Cricklade 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

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.

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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff checked people’s health, care, and wellbeing needs during health reviews.

The service did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

During our remote clinical searches, the monitoring of people with long-term conditions was not always up to date with National Institute for Health and Care Excellence (NICE) guidelines. For example, of the people diagnosed as asthmatic,18 were identified as having been prescribed 2 or more courses of rescue steroids in the last 12months following an exacerbation of asthma. Of the 5 records we reviewed, none had been issued with a steroid card, in line with national guidance. Only 1 person had been issued a rescue pack, which is not in line with national guidance. The service was unable to provide evidence of a formal pathway in place for the management of asthma exacerbations.

The service was informed of the findings of the clinical searches during the inspection, and we requested information on how the identified people would be followed up. This information was not provided by the service within the deadline given.

The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

The service was unable to provide any evidence of regular multidisciplinary team (MDT) meetings to discuss vulnerable people who required care and treatment from different services working together. The service also could not demonstrate any evidence of different services collaborating to support people’s needs.

However, people referred via NHS 111 had access to designated appointment slots managed by the duty doctor each day. The service told us these slots were not always utilised by NHS 111, although a bypass telephone number was available for 111 to contact the service directly if needed. The service had also provided this bypass number to consultants at local hospitals.

The service had access to interpreters for appointments via Language Line and could provide leaflets in other languages or easy read leaflets on request. They outlined information relating to reasonable adjustments clearly on their website.

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.

The service supported people to live healthier lives and, where possible, reduce their future need for care and support. The service displayed information boards with posters and leaflets for people, including materials promoting cervical screening awareness.

Staff were focused on identifying risks to people’s health, including those in the last 12 months of life. The service had arranged meetings involving a local hospice, the community nurse lead, and a GP locum from the service to discuss and review the needs of people approaching the end of life.

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

People with long‑term conditions were not always managed in line with national guidance. For example, we identified 70 people who may have had a missed diagnosis of chronic kidney disease (CKD) stage 3, 4 or 5.

When reviewing the service’s clinical system, it was not clear whether staff had been using clinical coding appropriately, which may have contributed to these potential missed diagnoses. In response, the service confirmed they would undertake a review of coding.

The service was unable to provide us with any evidence of audits to monitor and improve people’s outcomes.

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, and records showed that capacity and consent were clearly documented. Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) decisions were appropriate and made in line with relevant legislation. The service was supported by primary care network (PCN) paramedics to complete ReSPECT forms for people who may need them. Once a ReSPECT form was completed, a task was sent to a GP to review and provide an additional signature. A ReSPECT form is a pre-emptive plan that documents a person’s wishes regarding emergency medical care if they are unable to express them.