Sheepcot Medical Centre

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 advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this. This key question has been rated as requires improvement. The service was in breach of legal Regulation 17(1) and 17(2), Good Governance, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff followed protocols to ensure they prescribed all medicines safely, and ensured people received all recommended medicines reviews and monitoring. Medicines including controlled drugs were stored securely and at appropriate temperatures. Staff regularly checked the stock levels and expiry dates for all medicines, including emergency medicines and vaccines. There were no controlled medicines held on site. Staff stored medical gases, such as oxygen, safely and completed required safety risk assessments. The provider had effective systems to manage and respond to safety alerts and medicine recalls. Staff followed established processes to ensure people prescribed medicines with specific risks received recommended monitoring. There were suitable processes for staff to follow when dispensing medicines (dispensing practices). Staff took steps to ensure they prescribed medicines appropriately to optimise care outcomes, including antibiotics. Prescribing data reviewed as part of our assessment confirmed this.

People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. The reception staff were aware of the needs of the local community. 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 well-being needs during health reviews. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and well-being. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber. Staff meetings were held and all guidelines were available on the practice internal computerised system used. Clinical records we saw demonstrated care was not always provided in line with current guidance. Systems were not always in place to ensure staff were up to date with evidence-based guidance and legislation. For example, there was no formal policy or protocol for following up with asthma patients in a short time frame who had received 2 or more courses of steroids. Additionally, there were 53 out of 648 people who had received 2 or more courses of steroids. We randomly sampled 5 records and identified there had been steroids issued, with no assessment, follow up or asthma review completed. This left patients at risk of asthma deterioration. We told the provider to review these people. We identified through our clinical searches, that there were 7 out of 29 people who were diagnosed with chronic kidney disease (CKD) stages 3-5 who had not received monitoring in line with national guidance. A random sample of 5 records showed that 2 people had not received the appropriate blood monitoring to ensure their CKD was not deteriorating. We told the provider to review these people.

Staff did not always have access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. For example, processes for monitoring the prescribing competence of non-medical prescribers were not in place. There was no formal documented approach to oversight of prescribing competence and no processes of random sampling of clinical prescribers. This was not in line with The Royal Pharmaceutical Society, a competency framework for all prescribers (2022). The monitoring and auditing patients who were referred under a 2-week wait referral was not wholly robust. The practice ran searches for 2 week-wait referrals; however, there was not a formal documented tracker for referral follow ups. We discussed this with the provider who told us they would implement a a new process protocol. This was provided following our inspection. The provider did complete practice meetings and staff meeting minutes were emailed to staff.

The service did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. The service did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. We identified 110 out of 726 people diagnosed with diabetes who had not received the appropriate monitoring. A random sample of 5 records showed that 2 people had overdue blood testing required. There was a risk of some deterioration or complication of diabetes which could be missed, or treatment may have been suboptimal. We asked the provider to review these people and to implement a protocol for diabetes. Staff did support 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. For example, our clinical searches found that 61 out of 493 people diagnosed with Thyroidism had not received appropriate monitoring. A random sample of 5 records identified all were overdue blood testing. People were at risk of being over or undertreated for Thyroidism. We told the provider to complete a review all these patients immediately. The practice had not met national targets for screening and immunisations for measles, mumps and rubella (one dose of MMR), Pneumococcal infection (i.e. received Pneumococcal booster) (PCV booster) and Haemophilus influenza type b (Hib) and Meningitis C (MenC) (i.e. received Hib/MenC booster). Data we reviewed showed the provider had only achieved 84% for the past 2 years. From the clinical notes we reviewed, we found that people who used the service did not always experience 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. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation. Our clinical searches reviewed peoples records and found no concerns with DNACPR processes for reviewing and documenting.