Burnley Group 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

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. 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 71 (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 usually made sure people’s care and treatment were effective by assessing and reviewing their health, care, wellbeing and communication needs with them. However, feedback from people using the service was not always positive.

The results of the National GP Patient Survey were below national and local averages. For example, 83% felt the healthcare professional they saw had all the information they needed about them, compared to 92% nationally and 92% locally, and 79% felt their needs were met during their last general practice appointment, compared to 90% nationally and 91% locally.

Staff at the practice appeared to be aware of the needs of the local community. Staff had systems for placing digital flags within the care records system to highlight specific individual needs, such as those who were carers, those who were housebound or were vulnerable. However, we noticed some missing flags on some records for some potential safeguarding information.

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

The experience of people who used the service, as indicated in the National GP Patient Survey, was lower than national and local averages. They showed that 85% of respondents, compared to 93% nationally and locally, stated that during their last appointment, they had confidence and trust in the healthcare professional they saw or spoke to.

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. However, their system for overseeing diagnostic results did not fully provide assurance that all results were dealt with in a timely way; this was more a process issue, rather than results not being reviewed. Managers stated they would make sure that this was reviewed and cleared regularly, with an individual having oversight to ensure this was achieved.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. The practice supported people to live healthier lives and, where possible, reduce their future needs for care and support.

The practice supported national priorities and initiatives to improve the population’s health, including stop smoking and tackling obesity campaigns. Patients were encouraged to attend cancer screening and take up vaccinations offered as part of national programmes. However, the practice was below target for the percentage of persons eligible for cervical cancer screening who were screened adequately within 3.5 years for persons aged 25 to 49 (64.2%, expected rate 80%) and within 5.5 years for persons aged 50 to 64 (69.7%, expected rate 80%). They were also below target for childhood vaccinations, achieving less than the 90% minimum for all 5 of the childhood vaccinations.

The practice demonstrated the initiatives they had made to engage with and encourage uptake of national priorities, such as education sessions and flexible appointment times, but explained the challenges with some patient groups who were reluctant to take up the screening or childhood vaccination programmes.
 

The practice 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.

Our clinical searches identified people with hypothyroidism who had not had their thyroid function monitored for 18 months. This identified 624 people with hypothyroidism; it appeared that 36 may not have had the relevant monitoring of 18 months or more. Thyroid stimulating hormone (TSH) should be checked annually when thyroxine is prescribed. This helps to determine if the dose is correct. An incorrect dosage could lead to bone loss or heart problems. We examined 5 records and found all of them were overdue monitoring, some had not been monitored for up to 3 years. The practice had sent requests to those people to ask them to attend for tests shortly before the inspection.

We looked at management and monitoring of people with chronic kidney disease (CKD) stages 4 or 5, we looked at those who may not have had the appropriate blood tests used to assess kidney (renal) function and monitor electrolyte balance in the last 9 months, which is essential for safe management of medications. We found that 100 people were recorded as having CKD stages 4 or 5, and that 11 may not have had the monitoring. We looked at 5 records in detail and found they were overdue monitoring, 1 had not had monitoring for 2 years, another 18 months, and 2 around a year. A recent test had been done for 1 patient, but it had not been recorded on their record. All had been requested to attend by the practice.

We looked at people who have had blood test results that indicate they may have diabetes. We identified 26 people this may have applied to and we looked at 5 cases in detail. We found that 2 out of the 5 who should have been recorded as having diabetes and the appropriate follow-up implemented.

We looked at the management and monitoring of people with a diagnosis of diabetes and found this was generally good, with regular reviews taking place in line with recommendations. Similarly, we found that the monitoring of patients with exacerbation of asthma were managed appropriately.

The practice told people about their rights around consent and respected these when delivering person-centred care and treatment.

However, the practice did not undertake a formal documentation audit around do not attempt cardiopulmonary resuscitation (DNACPR) and decision making, best interests and mental capacity assessments. We saw they reviewed records on an opportunistic basis and corrected any issues as they were noticed, however this was not done in a systematic and comprehensive way and as so lacked the assurance required. We reviewed 5 records of persons recorded as having DNACPR status in place and found inconsistency and limited information recorded in relation to mental capacity in some records