Glenroyd Medical

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• 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 with advice and support.

Systems did not ensure that staff were up to date with or followed national guidance. There was no effective appraisal system to ensure care and treatment was being delivered in line with guidelines. Staff worked with all agencies involved in service users’ care for the best outcomes and smooth transitions when moving between services. People were involved in assessments of their needs. Staff involved those important to people and took decisions in people’s best interests where they did not have capacity.

At our last assessment, we rated this key question as good. At this assessment, the rating has changed to requires improvement.

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.

The practice usually made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. However, our clinical searches identified areas where the monitoring of service users’ conditions was not up to date, or it was not apparent their condition had been monitored elsewhere.

The practice had a navigation pathway document to easily guide staff. It listed many acute conditions and advised whether the person should be triaged at the service or be directed to a more appropriate service, such as AE. The practice 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 practice did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. They did not always follow legislation and current evidence-based good practice and standards.

Systems were not in place to ensure staff were up to date with national guidance, evidence-based good practice and required standards. Our clinical searches identified areas where up to date guidance had not been followed. Meetings were held but these were often informal with no records being kept. One clinical team had a one-off minuted meeting in April 2025 but decided to continue informal meetings going forward unless the need for formality arose. Therefore, any individuals unable to attend meetings would not have the ability to catch up on anything missed. Some clinical staff feedback was that changes to the practice were communicated poorly, and they would benefit from having meetings with their colleagues.

For the majority of staff, appraisals had not taken place for over 5 years.

The practice did not always work well across teams and services to support people.

There were various clinical teams within the practice including GP partners, salaried GPs, advanced clinical practitioners, clinical pharmacists and practice nurses. The practice had a clinical hub, which had been put in place for several reasons, including to reduce professional isolation, create a multi-disciplinary approach to the planning and delivery of care, and to optimise collaborative working. This meant that some clinicians carried out work, with the exception of physically seeing service users, in the same room as other clinicians. Informal discussion took place regularly but there was no formal interaction between clinical teams. No-one had a full oversight of all the teams at the practice.

We saw examples of the practice working well with other services. This included evidence of working closely with the local hospital managing a complicated issue.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. They 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. Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity. People were referred or signposted to local support services for information, education, advice and support linked to their needs. There was information at both sites to promote healthy living.

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 that people prescribed Amiodarone (a medicine used to treat life-threatening heart rhythm problems) had not always received appropriate monitoring. Magnesium had not been tested. Following the assessment the service told us they were now aware their clinical systems did not prompt for these checks, and they amended their procedures. Records were unclear in the case of some monitoring. It was not coded when monitoring had been carried out by secondary care and evidence was not kept that prescribers had checked monitoring was up to date.

The practice 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, well completed, and were made in line with relevant legislation. We saw an example of where consent and the mental capacity of a person had been fully and frequently assessed and recorded.