Bowling Highfield 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

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice 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. Clinical staff checked people’s health, care, and wellbeing needs during health reviews. The provider had effective systems to identify people with previously undiagnosed conditions.

The practice had multi-disciplinary team (MDT) meetings every 4 weeks, new cancer diagnoses were discussed.

As part of our inspection a Care Quality Commission (CQC) GP specialist advisor (SpA) undertook searches of patient records on the practice’s clinical system. We reviewed a sample of clinical records of patients with long term conditions.

We found the following:

Patients with asthma who had 2 or more courses of rescue steroids prescribed in the last 12 months: There were 1,275 patients on the practice’s asthma register, of which 53 had been prescribed 2 or more courses of rescue steroids. We reviewed 5 patient records in more detail and found that none of these patients had been followed up within a week of their exacerbation. We discussed this with the practice, and they acknowledged that this was an area requiring improvement and advised that they planned to review and implement new systems.[LC1][LT2] Of the 5 patient records we reviewed, all had an adequate annual asthma review documented.

Patients with Chronic Kidney disease (CKD) stages 4 or 5 who had not had the required monitoring in the last 9 months: We identified 474 patients with CKD, and all had received the required monitoring within the last 9 months.

Patients with Hypothyroidism who had not had the required Thyroid function testing (TFT) monitoring for 18 months and had abnormal Thyroid -stimulating hormone: we found 457 patients with hypothyroidism. Three of them had not had the required monitoring within the past 18 months and we looked at them in more detail. We investigated 3 records further; 2 of these patients were monitored under hospital care.The remaining patient record indicated that the individual had not engaged with attempts by the practice to arrange a review appointment

The practice planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Clinical records showed care was delivered in line with current guidance. The practice implemented protocols based on NICE guidance and ensured staff were informed of updates. For example, changes to asthma prescribing were shared with all staff and displayed in clinical rooms. A protocol for managing blood test results was also in place and communicated to relevant team members.

Systems ensured staff remained up to date with evidence-based guidance and legislation.

The practice 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 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.

The practice 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 practice had 135 people on their learning disability register. Of these, 131 patients had their annual review, the remaining 4 had either opted out or did not respond to any of the practice’s contacts.

The practice had 676 people eligible for NHS health checks and in the last 12 months they had completed 224. The practice supported health checks through the community partnership, this included their nurses going to community venues and workplaces.

There was a process in place to contact patients who had not responded to communication with regards to cervical screening or children who had not been brought to their immunisation appointments.

They had system in place for registering people with “no fixed abode” and protocols for vulnerable patents. The practice was also a veteran accredited site.

The lead GP for palliative care had meetings with district nurses, and those patients were able to call straight through to the practice and were placed on to the on-call doctors list.

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 routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The National GP Patient Survey showed that 60% of patients felt they had enough support from local services or organisations to manage long-term conditions, compared to the national average of 69%.

The practices cervical screening uptake rate as of June 2024 was at 64.7% for women aged 25-49 and at 69.4 % for women aged 50-64. The practice had an action plan in place to increase these figures.

We spoke to staff who could outline the systems the practice had in place to recall and review patients, and they understood their role in this process.

The practice took steps to encourage patients to attend for cervical screening, for example by sending regular recalls, and through opportunistic screening. Appropriate registers were held to ensure effective monitoring of specific groups such as those receiving palliative care.

The practice informed people of their rights regarding consent and respected these when delivering person-centred care and treatment. Staff had a clear understanding of the legislation relating to consent and applied it appropriately. Capacity assessments and consent were consistently recorded.

We reviewed 5 Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) and Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms during the site visit. These were completed in line with relevant legislation and included input from patients and carers where appropriate. All forms were signed, dated, and had documented reviews.

We found that 1 patient did not have a copy of their ReSPECT form available within their clinical records. A hard copy was held at the patient’s care home, and a copy was provided on the day of the assessment. The provider later clarified that the form was present in the patient’s records but not clearly accessible.

Staff demonstrated a clear understanding of consent, including verbal, implied, and written forms. Written consent was obtained for complex or invasive procedures. Consent processes considered the needs of children, young people, and patients lacking capacity. Staff had received appropriate training in mental capacity legislation.