Westbury Medical 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 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 has changed to requires improvement.

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.

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.

Feedback from people using the service was positive. The National GP Survey results found 95% of people who responded to the survey said they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. This was above the national average of 91%.

Staff told us they were aware of the needs of the local community with being a small practice. They said they checked people’s health, care, and wellbeing needs during health reviews.

We sampled 5 medication reviews, and found they were frequently documented only in the context of consultations for unrelated issues, with no clear evidence that a full medication review had been conducted. The records lacked the required detail which meant we could not be assured key safety considerations had occurred in a medication review. We found the provider did not have effective systems to identify people with previously undiagnosed conditions such as diabetes.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Clinical records we saw demonstrated care was not always provided in line with current guidance, for example the surgery had 114 patients on Direct oral anticoagulants (DOACs) ,45% of which had not had their creatinine clearance calculated at all and 74% had not had the calculation done within the last year. Creatinine clearance calculations allows for correct dose checking. Patient medicine review notes lacked detail, clinicians told us actions were taken but not always documented.

The service worked across teams and services to support people.

Staff had access to most information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services to ensure continuity of care.

The service did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. Staff did not always focus on identifying risks to patients’ health, including those patients at risk of developing a long-term condition.

Our clinical searches showed 10 patients with a potentially missed diagnosis of diabetes. After reviewing all records, we identified 3 patients who were inappropriately managed, including 6 missed cases of diabetes. These findings showed the service did not have effective systems to ensure timely recognition, and diagnosis of diabetes. A further clinical search looking at high-risk diabetes patients with raised blood sugar levels showed out of 5 records, 2 patients had not been reviewed following their high readings. Following our inspection the practice took action and reviewed the patients highlighted within our searches.

The practice told us they used to refer patients to a local authority social prescriber for help with social needs, but the service was no longer available. However, patients could obtain support with sleep, mental wellbeing, food and exercise via a science based health coach software application, designed to improve their mental and physical wellbeing.

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 had not met the national target for childhood immunisations. All 5 indicators were below the World Health Organisation (WHO) target of 95%. The practice told us appointment reminders were sent to parents; however, they had difficulties with meeting the target due to small numbers of children registered at the practice and parents cancelling appointments.

Uptake of cervical screening was below the national target of 80% for both age groups. The practice was aware of the uptake and told us cervical screening used to be carried out by a nurse practitioner, and they were achieving well but they had since left the practice. Training had been arranged for the current clinician; however, this had not yet taken place. The practice arranged for another nurse practitioner to undertake a session once a month to complete cervical screening as required. Patients could also obtain these appointments via their Primary Care Network extended access.

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.

The practice told us a variety of people completed the Do not attempt cardiopulmonary resuscitation (DNACPR) form, including the visiting paramedic from the Primary Care Network and these decisions were reviewed when they saw the patients.