Colliers Wood 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.

This service scored 75 (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. One patient told us “They gave me so much information to help me make decisions about managing my condition”.

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. The practice had a system in place to carry out health checks and annual reviews in line with NHS recommendations, such as annual reviews for patients with mental health problems and the 40-64 years health check. They also had support in place for carers, which included appointments with the person they cared for and offer of the flu vaccination.

Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The provider had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

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. The practice received safety alerts, plus updates from CQC and NHS England.

Clinical records we saw demonstrated care was provided in line with current guidance. For example, we saw that systems to identify and call people regarding vaccinations and immunisations was in line with national guidance for people in “at risk groups”. They had a dedicated member of staff who was responsible for recalling patients and inviting them to book their vaccination. This invitation was repeated up to 3 times if the person did not respond. It was also followed up with a telephone call or text message if they still did not respond.

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 practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. For example, they had monthly meetings with the primary care network and community teams to discuss patients who were at end of life. They also met regularly with district nurses and social workers to share information and assess needs of patients for continuity of care.

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. The practice had systems in place to refer patients to weight management and smoking cessation services.

Processes were in place for patients to be referred to a social prescriber for support with social issues such as housing and emotional support.

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 some of the national targets for screening and immunisations. For example, the number of women aged 50 to 63 who had a breast screening test within the last 5.5 years was 66%, compared to their target of 80%; and the percentage of children aged 2 who had received their booster immunisation for Pneumococcal infection was 75% which was below the 80% target. Whilst the practice was below these targets, we saw that they were taking appropriate and adequate steps to try, and increase take up. They had increased posters and information in the waiting areas to raise aware and had dedicated staff who worked on raising awareness and contacting patients. They had also completed an audit about immunisation take up to monitor their progress.

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

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. We reviewed training records and saw that staff had completed relevant mental capacity training. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.