Thorneloe Lodge Surgery

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. 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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.There were systems and processes in place to identify patient’s needs and preferences. Reception staff were aware of the needs of the local community. Patients were coded dependent on their needs. For example, carers were coded on the system to highlight any additional requirements. Information was also accessible in different languages on their website. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties to a social prescriber within the primary care network. Although feedback from the National GP Patient Survey data showed that most feedback scored below the national average, feedback given directly to us at CQC was overall positive. Patients felt involved in their care and felt confident that staff understood their individual and cultural needs. 88% of patients that completed the National GP Patient Survey data agreed that they felt they had confidence and trust in the healthcare professional they saw or spoke to during their latest appointment.

There were systems in place to ensure staff were up to date with relevant legislation, evidence-based practice and required standards. Clinical meeting minutes evidenced clinical updates including changes to existing procedures and developing policies. These were circulated between staff to ensure they remained up to date with evidence-based guidance and legislation.

As part of the clinical searches, we reviewed if care and treatment was delivered in line with best practice. Our findings from the clinical searches showed that monitoring of patients with long-term conditions was not always followed in line with National Institute for Health and Care Excellence (NICE) guidelines. For example, one of our clinical record searches reviewed the number of patients with asthma who had been prescribed two or more courses of rescue steroids in the last 12 months. We identified a total of 57 patients and reviewed a random sample of 5 patient records. We found that 3 out of 5 patients had not been followed up within 48 hours to check their initial response to the treatment. However, all 5 patients did have their annual review which provided the patient with an asthma care plan.

The practice worked well across teams and services to support patients. Information was shared between teams and services to enable continuity of care and ensure patients only had to tell their story once when moving between different services. Patients felt their referrals were dealt with in a timely manner.The merging of reception and administration staff led to a broadened skill mix, increasing productivity. Staff had access to the information necessary to allow them to appropriately assess, plan, and deliver patient’s care, treatment, and support. The practice had an open-door policy to encourage staff to speak up and ensure all queries were answered. Regular multi-disciplinary team meetings were had to ensure all staff were updated with the latest information, guidance and changes within the practice.

The practice supported patients to manage their health and wellbeing to maximise their independence, choice and control. The practice supported patients to live healthier lives and where possible, reduce their future needs for care and support. Staff gave patients advice and guidance about leading healthier lives. They encouraged patients to take an active role in reviewing their own health and wellbeing so they would recognise changes to their health and wellbeing. Health promotion material was observed in the practice and further information could be found on their website. Smoking cessation information was provided on their website. Patients were encouraged to attend health screening appointments.

As part of our assessment, a series of patient clinical record searches were undertaken by a CQC GP specialist advisor. Findings from these searches indicated that 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. Although the practice showed appropriate monitoring for patients diagnosed with chronic kidney disease, we identified 250 patients that had a potential missed chronic kidney disease diagnosis. The practice was responsive and took action to review and contact these patients identified through our patient clinical record searches to provide assurances.

At the time of our assessment, the latest information from the UK Health Security Agency (UKHSA) showed that the practice met the national target for the number of children immunised against various infectious childhood diseases. However, the latest information from NHS Digital showed the practice’s uptake of cervical cancer screening was below the 80% national target and was observed as 73.9%. Staff told us they were aware of these figures and told us systems were in place to improve the uptake of cervical cancer screening. For example, the practice liaised with the appropriate staff including the cancer care-coordinator and nurses to contact patients to encourage uptake of screening. Any concerns were discussed, and support was provided if needed. Follow up arrangements for patients who failed to attend appointments was in place to also improve the uptake of cervical cancer screening.The practice has shared evidence with us following the assessment, demonstrating that cervical screening uptake has increased.

The practice 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. Staff understood the importance of ensuring that people fully understood what they were consenting to and respected the importance of obtaining consent before they delivered care or treatment. Staff said they always obtained consent from patients or if appropriate their guardian. People received information about care and treatment in a way they could understand. Patient’s capacity and ability to consent was considered and clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation. Chaperones were available upon request. This information was on display in the form of posters in the practice and chaperone information could also be found on their website. We did not receive any concerns about consent from the feedback we received from the patients who use the service.