Tower House 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 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 stayed the same.

This service scored 67 (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 was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. The provider did not have effective systems to identify people with previously undiagnosed conditions. For example, our remote clinical searches identified some people diagnosed as diabetic had not received the appropriate monitoring. The service did respond to this immediately, reviewing all people.

However, feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident staff understood their individual and cultural needs. 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. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. 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 practice and standards. Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance. For example, our remote clinical searches showed people on Disease-Modifying Anti-Rheumatic Drugs (DMARDS) received excellent monitoring with only 1 person out of 64 people lacking a blood test.

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. For example, people were flagged on their clinical care record to alert staff to the person’s need. The service worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. For example, the service worked alongside external stakeholder services such as the community mental health team to support vulnerable people through treatment planning as part of a multi-disciplinary team. New registrations to the service were currently up to date.

A business continuity plan was in place and staff shared how it had been used. For example, the service had recently lost power for a few hours. The staff knew to switch to using paper documentation to record consultations or treatment, and once the power was restored the notes were uploaded ensuring continuity of care was maintained in people’s clinical records

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; for example, the service provided nurse-led clinics every week for people who had heart disease. Staff focussed on identifying risks to people’ health, including those in the last 12 months of their lives, people 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 service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, or they met both clinical expectations and the expectations of people themselves. For example, some people on multiple medications had not received a medicines review.

The service was aware it had not met national uptake targets for screening and immunisations. For example, the cervical screening uptake was 10% lower than the national target of 80%. The service was working to increase uptake by following up with people who had not attended cervical screening and providing leaflets to help understanding of the purpose of the screening. As per the service’s achievement measures they were observed to be higher than the national average in the prescribing of psychotropic medicines. However, the provider was aware of this and recognised this was due to a higher percentage of people in their demographic being prescribed these medicines. The service was aware of STOMP - the UK NHS programme for stopping the over-medication of people with learning disabilities and autism and were using this tool to support reduction in medicines.

However, from other clinical records we reviewed, we found people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance. The service had undertaken a hydration care home audit. The background to this audit was due to the known risk of dehydration in the elderly being associated with adverse health outcomes including increased risk of falls, leg ulcers, urinary tract infections, constipation, admissions to hospital and mortality. The service worked with a local care home providing tools and visual aids to look at health outcomes for people living in the home. The outcomes for the people being supported were positive with a notable improvement in reducing the number of falls and constipation to 0.

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. The provider had access to an interpreter service for people who required this to aid understanding the decisions needing to be made. There was a formal system for obtaining written consent for minor surgery procedures, for example, the insertion of contraceptive devices.