Dr Umadevi Parameswaran Also known as Ashburton Park Medical Practice

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.

At our last assessment, we rated this key question as Good. At this assessment, the rating has changed to requires improvement.

The service was in breach of legal regulation in relation Regulation 12 of the Health and Social Care Act. Assessments of the risks to the health and safety of people receiving care or treatment were not being carried out. The needs of patients, in particular, patients with long term conditions were not always being assessed appropriately; evidence-based guidance was not always being followed when treating patients; and where a person lacked capacity, we did not see evidence that a metal capacity assessment had been carried out and its outcome recorded.

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.

The service did not make sure people’s care, and treatment was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Our review of clinical records found that staff did not always check people’s health, care, and wellbeing needs during health reviews. We reviewed records of people with long-term conditions and found that patients with asthma and diabetes were not always reviewed appropriately. We reviewed 4 records of patients with asthma and in each of them we found an inadequate assessment at the time of prescribing steroids. For example, record assessment did not include how often to use their inhaler, there was a lack of information about how their condition was affecting daily living. Examinations were not comprehensive, for example they did not include parameters such as respiratory rate, peak flow or oxygen saturations.

When a patient experienced a sudden or worsening episode the assessments were inadequate. For example, patients were not followed up within 48 hours even when they had experienced a severe attack requiring nebuliser in the surgery in line with NICE guidance recommendations.

Annual asthma reviews were not adequate as they did not identified exacerbations, and they were not completing appropriate monitoring.

Our clinical record review also identified concerns with the management of patients with diabetes. For example, we identified patients with poor control who had not had their HBA1c repeated for over one year, medication reviews were overdue, some diagnosis had been missed and annual reviews had not been completed.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They generally did this in line with legislation and current evidence-based good practice and standards. However, improvements were required with regards to following guidance for patients with asthma. Clinical records we saw demonstrated care was not always provided in line with current guidance. For example, we saw instances where the dosage and duration of steroid medicine was not always done in line with guidance. Insufficient quantities were also prescribed for courses.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. This included attending GP meetings with the primary care network (PCN) and sharing learning with the team after attending training events. For example, they identified they were a high prescriber of a particular medication. After attending a course, the doctor shared best practice learning with the team and as a result they saw a reduction in prescribing in this area.

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.

The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. For example, if they referred a patient to another service, they received letters from these services to keep them updated. Hospital discharge summaries were always reviewed and actioned if required.

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 and tackling obesity. This included participating in referring patients to weight management schemes. There was a member of staff who followed up if a referral was rejected and they liaised with a GP who would chase it up. They were also active in referring patients to the practice social prescriber.

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

Whilst the service was performing below national targets for the uptake of childhood immunisations and cervical cancer screening, the practice had measures in place to try and increase uptake. This included contacting patients’ multiple times to offer appointments and discussing opportunistically when they visited the practice for other appointments. The practice maintained a list of patients who had declined immunisations and tried to provide additional education and support to build a relationship to improve uptake.

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. Consent was clearly recorded in the records we reviewed. Our discussions with clinicians indicated that they involved people in planning and managing their care and treatment. Staff told us capacity assessments were completed on a decision specific basis. For example, doctors said that patients with conditions such as dementia still had capacity for some decisions and they considered this when providing care and treatment.

Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and made in line with relevant legislation. However, on some of the records we reviewed for people who were described as lacking capacity, there was no evidence that a mental capacity assessment had been carried out and its outcome recorded. We did see that clinical notes from the DNACPR meeting were completed, comprehensive and detailed. This information, however, was not always translated to the DNACPR form.