Teldoc-Lawley 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 found patients care and treatment was not always provided in line with evidence-based guidance, and we identified concerns in the care of patients’ health conditions. We found there were some systems and processes for assessing needs, monitoring and improving outcomes and supporting people to live healthier lives, however these required strengthening to ensure all people received the appropriate care and treatment. We saw evidence of how staff, teams and services worked together to provide effective care to patients. Staff demonstrated a good understanding of the service people received and received support from managers to do their job. Training was made available to staff to ensure they had the skills and knowledge to support people. Managers ensured staff had the appropriate knowledge to support people appropriately.

 

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders and staff told us the practice used codes and alerts on patients records to highlight any communication needs and any impairments. There were appropriate referral pathways to make sure that patients’ needs were addressed. We spoke with staff who were able to describe the process for coding of correspondence and care and treatment records for people.
Staff we spoke to were aware of the workflow and clinical staff were able to demonstrate how the practice provided further education and support to patients. We found that staff had the appropriate skills and training to carry out reviews where appropriate.
We found that systems and processes to ensure the safe, care and treatment of patients required strengthening to ensure all people received the appropriate monitoring. For example: people on high-risk medicines. For example: The remote clinical searches showed 59% of people on medicines used to treat epilepsy or neuropathic pain had not received a medication review in the past 12 months.
There were processes in place to keep clinicians up to date with current evidence-based practice. We found the practice held registers to prioritise care for their most clinically vulnerable patients, however we found that there was an issue with the coding of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) records on clinical records as on reviewing a random sample of records we found 2 of the records had no evidence of a DNACPR being in place.

We found people with long-term conditions were offered a structured annual review to check their health and medicines needs were being met. The remote clinical searches that we undertook of the practice’s clinical records system showed the monitoring of people with long-term conditions were followed in line with National Institute for Health and Care Excellence (NICE) recommendations. For example, we identified 1496 people with hypothyroidism, a condition which results in low activity of the thyroid gland. We reviewed a random sample of 5 clinical records and found all 5 people had not received the appropriate blood monitoring, however the practice had taken appropriate action and had sent reminders for blood tests to be completed.
During our clinical records review, we identified 652 people with high-risk diabetes, and reviewed 5 clinical records which showed all 5 people had received a diabetic review in the past 12 months. We identified 43 people with later stage chronic kidney disease and found all patients had received the appropriate monitoring.
We found people with acute exacerbations of asthma were followed up in line with national guidelines to provide safe and effective care and treatment . Staff had the appropriate authorisations to administer medicines through Patient Group Directions or Patient Specific Directions.
 

Staff told us how they worked together with other organisations to deliver effective care and treatment. There were regular integrated care meetings with community health care staff as part of the primary care network to discuss the care and support needs of all patients. Staff said they had access to the information they need to appropriately assess, plan and deliver people’s care, treatment and support; and they had enough information to plan and refer people and receive subsequent results and information following referral.
There were systems and processes in place to enable information to be shared between the provider and services to ensure continuity of care. Regular meetings were held with multi-disciplinary teams to ensure care is co-ordinated effectively. Teldoc had a team of clinical staff in a variety of roles which helped to support the practice by providing links to pharmacists, dieticians, mental health practitioners and social prescribers.
Systems were in place to share information about patients electronically with other services. There were a range of clinical meetings and practice meetings to ensure all staff were kept up to date with guidance and best practice.
 

Processes were in place to support people to live healthier lives. There were flags on patients who were vulnerable and required ongoing monitoring and recalls in place to review patients and educate them to manage their health needs. There was regular engagement with community services and referral pathways in place. The practice website detailed information and links for health promotion, health conditions and common health questions.

We found that processes were effective to recall and monitor patients, however required further strengthening to ensure people prescribed high risk medicines received regular monitoring . The practice had a number of clinical audits in place to ensure the quality and safety of people’s care and treatment was effectively monitored and that the practice continuously improve their outcomes.
The GP patient survey demonstrated that 43% of patients said they have had enough support from local services or organisations in the last 12 months to help manage their long-term condition(s)which was below local and national averages.
 

We saw evidence that consent was obtained for patients so that they understand their rights around consent to the care and treatment they are offered. Staff we spoke with were able to demonstrate the requirements of legislation when considering consent and decision making and had access to policies to support them.
We found the practice needed to strengthen their processes for consent to care and treatment in line with legislation and guidance. We found that Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) required strengthening to ensure DNACPR’s accurately reflected the most recent decision. All staff had completed training for mental capacity, learning disability and autism.