Dalton Surgery

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• 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 with advice and support. Although staff regularly reviewed people’s care and worked with other services to achieve this, the management of some patients with long-term conditions was not always in line with guidance. There was limited quality improvement activity, including clinical audits, to drive patient outcomes.

At our last assessment, we rated this key question as good. At this assessment, the rating has changed and is now 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.

Although patients’ needs were assessed, including accessibility and communication, we found that care and treatment were not always delivered in line with current legislation, standards and evidence-based guidance. When we carried out our remote clinical notes review, we found that although the practice had systems and processes in place to recall patients for health checks and monitoring, some patients with long-term conditions had not been monitored in an appropriate timeframe. For example, searches indicated there were 45 patients with hypothyroidism who had not had thyroid function test monitoring for 18 months and searches indicated there were 7 patients with chronic kidney disease (CKD) 4-5 who had not had their bloods monitored in the last 9 months.

We reviewed current performance dashboards provided by the Integrated Care Board (ICB) and found that the practice were negative outliers in some areas. For example, the percentage number of dementia care plan reviews undertaken was 65.8%, the percentage of patients on the severe mental illness (SMI) register with all health checks complete was 18.9% and the percentage of patients who had a completed learning disability health check in the last 12 months was 57.1%.

However, feedback from people using the service was positive. In the recent National GP Patient Survey, 89% of respondents said they felt their needs were met during their last practice appointment (national average 90%).

As part of our assessment, a CQC GP specialist advisor (SpA) conducted a series of remote clinical searches of patient records to assess the practice’s procedures around the management of patients with long-term conditions. For example, asthma, chronic kidney disease, hypothyroidism, diabetes and the potential missed diagnosis of diabetes. We found the practice did not always make sure patients’ care and treatment were effective and patients did not always receive the required reviews for their care and treatment within the required timeframes.

There were 792 patients on the asthma register, of which 23 patients were identified as having been prescribed 2 or more courses of oral steroids for asthma exacerbations in the last 12 months. We reviewed 4 records and found patients had not always been followed up in an appropriate timescale post-exacerbation as recommended by the National Institute for Health and Care Excellence (NICE). In addition, 4 patients had not been issued a steroid card and 2 were overdue an annual asthma review.

There were 593 patients with diabetes, of which 86 patients had a latest HbA1c of more than 75mmol/l. HbA1c is a blood test that measures the average blood sugar (glucose) levels over the past 2 to 3 months. Those who have a higher HbA1c are at increased risk of having cardiovascular problems as well as conditions affecting the eyes and vision, the feet, nerves and kidneys.

There were 24 patients with a potential missed diagnosis of diabetes, of which we reviewed 5 patient records and found concerns about the missed diagnosis of diabetes for 3 patients. Patients with a missed diagnosis of diabetes are at risk of diabetic complications including cardiovascular events, eyesight damage and kidney damage without being identified for appropriate treatment or monitoring to reduce these risks.

The practice worked well across teams and services to support people. Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services, such as via secondary care referrals. There was evidence of working with the wider health care teams though multi-disciplinary team (MDT) meetings.

The practice supported patients to manage their health and wellbeing in order to maximise their independence, choice and control. Staff told us they were committed to promoting and encouraging patients to live heathier lives. They told us they used consultations to opportunistically discuss health choices and provide supporting information. This included encouraging patients to attend health checks and reviews and signposting to support groups and self-help advice. For example, staff could refer people with social needs, such as those experiencing social isolation, to a social prescriber.

Staff told us they supported national health priorities, initiatives and screening programmes to improve the population’s health. We saw the practice website had links to health and wellbeing information and there were health promotion noticeboards in the practice’s waiting room. The practice participated in the Community Pharmacy Consultation Scheme which enabled staff to refer minor ailments to the local pharmacy.

The practice did not always routinely monitor people’s care and treatment to continuously improve it. There was no formal programme of quality improvement, including clinical audits, to drive patient outcomes. The practice acknowledged that this was an area for improvement. For example, there was no formal audit of clinical decision making and prescribing for non-medical prescribers and minor surgical procedures undertaken by two GP partners had not been audited.

The latest published and validated data at the time of our assessment for the period up to end of March 2024 showed that uptake for childhood immunisations for 1-year-olds was 97.1%, for 2-year-olds ranged from 88.9% to 90.3%, and for 5-year-olds was 88.5% (expected target 95%). Clinicians we spoke with told us there were systems in place to follow-up on children not brought to appointments, and they would opportunistically promote uptake in consultations. Children not brought for immunisations were also discussed with health visitors.

Validated data for the uptake of cervical screening for the period up to June 2024 for the age group 25 to 49 years was 73.9% and for the age group 50 to 64 years was 80.3% (expected target 80%).

The practice had systems in place to promote national cancer screening programmes and actively followed-up non-attendance. We reviewed current performance dashboard data from the Integrated Care Board (ICB) and found that bowel screening uptake was 77.3% and breast screening uptake was 64.3%.

Staff told us they understood the requirements of legislation and guidance around people’s consent to care and treatment, including the assessment of a person’s mental capacity to make a decision. Records showed that Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training formed part of the practice’s mandatory training schedule. However, not all staff had completed the training.

We saw formal consent forms were in place for minor surgical procedures.

Staff were aware of the need to request consent to share records in line with General Data Protection Regulation (GDPR) principles.