Dr Murthy Motupalli Also known as Blackburn Road 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

People were not always involved in the assessment of their needs or in decisions about their care and treatment. Systems for reviewing assessments were not sufficiently robust, and there was limited assurance that communication preferences, personal circumstances and individual health needs were always considered. Although the provider described promoting healthier lives, including participation in national screening programmes and vaccinations, this was not effective. The management of patients with long-term conditions was variable, and governance processes, including clinical and non-clinical audits, were not sufficiently embedded to drive sustained improvement in patient outcomes. Our review of patient records identified inconsistencies in care and treatment, and evidence-based guidance was not always followed.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The systems in place did not effectively identify patients with potentially undiagnosed conditions, such as diabetes. Arrangements to prioritise clinically vulnerable patients were inconsistent, and coordination with other healthcare professionals was not always effective. Although patients with long-term conditions and learning disabilities were reportedly invited for review of their health, care and treatment, this was not evidenced. Systems to ensure these reviews were completed in line with expectations were not effective.

Support for people with additional or communication needs was available, including for those requiring interpretation services or those with a learning disability. However, this was not underpinned by clear or standardised processes. We identified occasions where family members were used to interpret for patients, where communication needs alerts were not visible to all clinicians, and where this had contributed to incidents occurring.

Reception staff reported that patients with symptoms potentially indicative of a clinical emergency could be seen on the same day or directed to more appropriate services and were advised on when to seek further help. However, there was no clear visual or step-by-step guidance in place to support decision-making and triage by staff.

Clinical staff could refer patients with social needs, such as social isolation or housing difficulties, to a social prescriber. While staff stated that relevant information was shared with other professionals and records updated accordingly, this was not evidenced in practice.

Systems to ensure staff were kept up to date with national guidance, evidence‑based practice and required standards were ineffective and not embedded. The provider’s attendance at meetings and supervision was negligible and minutes were poorly documented, providing limited assurance that staff were supported or that learning informed practice.

Our review of the workflow for managing clinical correspondence and tasks within the clinical record system identified significant failures in oversight. Large volumes of historical tasks had not been appropriately reviewed, actioned or closed, creating a serious risk that important clinical information, results or follow‑up actions were missed. There was no effective system to ensure administrative tasks were safely managed or prioritised.

A review of clinical records showed that care and treatment was not evidence‑based or aligned with good practice standards. Systems to monitor patients with long‑term conditions were ineffective, and clinical searches highlighted multiple gaps in required monitoring of people with diabetes and asthma. In addition, guidance from safety alerts was not followed such as providing information to those patients taking Mirabegron, a medicine used in the treatment of bladder issues. Action taken by the provider was reactive and occurred only after concerns were identified during the assessment, rather than through robust, ongoing quality assurance processes.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. However, there was no oversight to ensure that guidance was being used in practice, and no effective arrangements to monitor updates or to share learning with staff when guidance changed. Arrangements to work with other services to ensure continuity of care were not always effective, increasing the risk of fragmented care. Although the practice engaged with colleagues in the local PCN, this did not translate into improved coordination or outcomes for people using the service.

There was no evidence of multidisciplinary meetings to co-ordinate care for people who received support from multiple staff, teams or services, including those living in care homes. Information was not shared, and actions were not always clearly documented or followed up, limiting assurance that people’s needs were appropriately managed.

While staff described having good working relationships with each other, we saw that most staff worked in isolation. Some staff we spoke to reported that not all teams worked well together and that communication across the service was poor. As a result, there was insufficient assurance that care was well coordinated or that people were supported to navigate the health and social care system safely and effectively.

The service had recently experienced instability within the nursing workforce, but arrangements had been made to provide continuity from a long‑term locum at the time of the assessment. This meant that the facility to support people to live healthier lives and manage their health and wellbeing had improved. Nursing staff focused on identifying risks to patients’ health, including patients at risk of developing long‑term conditions. Systems to monitor patients with long‑term conditions were ineffective, and clinical searches highlighted multiple gaps in required monitoring of people with diabetes and asthma.

The practice supported local and national priorities to improve population health, including smoking cessation and promotion of national screening programmes. People with long‑term conditions were usually monitored and, where appropriate, referred or signposted to local support services for information, education and advice. However, we identified instances where this was not the case. We identified examples where patients with asthma had not received appropriate follow‑up after being prescribed rescue steroids.

The practice contacted patients who did not attend cervical screening or childhood immunisation programmes to encourage uptake, and people were supported to make healthier lifestyle choices. Uptake of preventative programmes required improvement, with cervical screening coverage for women between the ages of 25 to 49 at 66%, and those between the ages of 50 to 64 at 72.5%. These were below the expected target of 80%. Childhood immunisation uptake was below the World Health Organisation target of 90% in 2 of 5 age categories.

The service did not have effective systems in place to routinely monitor people’s care and treatment or to use this information to drive continuous improvement. Although some performance data and audits were available, these were not used to drive improvement or to provide assurance about the quality of care or patient outcomes.There were no clear action plans, and the audits were not repeated to demonstrate sustained improvement.Information from patient experience and GP practice indicators was not used in a systematic way to monitor outcomes or identify areas of risk. Our review of clinical records showed that outcomes for people using the service were variable and not aligned with best practice guidance.The provider was not able to demonstrate robust oversight of monitoring and improvement activity. While some clinical, non‑clinical and medicines audits had been undertaken by student employees, these did not form part of a coherent or effective quality improvement framework, and there was limited evidence that learning from audits led to sustained improvements in patient care or outcomes.

The National GP Patient survey results showed that 87% of respondents felt the health professional they saw had all the information they needed and 84% felt involved as much as they wanted to be in decisions about their care and treatment. However, these results were lower than local and national averages of 92% and 91%, respectively.

Most of the 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. Clinical staff had completed training in the Mental Capacity Act and understood the requirements of legislation and guidance when considering consent and decision making. However, non-clinical staff had not undertaken mental capacity awareness training.

We looked at a sample of ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) decisions in patient records. Appropriately completed documents were available. However, we did not see evidence of a process in place to ensure that DNACPR decisions were reviewed.