Tottenham Health Centre

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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 assessed all quality statements for this key question and rated the practice requires improvement for providing effective services. We found care was delivered and reviewed in a coordinated way when different teams, services or organisations were involved. Staff were passionate about supporting patients to live healthier lives and where possible, reduce their future need for care and support. However, we found patients’ care and treatment was not always provided in line with evidence-based guidance and the practice needed to improve their systems and processes to monitor patients’ health in relation to their long-term conditions.

At the last inspection we issued a requirement notice because the practice had several gaps in staff recruitment files, and staff did not always have the appropriate level of safeguarding training applicable to their role. We found that both these areas of concern had now been appropriately addressed.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We reviewed the results from the national GP patient survey carried out from January to March 2024. This asked patients whether their needs were met, was the healthcare professional good at listening to them, and were they involved in decisions about their care. The patients’ responses for these categories were in line with the national and local area national averages.

Staff we spoke with were aware of the needs of their patients and could demonstrate changes had been made to suit patient needs in their population. Leaders and staff told us the practice used codes and alerts on the patient record to highlight people’s needs. The practice had systems and processes to identify people’s needs and preferences during the registration process. Staff told us they checked people’s health, care, wellbeing and communication needs during health reviews. However, as a result of our remote clinical searches, the practice acknowledged they had gaps in their monitoring of patients with long term conditions.

There were appropriate referral pathways to make sure that patients’ needs were addressed. There were processes to ensure practice staff could identify patients presenting with symptoms which could indicate serious illness and follow up in a timely and appropriate way. This included a navigation tool used by receptionists, which assisted staff in identifying immediate concerns or red flags and what action to take. Processes were in place to assess patients’ immediate and ongoing needs. However, some of these processes were not working as expected. However, we found medicine reviews did not always contain information in line with best practice guidance. For example, we found patients with long term conditions did not always have timely interventions and care provided in accordance to best practice guidelines and legislation.

Staff told us that they followed protocols and National Institute for Health and Care Excellence (NICE) guidelines to ensure safe care and treatment was delivered. However, we found that systems were in some cases were inadequate to ensure effective monitoring of patients care and treatment. We found long term condition monitoring still required strengthening to ensure patients were monitored effectively.

The practice did not always make sure people’s care and treatment was effective. As part of the assessment several set clinical record searches were undertaken by a CQC GP specialist advisor. A sample of the records of patients with long-term health conditions were checked to ensure the required monitoring was taking place.Our clinical searches highlighted patients prescribed immunosuppressant medication; potassium sparing diuretic; and medication to treat diabetes was not always delivered in line with current legislation, standards and evidence-based guidelines (explained in more detail within the medicines optimisation above).

Staff described systems to share information between teams and services to ensure continuity of care, such as when clinical tasks were delegated or when people were referred between services. Staff told us there were clear policies and procedures in place, which were easily available to use. There were appropriate referral pathways to make sure that patients’ needs were addressed. Referrals to specialist services were documented and there was a system to monitor the timeliness of referrals. Multidisciplinary teams met regularly to discuss and support vulnerable patients.

The practice told us they attended regular multidisciplinary team (MDT) meetings with external partners such as district nurses, social workers and community healthcare staff to discuss patients’ needs and plan their care holistically. It was explained that one of the partners worked full time and carried out managerial responsibilities both clinical and administrative. The other GP partner was semi-retired and worked predominantly from home. The full time GP partner told us that as they were single handedly managing the practice, at times the work could be overwhelming. The practice recognised that there was a requirement to improve and increase managerial staff. To address this the GP partner told us they are looking to merge with a nearby practice and this would enable them to share the managerial responsibilities.

The practice had a process and audit trail for the management of information about changes to a patient’s medicines including changes made by other services. The GP partner processed clinical correspondence, prescriptions, coding and other associated actions. During our assessment, we did however find a backlog of information and test results that needed to be reviewed and followed up in a timelier manner.

During this assessment, we spoke to eight patients who told us they were encouraged to live a healthier lifestyle. Patients told us that they found the social prescriber helpful, and one patient had praise for the smoking cessation clinic.

Staff told us that they supported people to live healthier lives and where possible, reduce their future needs for care and support. Staff said patients had access to social prescribers and access to range of clinics for long term conditions. Posters and leaflets were available to direct patients where to seek further advice.

We found that staff encouraged and supported patients to be involved in monitoring and managing their own health. We reviewed consultation notes and medication reviews, which also confirmed this.

We found most people were positive about the experience of care and treatment they received at the practice in the last 12 months. We did not receive any concerns or identify any specific feedback about this quality statement.

All staff demonstrated a passion to support patients to manage their health and wellbeing so they can maximise their independence, choice and control. Staff we spoke with told us wanted to support them to live healthier lives and where possible, reduce their future needs for care and support. Nursing staff was aware that cervical screening needed improving as the uptake was under national targets, and we were provided with an action plan aimed to improve the uptake rate.

We found documented evidence of shared learning through complaints and significant events, which improved outcomes for patients. The practice also had a programme of clinical audit and second cycle audits, this included audits of prescribing and medicines management and reduction of Accident and Emergency attendance. We were provided with evidence of two specific audits, one which aimed to improve outcomes for patients with atrial fibrillation and the other for diabetes. However, due to the concerns identified within our clinical searches the processes for monitoring and improving outcomes required improvement. (please see safe section, medicines optimisation for more details)

We reviewed the practice performance for indicators including prescribing safety, prevention, diagnostics and access. We found the practice was generally in line with national averages. However, cervical screening uptake was reported at 60% which was below the national target of 80%. The practice was aware of this and had an improvement plan in place.

We did not receive any concerns from patients relating to consent to care and treatment.

All non-clinical staff were trained to carry out chaperone duties at the practice and had received a Disclosure and Baring Service (DBS) check. Staff we spoke with had a good understanding of consent and had received appropriate training.

Staff were aware of the processes and the importance of making sure a patients consented to their care. Staff received training in legal requirements related to consent, such as the Mental Capacity Act (2005). We reviewed the Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions of five patients and found decisions were made in line with relevant legislation with appropriate consent obtained.