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

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. Clinical searches showed that all patients with chronic kidney disease (CKD) had received the required monitoring or were offered an appointment in the last 9 months. Clinical searches identified 24 patients with a potential missed diagnosis of diabetes. We looked in detail at 5 patient’s records and found that 3 patients had evidence that a follow up appointment had been done and the patients were subsequently coded for prediabetes. Searches showed that 2 patients had the required monitoring but there was a gap between readings. The practice assured us that they had arranged appointments for review.

Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The practice ensured patients with a learning disability received an annual health check.

The service 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.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance.

Searches on the practice’s clinical system identified 102 patients with diabetes with a HbA1c greater than 75. A review of 5 patient records showed that all had received the required monitoring with good interventions and medicine reviews recorded.

Searches identified 49 patients with asthma who had been prescribed 2 or more courses of rescue steroids out of 1656 patient in the last 12 months. We reviewed 5 patient records and found that adequate assessment was undertaken at the time of prescribing the steroids and that annual asthma reviews had been carried out but patients had not been reviewed within the NICE guidance that advises patients be reviewed within 48 hours of an acute exacerbation of asthma. The practice reviewed these patients and provided us with an updated post exacerbation asthma protocol. They started an asthma care quality improvement process including identifying those patients admitted to hospital and out of hours services.

Patients who have repeated courses of oral steroids (3 or more) or take high doses of inhaled steroids to treat their asthma should be provided with a steroid warning card. Of the 5 patients reviewed, issue of a steroid card was considered appropriate for 4 patients. Issue of a steroid card was not seen for these patients. The practice reviewed the policy to include the issue of steroid cards. When we completed our site visit, all patients had been appropriately reviewed.

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 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.

We saw evidence that the practice had regular meetings which were used to share any changes across the practice and with other community teams such as district nurses and health visitors. Palliative care meetings were held along with local communities such as Harrogate Rural Alliance meetings. The practice held a daily huddle meeting for all staff and clinicians and an afternoon meeting to discuss concerns and patient needs.

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 practice held drop-in clinics for the vulnerable and homeless which were held weekly and dedicated GPs were allocated to these clinics for continuity of care

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 offering NHS health checks. There was access to a practice social prescriber to support patients.

The practice offered a “VIP” telephone service for patients who were vulnerable or end of life. This allowed patients to access the practice in timely manner via telephone for ongoing support.

The service 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 practice met national targets for immunisations. The national target for routine childhood vaccinations is 90%. The World Health Organisation (WHO) recommends a rate of 95% for all routine childhood vaccinations. Those practices achieving this level are considered an example of good practice. The most recent data (2023/24) showed the practice had achieved 97% in 1 out of 5 routine childhood vaccination age groups and over 90% in 4 out of 5 areas.

The national target for cervical screening coverage is 80%. The most recent data (2024) showed that practice had achieved 77.8% for 50-64 year olds and 74% for 25-49 year olds. The practice assured us that extra clinics had been provided during extended hours clinics to increase uptake and capacity. Data provided by the practice showed that they were on course to meet these targets this year.

From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

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.