Castle Medical Group

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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 monitored people’s care and treatment and supported them to live healthier lives. At our last assessment, we rated this key question as good. At this assessment, the rating has changed to requires improvement because a review of patient records identified concerns relating to medicines management, the delivery of evidence-based care and treatment, and the monitoring and review of patient outcomes.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service did not always provide care and treatment in line with current legislation, standards and evidence-based guidance.
Staff had access to clinical guidance through meetings, training and internal systems. However, findings from our clinical searches demonstrated that evidence-based guidance was not consistently followed. Concerns identified during the assessment included weaknesses in the management of some patients with asthma and gaps in the management of medicines subject to national safety requirements.
For example, our review of patients prescribed high numbers of asthma reliever inhalers identified records where patients had not always received care and treatment consistent with recommended asthma management guidance. In addition, records relating to medicines subject to national safety requirements did not always demonstrate that appropriate reviews, safety arrangements and risk management processes had been completed in line with current guidance.
These findings demonstrated that care and treatment was not always delivered consistently in line with current guidance and best practice. As a result, clinical oversight was not always effective in ensuring evidence-based guidance and national safety requirements were consistently followed.
 

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

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.
The service promoted national health priorities and initiatives through health promotion advice, social prescribing services and opportunistic discussions during appointments. Patients could access support for a range of health and wellbeing needs through a social prescriber, care coordinator and a PCN-funded social prescribing service.
The service offered a range of health assessments and checks, including NHS Health Checks and Learning Disability Health Checks. Staff used patient records and electronic recall systems to identify people who may benefit from vaccinations, screening programmes and preventative interventions and invited them to attend for appropriate reviews and appointments.
Performance data demonstrated positive outcomes across a number of preventative health areas. Childhood immunisation uptake met or exceeded national targets across most indicators. For example, 97.4% of children aged 2 had received their first dose of the measles, mumps and rubella (MMR) vaccine, compared with the World Health Organisation target of 95%. In addition, 96.8% of children aged 2 had received their pneumococcal booster vaccination, which was above the target of 95%. The service also supported people to participate in national screening programmes. Cervical screening uptake was above the national average, demonstrating that eligible patients were encouraged and supported to access preventative healthcare and screening services. For example, cervical screening coverage met or exceeded the national target of 80% across both eligible age groups. The most recent available data showed coverage of 80% for women aged 25 to 49 and 83% for women aged 50 to 64.
These arrangements helped to support people to live healthier lives and promoted positive health outcomes across the service population.

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive, consistent or met people's needs and expectations.
Findings from our assessment demonstrated that staff had not always ensured patients received the reviews, monitoring and follow-up required to support safe and effective care. A review of patient records identified patients who continued to receive treatment despite overdue reviews and monitoring requirements. We also found occasions where follow-up actions had not been completed when concerns had been identified and opportunities to reduce risks of harm had been missed.
The concerns identified were recurring across multiple areas reviewed and demonstrated ineffective systems for overseeing and monitoring patient care. Although the service undertook audits and monitoring activities, these had not been effective in identifying the concerns found during our assessment or ensuring that patients received appropriate reviews, monitoring and follow-up in a timely manner.
Records did not consistently demonstrate that risks had been recognised, acted upon or escalated appropriately when patients became overdue monitoring or review requirements. This meant the service could not be assured that patients requiring additional oversight, intervention or follow up were being identified and managed in a timely manner.
These findings demonstrated that the systems and processes intended to identify, assess and respond to risks were not always operating effectively. As a result, the service could not be assured that patients received the monitoring, review and follow-up required to support positive outcomes and reduce the risk of avoidable harm.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.