Castlegate & Derwent 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

People were involved in assessments of their needs. Staff reviewed assessments, sometimes taking account of people’s communication, personal and health needs. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people took decisions in people’s best interests where they did not have capacity.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us that the practice were understaffed, and we saw evidence of patients being assessed and triaged via telephone inappropriately. Reception staff sometimes used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments. 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. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

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

Clinical records we saw demonstrated care was not always provided in line with clinical guidance, where this had happened the clinicians involved had not provided a documented rationale that outlined the reasons for their decisions.

The service mostly made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs. However, we reviewed evidence of specific examples whereby a patient’s accessible communication needs were not recognised or monitored effectively by the practice.

The results from our clinical searches showed that improvements could be made to the recall system, particularly for patients with asthma. We highlighted Several patients to the practice as not being effectively assessed before being prescribed a rescue pack. Furthermore, we discussed the importance of steroid cards for these patients at our last assessment, at this assessment there were still patients who required a card who had not been provided one.

The practice did not have a process in place whereby clinical leaders were ensuring clinicians were following up to date guidance. Safety alerts were managed by a lead GP and disseminated to staff where they felt this was appropriate.

The service did not always work well across teams and services to support people. Patients told us staff had not always handed over information and therefore had to repeat themselves on numerous occasions. Patients also told us they needed to make extra telephone calls for results or follow ups. We saw evidence of staff within the practice working to different processes. The practice sometimes worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services, but lacked oversight of follow-up.

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 supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity. The practice had implemented an exercise class for patients who were diabetic, we reviewed positive patient feedback in relation to these classes.

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.

We reviewed data from the practice which indicated that targets for cervical smears and childhood immunisations were being met. There was a clear process in place for recalling patients who had not attended appointments.

At our previous inspection we said the practice should develop a more proactive and structured approach to identifying clinical audit and quality improvement. At this assessment the provider was still unable to provide us with an example of a quality improvement project or audit that had improved patient outcomes. However, we did review evidence of an audit that was in progress which aimed to improve patient outcomes in relation to Hormone Replacement Treatment and the Mirena coil, this was commenced due to incidents flagged by the practice during the significant events process. As this was in progress we were unable to assess how patient outcomes had been improved due to the work being carried out. The completed audits the practice provided evidence of were single cycle, and there was no rationale as to how they ensured the audits carried out by trainees were of benefit to the practice. The audit process lacked clinical oversight.

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.