Fairfield PMS

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 patients in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed patients’ care and worked with other services to achieve this.

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

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 service made sure patients’ 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. Patients 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 patients’ health, care, and wellbeing needs during health reviews. The provider had effective systems to identify patients with previously undiagnosed conditions.

The practice held a register of patients identified as a carer and offered annual flu vaccinations and health checks to this group. Carers could be signposted to a local carers centre, which offered support particularly to carers of people with dementia.

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

The service planned and delivered patients’ 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.

The service worked well across teams and services to support patients. They made sure patients only needed to tell their story once by sharing their assessment of needs when patients moved between different services.

Staff had access to the information they needed to appropriately assess, plan, and deliver patients’ 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 service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support.

Staff focused 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, tackling obesity and prevention of type 2 diabetes.

The practice had recently launched community café along with other local practices. This was a local space run by volunteers from the practices with a focus on reducing loneliness and social isolation within the community.

NHS England data from June 2024 showed the practice had not met national targets for the uptake of cervical cancer screening. Screening for eligible patients aged 25 to 49 years old was 69.2% and for eligible patients aged 50 to 64 years old was 76.2% (the national target for both groups is 80%). Whilst uptake did not meet national targets, the percentage of patients screened for both age groups was higher than local averages. The provider had processes in place to ensure their register of eligible patients was reviewed regularly and remained accurate. Patients could self-book and appointments were available on evenings and weekends. Practice staff had visited local groups, including places of worship, to engage with the local community and answer any questions about cervical cancer screening.

UK Health Security Agency (UKHSA) data for the period of April 2023 to March 2024 showed the practice had not met the World Health Organisation (WHO) minimum recommendations for uptake of childhood immunisations. Four of the indicators were below 90% uptake and one indicator (for 5 year olds who had received immunisation for measles, mumps and rubella) was below 80% uptake (76.8%). The recommended rate is 95% for all routine childhood vaccinations. The provider sent reminders using different communication methods to encourage parents to bring their children for immunisations. The practice sent annual reminders to parents who had previously declined and encouraged patients to discuss their concerns regarding childhood immunisations with clinical staff.

The service routinely monitored patients’ care and treatment to continuously improve it. We saw examples of cyclical audits where performance was formally assessed, and improvement criteria set, including of antibiotic prescribing and Medicines and Healthcare products Regulatory Agency (MHRA) alerts.

The service told patients 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.