Brunswick Park Family Practice Also known as Dr Patel practice at St gilesSsurgery

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 inspection, we rated this key question as good. At this inspection, the rating service is rated as requires improvement.

The service was in breach of legal regulation in relation to Regulation 12, safe care and treatment of the Health and Social Care Act, in the way need were assessed. We saw that people with diabetes were not consistently diagnosed or treated in line with NICE or other relevant guidelines. The service was also in breach of the same regulation in relation to monitoring and improving outcomes. The service was not able to demonstrate cyclical audit showing improving outcomes for people.

This service scored 62 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

In most cases the service assessed needs in line with their requirements. However this was not always the case with people with diabetes. In undertaking clinical searches, we looked for people who had least 2 consecutive hemoglobon A1C (HbA1c) readings of 48 mmol/mol and above, who should have been diagnosed as diabetic (HbA1C tests show average level of blood glucose over a period of two to three months, and is an indicator of diabetes). We found 22 records where this was the case. In a review of 3 of the 22 cases, all of the service users should have been coded as diabetic. Two were coded as pre-diabetic, and one had no coding at all. In the absence of coding, the service users would not have received monitoring and care required for the condition.

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

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.

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. For example, clinical staff participated in regular multi-disciplinary meetings to discuss the needs of their service users.

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 people’s health, including those in the last 12 months of their lives, people 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.

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.

The practice had not met national targets for immunisations, but was performing similarly to local averages, and was involved with a local project to improve uptake. 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 was not able to provide information on how audit was used to monitor and improve outcomes. The service did not undertake cyclical audits where performance was formally assessed, and improvement criteria set.

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.