St Johns Wood Medical Practice

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 in August 2017, we rated this key question as good. At this assessment, the rating remains the same because we found no issues with the effectiveness of assessing, monitoring and improving patient needs and care.

This service scored 63 (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. Feedback from people using the service was positive. 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. There were digital flags within the care records system to highlight any specific individual needs. Staff checked people’s health, care, and wellbeing needs during health reviews. Care plans for patients with learning disability and autistic people were adequate. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The practice ensured reasonable adjustments for patients who needed them. For example, people with learning disability and autistic people were offered longer appointments and dung less busy times of the day. The practice had a carers’ information board at the reception; however, health checks for patients with caring responsibilities were not offered proactively. Flu vaccinations were provided, and patients were referred to relevant support services where needed.

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. Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw did not always demonstrate care was provided in line with current guidance. In particular, we found instances of the practice not acting on MHRA and NICE guidance, and UK Health Security Agency (UKHSA) updates.

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 had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The service worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.

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, and patients at risk of developing a long-term condition.

The service 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.

The service did not meet national targets for cervical screening and childhood immunisations. This was also identified at the last assessment in August 2017. The percentage of women aged 25-49 who had an adequate cervical screening test was 42.7% which was below the 80% national target. The percentage of women aged 50-64 who had an adequate cervical screening test was 48.1% which was below the 80% national target.

The service was below the childhood immunisation uptake rates in all the categories. The provider was achieving childhood immunisation uptake rates of 81% for children aged 1, 70 – 78% for children aged 2 and 63% for children aged 5. There was a system of recall to educate patients who did not engage with the health offers about the health benefits. The impact of this action on the uptake was not yet known. The practice informed CQC that some of the patient population undertook cervical screening privately but this was not added to the national database because of the established protocols that needed to be followed to ensure safe parameters and standards which had contributed to the low uptake data of the cervical screening.

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 not always appropriate or made in line with relevant legislation. For example, our review of some DNACPR records showed that decisions initiated with patients during hospital admission were not reviewed to ensure they remained current and relevant to the patient after discharge to the community. In addition, 3 of 8 patient records did not have copies of the completed forms on file.