The Endeavour 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

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. 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. The practice had a direct phone line available for known palliative patients to make it easier to access the service. 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. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber. On review of clinical records, we saw that people were supported to consider their wishes for their end-of-life care, and these needs were assessed annually. Staff told us they were able to identify carers and support those in carer roles.

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. For example, we saw that patients prescribed sodium valproate had documented discussions regarding contraception. There were processes in place for the management of safety alerts within the practice.

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 that clinical tasks were actioned in a timely manner. Clinical staff attended a daily catch-up meeting to share knowledge and discuss complex cases. We saw examples of knowledge sharing between clinical staff where a member of staff had specialist experience. For example, the GP with a specialist interest in Women’s Health had provided training in this area to other clinical staff within the practice. Representatives from local care homes provided good feedback in this area.

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 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. Information about these national initiatives was available on the practice website and within the waiting room.

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.

Practice leaders recognised the needs of their local population, and worked with initiatives such as the Deep End Project to target screening and immunisation rates, with the aim to increase uptake. This initiative is a network for primary care staff that serves the most socioeconomically disadvantaged communities in the North East and North Cumbria. Practice leadership told us that the uptake of cervical screening remains a challenge in their locality. Screening figures were reviewed regularly by practice leadership. 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. Written consent was obtained for minor surgery procedures; we saw that these documents were completed to the expected standard. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation. These were reviewed annually.