The Vale Surgery

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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 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.

The service was in breach of legal regulation in relation to Regulation 11 (need for consent) as the provider did not act in accordance with the Mental Capacity Act 2005. We have asked the provider for an action plan.

This service scored 71 (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. Staff explained that the reviews went beyond clinical checks to look at each person’s wider wellbeing, making the discussions meaningful and personalised.

People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. For example, the National GP Patient Survey showed that 95% of patients felt they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment, compared with local and national averages of 90% and 91%.

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. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. Our clinical searches indicated that the practice had an effective system in place for managing patients with asthma. The provider had effective systems to identify people with previously undiagnosed conditions.

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. Staff told us they maintained their professional knowledge through regular revalidation and attending clinical meetings.They added that the team routinely shared information, used meeting time to discuss new developments, helping ensure care remained current and person‑centred.Systems were in place to support staff were up to date with evidence-based guidance and legislation. The practice was signed up to receive safety alerts and received updates from CQC and NHS England.

The service worked well across teams and services to support people. The practice worked with other services such as community services, and voluntary organisations to ensure continuity of care, including where clinical tasks were delegated to other services. Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Staff described close joint working with Primary Care Networks (PCNs) roles and community services, supported by shared clinical systems that allowed access to shared records.

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. For example, the practice promoted HIV testing and awareness campaigns, sharing information via its website and through waiting room posters. They also signposted patients to services and activities, such as swimming, to support healthier lifestyles.

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 national targets for screening and immunisations; however, it faced challenges linked to its population demographics. Staff reported that language barriers and varying levels of confidence in engaging with healthcare services may have influenced uptake. It was also noted that some families chose to have vaccinations administered abroad, and these were not always updated in NHS records, which may have impacted reported figures. There was evidence that the practice had been proactive in encouraging patients to attend screening programmes. For childhood immunisations, the practice provided education and reassurance. Conversations were handled with care, using appropriate training to communicate effectively with families, ask relevant questions, and provide clear, evidence-based reassurance. Missed appointments were followed up, with flexible options offered, and any refusals were recorded while support continued. For cervical screening, the practice actively encouraged attendance through reminders and reassurance. Patients were informed about current guidance and options, including self-cervical testing where appropriate.

From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in evidence-based clinical guidance.

The service told people about their rights around consent. However, staff, including clinicians, did not demonstrate sufficient understanding and application of legislation relating to mental capacity. From the records reviewed, we identified two examples where, although Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions had been discussed with families when patients lacked capacity, mental capacity assessments were not recorded in line with the Mental Capacity Act 2005. Evidence indicated reliance on template-based cognitive impairment tests, which did not align with the legislation. Since this assessment, leaders developed a Mental Capacity policy aligned with the Mental Capacity Act 2005.