Laurbel 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

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 services. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people and took decisions in people’s best interests where they did not have capacity.

We found that the practice had consistently achieved high uptake of cervical cancer screening and childhood immunisations. This had been recognised by the Integrated Care Board (ICB) and the practice had been asked to share with other practices how they consistently met national targets for screening.

This service scored 79 (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.

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.

Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. 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 provider had effective systems to identify people with previously undiagnosed conditions. Clinical searches identified 30 patients with a potentially missed diagnosis of diabetes. We looked in detail at 4 patient’s records and found that patients had received the required reviews and support however they needed to be coded appropriately. The practice had already identified this and completed an audit on potentially missed diagnosis of diabetes which identified a fault from the local laboratory which produced the wrong results for patients.

We found that 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. 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. We identified 9 patients with asthma who had been prescribed 2 or more courses of rescue steroids. We reviewed 3 patient records and found that adequate asthma reviews had been completed, however 1 review was slightly overdue. This was fed back to the provider and addressed immediately.

We saw evidence that non-medical prescribers had their competencies assessed. Following feedback after our assessment this process was strengthened to contain formally documented discussions with non-medical prescribers in-line with national guidelines.

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 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, including where clinical tasks were delegated to other services.

We saw evidence that the practice had regular meetings which were used to share any changes across the practice. We also saw that the practice had strong relationships with the other practices that made up its Primary Care Network (PCN). This included being able to utilise resources such as wellbeing coaches and host training sessions for staff to attend.

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, diabetes prevention programme and tackling obesity.

Staff had lead roles in areas including diabetes and asthma and worked closely with community teams to support patients. Staff had worked to build connections with patients and their carers to ensure a positive response to invites for regular health checks. We received positive feedback from patients regarding how positive and supportive staff were. They said things such as “everyone at the surgery is approachable, helpful and friendly.”

The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The practice met national targets for screening and immunisations. We saw that the practice had continuously met the 95% World Health Organisation (WHO) target for achieving childhood immunisations. We also saw that the practice had continuously achieved more than 80% uptake target of cervical cancer screening for a number of years. The most recent data showed that the practice had achieved a screening rate of 86.2% for all eligible patients. The practice had been recognised by their Integrated Care Board (ICB) as achieving the highest amount of cervical cancer screening in the local area. The practice also ran regular audits on their cervical cancer screening to ensure that they were achieving the best results possible.

From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

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. As part of our assessment, we looked in detail at 5 do not attempt cardiopulmonary resuscitation (DNACPR) decisions and found that these were appropriate and were made in line with relevant legislation.