Old Bridge 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. 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.
People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people and took decisions in people’s best interests where they did not have capacity.
Our clinical searches found that the service did not always identify people with previously undiagnosed condition or receive the correct monitoring for some medicines. The service took action following this to ensure that patients affected received the correct monitoring and reviewed their processes to make improvements.
 

This service scored 62 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.
As part of our assessment a number of set clinical record searches were undertaken by a CQC GP Specialist Advisor.
We evidenced that the service did not always identify people with previously undiagnosed conditions. Our clinical searches identified 199 patients with potential missed diagnosis of chronic kidney disease (CKD) stage 3, 4 or 5. A sample review found 4 out of 5 patients had not been informed of the diagnosis. The service took immediate action, implementing a plan to make contact with patients affected.
The service had 458 patients diagnosed with an underactive thyroid. (A condition where the thyroid gland does not produce enough thyroid hormones, leading to a slowing of the body's functions and causing symptoms like fatigue, weight gain, constipation, feeling cold, and depression). Of these patients, 10 patients had potentially not received relevant blood tests in the past 18 months. We sampled 5 patients records and found that patients had not had the required monitoring. The service took action to address all patients affected, in a timely way.
We reviewed the records of people living with asthma who had had 2 or more courses of rescue steroids in the last 12 months. National Guidelines stipulate that people who have had 2 or more courses of rescue steroids in the last 12 months require follow up within 48 hours. We found that patients had been followed up in line with this guidance.
Patients with chronic kidney disease had received the correct monitoring and patients living with diabetes had received the correct support after HbA1c in the sample we reviewed. Staff and leaders were aware of the needs of the local community. The service had implemented a digital triage system and recognised that people may support during the transition. The service offered people the option of contacting the service by telephone or walk in.
Reception staff had established processes to assess people’s needs and used national digital flags within the care records system, to highlight any specific individual needs. Staff had received chaperone training to be able to support people during their appointments.
 

There were policies such as chronic disease management that reflected best practice guidance and standards. The policy outlined the process for clinicians to carry out opportunistic reviews for people with certain health conditions.
During our clinical searches we found reviews and monitoring of patients following receipt of Medicines and Healthcare products Regulatory Agency (MHRA) alerts were not always effective. For example, we reviewed the records of 14 people prescribed mirabegron (medicines for treating an overactive bladder but with risk of severe hypertension). We found 5 out of 5 clinical records reviewed did not always have blood pressure recorded routinely in their records.
Following our clinical searches, the service provided information to show that people affected had attended or had arranged appointments for reviews and required testing.
The service took further steps to improve their systems for medication monitoring, to ensure risks were negated and we received evidence of this following our inspections.
There were systems to ensure staff were up to date with evidence-based guidance and legislation. The service had regular clinical meetings where guidance and standards were discussed, and staff told us they had sufficient time for continuous professional development.

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 collaborated with other teams to ensure continuity of care and staff told us the steps they took to share information with other services. Technology was used to share information across sites and teams.
Monthly multidisciplinary meetings took place that included all practices within the Primary Care Network (a group of GP practices that work together with other local health and social care organizations to provide integrated services for their communities) and attended external teams. This allowed for a collaborative approach to people’s care, such as attending joint visits with external teams. Within the practice a daily huddle took place that included a variety of clinical staff.
 

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.

There were health promotion leaflets available to inform people about health and wellbeing topics. The services’ website provided information about national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.

The service was supported by a social prescribing link worker who could signpost people to access services to improve their health and wellbeing. (Social prescribing is an all-age, whole population approach that works particularly well for people who: have one or more long term conditions; who need support with low level mental health issues; who are lonely or isolated; who have complex social needs which affect their wellbeing).

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.
We reviewed data related to the performance of the practice. We found:
• The practice met national targets for cancer screening and MMR vaccines
• The service had not met national targets for cervical screening and not always met targets for childhood immunisations.
The service had not always met national targets for 3 of the 4 childhood immunisations of 90%, having attained between 75% and 79%. The provider was aware of the population of its service and had a delivery plan in place. However, further improvements were required to ensure national targets are met.
We saw evidence of clinical audits which they had carried out to improve outcomes for people. These covered prescribing, dispensing and medication safety reviews. Leaders and staff told us that audits were discussed at clinical meetings and half day closures for protected learning time (PLT).

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. We reviewed DNACPR decisions for 5 people and evidenced they were maintained in line with relevant legislation.

Staff could tell us the steps they would take to ensure people could consent to care and treatment. Staff had completed Mental Capacity Act training. The service had policies, protocols, and guidance to support people to consent to care and treatment.