The Mockett's Wood Surgery Also known as The Partners T/A Mocketts Wood Surgery

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

People did not always have their needs assessed by the most appropriate clinician. Staff did not consistently follow agreed triage procedures. Some clinical staff did not receive formal and regular support or recorded supervisions on their practise to ensure their decisions were reflective of national legislation.

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 the person did not have capacity.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not always have their needs assessed by the most appropriate clinician. Some staff failed to consistently follow agreed triage procedures. We reviewed a random sample of consultations and found some patients had been seen by a clinician who did not have the knowledge, experience and competency to assess and treat them appropriately.

We found some clinical records completed by one clinician lacked details of their assessments and supporting rationales for actions taken.

Staff (clinician and non-clinical) benefited from access to the duty doctor accessible all day for advice and guidance.

Staff told us how patients were asked when they registered with the practice and/or during consultations their preferred method of communication and if they require support. They considered peoples wider health, care and well-being needs and worked with partners to support them to access appropriate services.

Patient records were appropriately coded and flagged to alert staff to individual’s needs and preferences. Vulnerable groups were proactively invited for health checks, such as carers and those with long term health conditions.

Some staff did not receive regular formal support and supervision. We found some clinical decisions were not reflective of national legislation, evidence-based good practice and met required standards.

We conducted searches of the practice clinical system. We found some people prescribed medicines for the management of long-term conditions had not been appropriately monitored. For example, we found 420 patients with long term conditions had not received appropriate monitoring for 18 months including a review of their prescribed medicines. Out of our sample of three patients we found all may be at risk of complications from undertreatment. These can include heart problems, increased cholesterol, and potentially, myxedema coma in severe cases.

We found 68 people with diabetes reporting heighten blood sugar readings. Out of our sample of five patients we found all may be at risk of short-term and long-term complications. Short-term risks can be life-threatening and long-term, chronically high blood sugar can cause damage to blood vessels and nerves, leading to issues like eye problems (diabetic retinopathy), kidney disease, nerve damage (neuropathy), and increased risk of heart attack and stroke.

We identified 9 patients prescribed benzodiazepine (a high risk medicine prescribed to treat conditions like anxiety, insomnia, and seizures). All patient patients we reviewed found they had not received appropriate monitoring in the last 6 months. This medicine carries significant risks including drowsiness, impaired coordination, cognitive impairment, and potential for dependence and addiction.

Following inspection, the practice contacted patients and reviewed or arranged a time to conduct the reviews of their prescribed medicines.

Staff were not provided with protected time to seek advice and guidance from senior clinicians in practice. Staff told us they were mindful of seeking advice and potentially disrupting the senior clinician’s clinical schedule and impacting negatively on patient care.

Best practice guidance was shared amongst staff, but our clinical searches showed some had not been embedded in practice.

Administrative processes such as the timeliness of cancer referrals were monitored.

Management meetings were held. Risks were documented for discussion for example, changes to ways of working.

Staff worked across teams and services to support people. The practice had a designated frailty co-ordinator directly accessible to people to support and assist in the coordination of their care needs.

There were established and effective systems in place to ensure the timely and appropriate management of referrals. Meetings were held with partner services to support people to access and/or move between services.

Information was shared between teams and services to ensure continuity of care, for example when clinical tasks were delegated or when people were referred between services. All relevant staff, teams and services were involved in assessing, planning and delivering people's care and treatment and staff worked collaboratively to understand and meet people's needs. Staff told us they were proud of the support and services provided to people and their families during end of life care.

Staff supported people to manage their health and wellbeing so they can maximise their independence, choice and control. Staff signposted people and provided advice and guidance to support people to live healthier lives and where possible, reduce their future needs for care and support. People were invited and supported to be involved in regularly reviewing their health and wellbeing needs where appropriate and necessary. People were involved in regularly monitoring their health, including health assessments and checks where appropriate and necessary with health and care professionals.

We found inconsistencies in the recording of the monitoring and actioning of some patient results. For example, we found improvements could be made in relation to the monitoring and recording of patients’ thyroid functioning, asthma follow ups, creatine clearance and weight checks.

The practice met only one out of five England immunisation or screening program targets. For example; the practice achieved 83.3%, below the England average of 95% of children aged 5 who have received immunisation for measles, mumps and rubella (two doses of MMR).

Staff told us they routinely monitored people’s care, booking follow up consultations and requesting additional interventions such as blood tests to continuously improve people’s health outcomes.

People’s clinical outcomes were primarily assessed through formal quality outcome frameworks used by local commissioners of healthcare to inform conversations regarding performance and prescribing behaviours.

Staff understood and assessed children under 16 years were Gillick competent and thereby able to consent to their own medical treatment, without the need for parental permission or knowledge.

Staff told us they received training in understanding and supporting people to make informed decisions. Consent was sought on separate occasions in accordance with best practice prior to some treatments to ensure patients had time to understand, consider and ask questions about the procedure.

The practice had established policies and procedures in place to ensure staff knew and observed best practice when recording and delivering care. Consent was appropriately documented prior to administering vaccinations to vulnerable people. Staff did ensure best interest decisions were appropriately made and recorded for people who lacked capacity to make decisions.