Merridale Medical Centre - RP Tew

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 with advice and support. Staff routinely reviewed patients 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 67 (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 had systems and processes in place to identify patients’ needs and preferences during the registration process. The practice 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. Clinicians used templates when conducting reviews to support the assessment of patients’ wider health and wellbeing. Staff could refer patients with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

As part of our clinical searches, we reviewed the care of patients with hypothyroidism (underactive thyroid). We identified 362 patients who were diagnosed with hypothyroidism of which 15 patients had potentially not received thyroid function test monitoring for 18 months. We looked in detail at the care records of 5 patients and found 2 patients were overdue thyroid function test monitoring and 3 patients had received this test in secondary care. In the absence of necessary blood test monitoring, patients prescribed this medicine could be under or over-treated for their hypothyroidism. Leaders immediately responded to our feedback on this issue and the small cohort of patients who were overdue thyroid function test monitoring were re-called and for any patients who failed to have their blood test in the next month, they would be moved to weekly prescriptions.

We reviewed the practice systems to identify people with previously undiagnosed conditions. Clinical searches identified 62 patients with a potentially missed diagnosis of chronic kidney disease stage 3, 4 or 5. We looked in detail at 5 patient records. We found 2 of these patients had been coded as having chronic renal impairment and not chronic kidney disease and therefore were not on the correct clinical register. Patients are at risk of missing regular monitoring and may become unwell as a result of not being accurately coded. In addition, we identified 1 patient who required a more up to date blood test to assess their kidney function. We fedback our findings to leaders who took immediate action to address this issue. Leaders told us they reviewed all patients who had the code ‘chronic renal impairment’ rather than chronic kidney disease. Leaders updated all staff on using the correct code. The practice ensured the correct code had been applied to patient records and recalled all patients with chronic kidney disease who were due their blood test monitoring.

The majority of feedback from patients using the service was positive. The National GP Patient Survey found 86% of patients felt their needs were met during their last general practice appointment.

There were systems in place to ensure staff were up to date with relevant legislation, evidence-based practice and required standards. Clinical meetings were in place to keep staff up to date. For clinicians who were unable to attend this meeting in person, these meetings were minuted and disseminated to all clinicians.

The remote clinical searches we undertook of the practice’s clinical records system included reviewing the monitoring of people with long-term conditions to assess if National Institute for Health and Care Excellence (NICE) recommendations were followed.

For example, we identified 136 patients with diabetes whose last blood glucose reading was over 75. We reviewed a random sample of 5 patient records and found all patients had their diabetic medication reviewed following this blood glucose result; and all patients had received a diabetes annual review.

The practice 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 people moved between different services. Staff had access to information they needed to assess, plan, and deliver patients’ care, treatment, and support. Systems were in place to share information about patients electronically with other services.

The practice worked with other services to ensure continuity of care and engaged in multi-disciplinary team (MDT) meetings. For example, for patients identified as approaching end of life, the practice referred to and worked closely with the community palliative care team. Home visits and care packages were implemented to ensure patients’ wishes were followed and carried out in their final stages of life.

In addition, the practice provided a weekly ward round with a clinician for residents of a local care home and worked closely with care home staff.

The practice referred patients to the additional roles reimbursement scheme (ARRS) staff such as the wellbeing team for appointments with health and wellbeing coaches and social prescribers; and the ARRS pharmacists who provided both telephone and face to face appointments for patients for advice and support with their medicines management.

First contact practitioner (FCP) physiotherapy was also available for patients with musculoskeletal (joint, muscle, or nerve) pain to have appointments with physiotherapy directly at the practice.

The practice supported patients to manage their health and wellbeing to maximise their independence, choice and control. Staff supported national priorities and initiatives to improve population health, including stopping smoking, diabetes prevention programme and tackling obesity.

For example, every Monday the practice hosted a Stop Smoking clinic; and every Wednesday 1:30pm-3:00pm there was ‘Merridale Weekly Wellness – Walk and Connect’ group run by the Wellbeing Coach and Social Prescriber, where patients could meet and go for walks together.

The practice waiting area and the practice website provided a wide range of health information for patients. We saw evidence of promotional events held in the practice hosted by the Social Prescriber including Type 2 diabetes support and advice; and adult education learning opportunities.

The practice routinely monitored patients care and treatment to continuously improve it. Staff endeavoured to ensure that outcomes were positive and consistent, and that they met both the clinical expectations and the expectations of patients. The practice undertook regular clinical audits, and we were provided with evidence of two-cycle audits which demonstrated quality improvement. 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.

As part of our assessment however, we reviewed the practice performance data for childhood immunisations. The World Health Organisation (WHO) recommends a rate of 95% for all routine childhood vaccinations. We found the practice was not meeting this target for childhood immunisations.

Published national data showed the percentage of children aged 5 who had received immunisation for measles, mumps and rubella (2 doses of MMR) was 71%.

The percentage of children aged 2 who had received immunisation for measles, mumps and rubella (1 dose of MMR) was 80%.

The percentage of children aged 2 who had received their booster immunisation Pneumococcal infection was 77%.

The percentage of children aged 2 who had received their immunisation for Haemophilus influenza type b and Meningitis C was 90%.

The percentage of children aged 1 who had completed a primary course of immunisation for Diphtheria, Tetanus, Polio, Pertussis, Haemophilus influenza type b (Hib), and Hepatitis B (Hep B) was 90%.

We discussed childhood immunisations with nursing staff and GPs. Nursing staff told us that some areas of the population are vaccine hesitant. In addition, there was currently only 1 nurse in the practice who could administer childhood immunisations following 1 nurse leaving employment at the practice. GPs told us to increase uptake the practice had been participating in roving clinics for childhood immunisations in the local community. Mobile vaccination services operate by bringing healthcare directly to convenient locations such as supermarket car parks, schools, and community centres, rather than requiring people to visit a GP surgery.

In addition to childhood immunisation data, we reviewed published national data for the uptake of cervical screening. The practice had achieved 53%, which was significantly below the national target of 80%. The practice was working to improve the cervical screening uptake, and staff told us they made telephone calls to patients who failed to attend their appointments.

The practice told patients about their rights around consent and respected these when delivering person-centred care and treatment. A consent policy was in place to ensure appropriate consent was obtained from patients when receiving care and treatment. Staff understood the requirements of legislation and guidance when considering consent and decision making.

Patients were offered a chaperone for care and treatment when this was appropriate. Chaperone posters were on display at the practice to inform patients of this service and staff who provided this service had completed chaperone training.