Dr Kanjana Paramanathan

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 remains the same.

This service scored 67 (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 the majority of people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

74% of patients that completed the National GP Patient Survey data agreed that they felt their needs were met during their last GP appointment which was lower than the local average of 88% and the national average of 90%

Additionally, 92% of patients felt the healthcare professional they saw had all the information they needed about them during their last general practice appointment which in line with the local average of 91% and in line with the national average of 92%.

Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. Reception staff were aware of the needs of the local community. 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. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The provider had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

Care plans and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) records were completed and reviewed regularly. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

Systems were in place to identify individuals with caring responsibilities, who were offered an annual review. All patients with a learning disability were invited to attend an annual health assessment.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

As part of the remote clinical review, we carried out a search to identify the number of people has having a potential missed diagnosis of chronic kidney disease (CKD) CKD stages 3 to 5. The search identified 46 people. We reviewed a random sample of 5 records and found 4 patients had a missed diagnosis of CKD. We discussed the findings with the clinical leadership team and was assured that action would be taken to review each patient identified in the search.

During the remote clinical review, we carried out a search to identify people with asthma who had been prescribed 2 or more courses of rescue steroids in the past 12 months. The search identified 2 people. We reviewed the 2 records and found 1 patient had not had a follow up review following an exacerbation and had not received an annual asthma review.

We carried out a clinical search on patients who had hypothyroidism and had not received the appropriate monitoring in the past 18 months. The search identified potentially 1 person. We reviewed the clinical record and found the appropriate monitoring had been completed.

Further reviews of the clinical system identified people with diabetes who had a HbA1c of 75 and over. A haemoglobin A1C (HbA1C) test is a blood test that shows your average level of blood glucose over time. We reviewed a random sample of 5 clinical records and found the appropriate reviews had been completed.

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.

Staff told us that 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. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.

There were systems and processes in place to enable information to be shared between the provider and services to ensure continuity of care. There were no meetings with multi-disciplinary teams, however we were told that there was regular contact with community teams to ensure care was co-ordinated effectively.

The Primary Care Network (PCN) helped to support the practice by providing links to pharmacists, physiotherapists and social prescribers. People were able to receive co-ordinated care between the practice and the PCN.

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.

The practice had made reasonable adjustments to provide support to vulnerable patients. This included home visits for patients who were unable to attend the practice.

The service was not always achieving positive outcomes in relation to preventative care and public health programmes. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The practice was below the national target of 80% uptake for cervical screening. Public Health data for 2024/25 showed the practice had achieved 55.6% for people aged between 25 to 49 years of age and for people aged 50 to 64 years, had achieved 62.1%. To encourage people to attend their appointments, appointments were available at different times throughout the week to provide choice and a range of availability. The practice had not achieved the 5 national targets for childhood immunisations. For example, Public Health data showed 67.3% of children aged 5 had received immunisation for measles, mumps and rubella, this was below the national target of 95%. Patients that failed to attend appointments were followed up and information was shared with the health visiting team.

Whilst records reviewed demonstrated many patients received care and treatment in line with evidence-based guidance, the practice had not achieved national targets for cervical screening and childhood immunisations and could not demonstrate consistently positive outcomes across all population groups.

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. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.