Woodsetton Medical Centre

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 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 service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

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. Care plans and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) records were completed and reviewed regularly. 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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

There were appropriate referral pathways to make sure that patients’ needs were addressed. We spoke with staff who were able to describe the process for coding of correspondence and care and treatment records for people.

Staff we spoke to were aware of the workflow and clinical staff were able to demonstrate how the practice provided further education and support to patients. We found that staff had the appropriate skills and training to carry out reviews where appropriate.

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. We found that patients mostly received appropriate monitoring at the required intervals. There were a few areas for improvement we identified and raised with the provider so they could take this forward.

During the remote clinical review, we carried out a search to identify people with asthma who had been prescribed 2 or more courses of rescue steroids in the past 12 months. The search identified 30 people. We reviewed a random sample of 5 clinical records and found they had not been followed up in the recommended 48 hour guideline; however, they had been safety netted and identified 1 out of the 5 patients required a steroid card.

Further reviews of the clinical system identified people with diabetes who had a HbA1c of 75 and over. A haemoglobin A1C (HbA1C) test is a blood test that shows your average level of blood glucose over time. We reviewed a random sample of 5 clinical records and found the appropriate reviews had been completed.

Our remote clinical search identified the practice had 8 patients with hypothyroidism who had not had a thyroid function test monitoring for 18 months. We sampled 3 of these patient records and found 2 patients were overdue but had been recalled by the practice.

Our clinical searches identified 3 patients with chronic kidney disease stages 4 or 5. We sampled 3 patient and found 1 patient required blood monitoring to assess their kidney function in the previous 9 months.

Systems were in place to manage and respond to safety alerts. However, our clinical searches identified the recommended monitoring was not always at the frequency required for frail people or those aged over 75 years. We discussed the frequency of monitoring with this specific cohort with the provider who agreed to take action.

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 told us that they had access to the information they need to appropriately assess, plan and deliver people’s care, treatment and support and they had enough information to plan and refer people and receive subsequent results and information following referral.

There were systems and processes in place to enable information to be shared between the provider and services to ensure continuity of care. Regular meetings were held with multi-disciplinary teams to ensure care was co-ordinated effectively.

The primary care network (PCN) helped to support the practice by providing links to pharmacists, first contact practitioner, physicians associate and social prescribers. People were able to receive co-ordinated care between the practice and the primary care network.

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.

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.

The practice was below the national target of 80% uptake for cervical screening with the practice having achieved 75% for people aged between 25 to 49 years of age and 74% for people aged 50 to 64 years. The practice achieved 4 out of 5 childhood immunisation targets, with coverage rates ranging between 94% and 96%. One target, relating to the percentage of children aged five who had received the measles, mumps, and rubella (MMR) vaccination, was recorded at 89%. This was just below the national threshold of 90%. Staff told us that they followed up all patients that failed to attend their appointments. The practice had systems and processes in place to recall patients and implement flagging procedures aimed at promoting opportunistic uptake..

The practice had a programme of clinical and non-clinical audits aimed at driving continuous improvement in patient care. For example, minor surgery post operative infection audit, physician associate consultation quality assurance audit.

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.