Dr Lalit Gurnani Also known as Nantwich Health 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 assessed all quality statements under this key question. At our last inspection we rated this key question as good. At this assessment the rating remains the same.

People were involved in the assessment of their needs whilst staff ensured they were involved in decisions about their care and treatment and offered advice and support throughout. Staff regularly reviewed assessments and took account of communication preferences, personal circumstances, and health needs. Care and treatment promoted healthier lives, including support for national screening programmes and vaccinations, and staff managed chronic diseases effectively. Both clinical and non-clinical audits were carried out and there was evidence of improved outcomes for patients in several areas.

A review of patient records showed care and treatment followed evidence-based guidance. Where improvements were identified, the provider took immediate action to rectify and resolve them. Staff worked closely with all agencies involved in each person’s care to ensure the best outcomes and smooth transitions when people moved between services.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patient experience of the service as indicated in the National GP Patient Survey showed that 90% of patients who responded felt involved in decisions about their care and treatment and 90% had confidence in the healthcare professionals treating them. These scores were lower than local and national averages 92% and 91% respectively. Support was available for people with additional needs or communication needs, for example, people who required the services of an interpreter or patients who had a learning disability. Of patients who responded to the National GP Patient Survey, 89% said their needs were met during their last appointment, lower than local and national averages of 91% and 90% respectively. The provider was aware of the lower-than-average scores and were responding to try to make improvements.

People who reported symptoms that could be considered a clinical emergency could be seen on the day following triage by the on-call duty GP. Reception staff had received care navigation training and were able to signpost people to alternative services when required. Patients were advised when to seek further help and what to do if their condition deteriorated. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber. Relevant information was shared with other professionals when planning care and treatment and treatment records were updated to reflect any changes made.

People living with a long-term condition and those with a learning disability were invited for regular reviews of their health, care and treatment and staff used templates for this to ensure the reviews were appropriately detailed and recorded. The provider had effective systems to identify people with potentially undiagnosed conditions, for example diabetes. However, our clinical review of patient records identified 95 potential missed diagnoses of chronic kidney disease. The provider took action to remedy any coding issues immediately and to invite patients in for immediate review if required. People who were the most clinically vulnerable were prioritised and the practice worked with other healthcare professionals to deliver coordinated packages of care.

Systems were in place to ensure staff were up to date with national guidance, evidence-based good practice and required standards. Staff attended meetings and received supervision. We looked at the workflow for managing clinical correspondence within the clinical patient record system and tasks and found these were updated daily. Clinical staff had time factored into their days to deal with administrative tasks. However, staff fed back that this administration time was often used to see patient follow ups due to work overload. This issue had been identified, and recruitment of 2 new medical members was in progress.

Our review of the clinical record system for the sample of people whose care and treatment we looked at, indicated that people received care, treatment and support that was evidence-based and in line with good practice standards. The results of the clinical searches for the management of patients living with long-term conditions were good and any gaps we identified in the monitoring of patients were dealt with immediately by the provider.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. Each GP had a specific patient list and practice staff worked with other services to ensure continuity of care. Leaders and staff worked closely with colleagues in the local Primary Care Network (PCN) to meet the needs of the patient population.

Multi-disciplinary meetings were held on a regular basis so that when people received care from a range of different staff, teams, or services, such as those in the affiliated care home, this was co-ordinated.

Staff demonstrated good working relationships with the local NHS Trusts and used those relationships to support patients to navigate the health and social care system. Shared care agreements were in place to ensure that prescribing arrangements between primary and secondary care were well managed. Nursing staff reported an open-door culture where support from GPs was easily accessible when required.

The service supported people to live healthier lives and manage their health and wellbeing. 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. People were called in for regular checks on their health when they were living with a long-term condition.

Staff supported local and national priorities and initiatives to improve population health, including smoking cessation and encouraging patients to take up national screening programmes.

People living with long-erm health conditions underwent regular monitoring. Staff referred or signposted them to local support services for information, education, advice and support linked to their needs. The practice contacted patients who did not attend cervical screening and child immunisation programmes to encourage uptake. People were also encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing and prevent deterioration. We identified consistent follow up in patients with asthma following rescue steroids except for 1 patient. We alerted the provider to this and they took immediate action.

As of 30 June 2024 the percentage of persons aged 25 to 49 years who had adequate cervical screening was 78.8% which was lower than the expected target of 80% and those aged 50 to 64 years was 82.8% which was above the expected target of 80%. Childhood immunisation uptake was between 99% and 96% in all 5 of the required categories which was above the 90% World Health Organisation targets.

The service routinely monitored people’s care and treatment to continuously improve it. They sought assurance through a series of key performance indicators and quality improvement activity. The practice was able to demonstrate improvements through audits such as antimicrobial prescribing, controlled drugs and COPD which they shared during the assessment. Positive outcomes were demonstrated through patient experience and GP practice indicators. From the clinical records we reviewed, we found that people who used the service experienced positive outcomes in line with best practice guidance.

Leaders demonstrated that monitoring and improving outcomes for patients was important to them and they used information and data to drive improvement. There was evidence of clinical, non-clinical and medicines audits carried out to improve outcomes for patients.

People who used the service felt they could make an informed decision about their care and treatment because they had been provided with the information they needed to support them to do so. The National GP Patient Survey results showed that 89% of respondents felt the health professional they saw had all the information they needed compared with the local result of 83% and the national result of 92%. A total of 90% of respondents had confidence and trust in the healthcare professional they saw or spoke to during their last general practice appointment compared with the local and national results of 93%.

Staff we spoke with demonstrated the importance of ensuring that people understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment.

We looked at a sample of ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) decisions in patient records. We found that decisions were made in accordance with best practice. Records were coded appropriately; however, copies of the documents were not visible on the patient record.