings. People gave positive feedback in relation to the clinical care and treatment they received. Care home representatives gave positive feedback regarding the clinical knowledge and skills of staff.

Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. People were recalled for reviews for example, for a long-term condition review using their month of birth and follow up arrangements were in place for people who did not respond to invitations. People were sent a long-term condition review questionnaire and arrangements were in place to coordinate any tests required. These were reviewed, and people were seen face to face or had a telephone review if preferred, or continued to be monitored. People with multiple long-term conditions were reviewed during 1 longer appointment, when appropriate.

We observed from the clinical searches practice staff delivered evidence-based care. For example, there were effective systems for monitoring people with chronic kidney disease stages 4 or 5, and people with hypothyroidism. One search identified out of 938 people with diabetes, 123 people had a blood result which was above the recommended level. We reviewed a sample of 5 people. People had received monitoring, and the practice demonstrated they worked to engage with people who found compliance difficult. There was a system for identifying, monitoring and reviewing people with a potential missed diagnosis of diabetes, however we found the correct code was not always used. We raised this with the provider and on the site visit we found the records of all people identified in the search had been reviewed. Where a diagnosis was confirmed, they had been coded. Where further tests were needed, all people had been invited for review and coded until results were available. The practice had established a monthly audit to monitor appropriate actions had been taken.

Another clinical search identified the practice had 1783 people on their asthma register, of which 80 people had been prescribed 2 or more courses of rescue steroids within the last 12 months. We reviewed the records of 5 people and found people with asthma who were prescribed emergency steroids were not consistently followed up to check their response to treatment in an appropriate timeframe. We raised this with the provider who took action to address this so people were consistently followed up in a timely way.

Practice staff worked well across many teams and services to support people which helped to reduce duplication, prevent delays in treatment and provided people with continuity. Practice staff maintained close connections with other tenants at Sudbury Community Health Centre, for example, community and school nurses, midwives and health visitors, and adult social care, mental health and physiotherapy teams.

People gave positive feedback about how the reception team identified who the right person was for people to see. Representatives from care homes gave positive examples of how they worked together with practice staff. Partners gave positive feedback regarding how practice staff worked together with them.

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, for example for people with palliative care and end of life needs. Some staff were multiskilled and covered a range of roles to support colleagues, for example helping with phone calls and queries from people. Additional staff had also been trained to cover certain roles following staff feedback.

The practice facilitated a monthly cancer care navigator clinic where people at any stage of their cancer journey could receive face to face support and advice from a Macmillan cancer support care navigator. They worked closely with the practice care coordinator.

Practice staff had engaged with an organisation working to support people with a learning disability and dementia. Some practice staff had received additional education to support people during diagnosis, and they signposted people to a local dementia café. Feedback from people obtained by the dementia café, was positive regarding their dementia review and support provided by nurses at the practice.

Practice staff supported people to manage their health and wellbeing to maximise their independence, choice and control. They supported people to live healthier lives and where possible, reduce their future needs for care and support.

People who provided feedback gave positive feedback about being invited for vaccinations. Representatives from care homes told us people received general and specific health checks and clinical staff visited to administer vaccinations.

Staff focussed 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, which including stopping smoking and tackling obesity. People who had newly registered at the practice were offered a health check. Staff gave examples of where people had been positively supported to live healthier lives, which included healthy eating and weight management. The practice had a health kiosk, where people could answer health questions and self-test their blood pressure, height and weight using a machine in the waiting room. People were advised their results were uploaded into their medical record and clinical staff were notified to review and act, if necessary.

Practice leaders had engaged with their local community through attendance at a health awareness day in June 2025. Display information included practice registration and NHS health checks for people aged 40 to 74 years. They had attended this day for the past 3 years. Practice staff also used this opportunity to network with local service providers to share information with people about a range of locally available health and social care services.

Practice staff 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 people experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

Care home representatives and people told us they received long term condition checks and were monitored effectively. People gave positive feedback in relation to the clinical care and treatment they received.

The practice was above the England average for breast screening and bowel cancer screening coverage. They had achieved the World Health Organisation target of 95% for 3 of the childhood immunisation indicators and met the minimum target of 90% for the other 2 indicators. The practice took responsibility for inviting and booking all childhood immunisation appointments.

Practice staff continued to improve the uptake of cervical screening. The practice had an effective recall system in place and strategies to educate and encourage attendance for cervical screening. This included staff receiving education on making reasonable adjustments and considerations for example, for the LGBTQ+ and multicultural communities, people with a learning disability and people who experienced domestic abuse. Discussions were held opportunistically, and prompts for discussion were given for example, during post-natal appointments. Appointments were available on weekdays, with extended hours appointments available until 8pm on 1 weekday and from 1pm to 5pm on Saturdays. Arrangements were in place to follow up people when they did not respond to an invitation or attend their appointment. Examples were given of successful reasonable adjustments made to support people to attend.

Staff told people about their rights regarding consent and respected these when delivering person-centred care and treatment. People’s feedback demonstrated they felt at ease during consultations and were listened to. People were appropriately informed when making care and treatment decisions. Care home representatives told us staff always spoke with people, their relatives and carers and obtained consent taking into account the person’s choices and decisions.

The practice had systems and processes in place to obtain consent to care and treatment in line with legislation and guidance. There were policies in place to support staff when obtaining consent from adults, children and people who lacked mental capacity.

Staff we spoke with had a good understanding of consent and staff had completed training on consent and the Mental Capacity Act. Clinicians supported people to make decisions, and where appropriate, they assessed and recorded a person’s mental capacity to make a decision and involved relevant people and advocates as appropriate. Clinicians told us they always obtained consent from people which was recorded on the clinical system. Chaperone information was displayed in the practice and information was available on the practice website.