Oak Tree 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 remained 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 conditions. We also found that patients needing follow-up after multiple steroid courses followed up in line with national guidelines.

This service scored 71 (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 peoples health, care, wellbeing and communication needs
Staff assessed and reviewed people’s health, care, wellbeing and communication needs with them. The GP survey results evidenced that 91.8% of respondents to the GP Patient Survey stated that during their last appointment, the healthcare professional was very good or fairly good at listening to them. A patient who gave feedback said ‘’We have never felt rushed and always felt listened to’’
Staff and leaders were aware of the needs of the local community. The service had moved to a digital triage system and recognised the need to support patients during the transition. Staff identified individual needs, including communication and could signpost people to services that supported digital inclusion, including a health inequalities hub.
Staff told us that patients were offered a choice of appointment location. They could refer people with social needs, to a social prescribing link worker. A patient who gave feedback said ‘’I have never been made to feel that I am wasting anyone's time and I am always given a choice of whether to attend the main surgery or its satellite surgery’’. Staff gave examples of person-centred approaches to help individuals access the practice. Staff had received chaperone training.
The provider did not always identify people with previously undiagnosed conditions. our clinical searches identified 146 patients with potential missed diagnosis of chronic kidney disease (CKD) stage 3, 4 or 5. A sample review found 4 out of 5 had not been appropriately coded, despite previous efforts to improve coding accuracy. The service took immediate action to remedy this.

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.
The service had 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.
Staff were supported to pursue further training and to progress in their role. We spoke with one member of staff who had recently progressed into a clinical role from an administrative role.
During our clinical searches we reviewed the records of 4 patients 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 not been followed up in line with this guidance. The provider took immediate action to ensure that in future, people were monitored in the recommended timescale.
 

The service always worked well across teams and services to support people. They shared assessments of people’s needs when they moved between different services, so people only needed to tell their story once.
Resources were coordinated across both sites which meant that patients had choice about where they were seen. Technology was used to share information across sites and teams and staff told us this works well.
A daily huddle took place that included staff from both sites and external teams, such as a representative from Adult Social Care. At one of the sites, staff from external teams were based on-site, including the district nursing team, health visiting team and the Integrated Transfer of Care Hub (IToCH). Staff told us this helped with the coordination of patient care when multiple teams were involved.
Staff had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. The service worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. The service had an information sharing agreement with the district nursing team, allowing the team access to the GP system to promote collaborative working and better patient outcomes.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The practice supported people to live healthier lives and where possible, reduce their future needs for care and support.
Staff had a holistic and joined-up approach to supporting people and discussed patient care in clinical and multidisciplinary team meetings. Where appropriate the meetings facilitated a space to monitor input from other services. This enabled the service to identify people who may need extra support and directed them to relevant services. The service was supported by a social prescribing link worker who could signpost people to access services to improve their health and wellbeing.
There were various health promotion patient available throughout the service to inform people about health and wellbeing topics. 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 that outcomes were positive and consistent, or 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 service had met national targets for providing childhood immunisations.
Data from June 2024 on cervical screening showed:
• For women aged 25 to 49 years 73.1% had been screened within the last 3.5 years, against the expected target of 80%.
• For women aged 50 to 64 years, 75.6% had been screened within the last 5.5 years, against the expected target of 80%.
There were systems and processes to recall women for cervical screening, but further improvement was needed to promote uptake.
Results from our clinical searches showed that improvements were needed for monitoring patients on high-risk medicines and reviews of patients with long term conditions.
We found:
One patient with chronic kidney disease out of 72 patients had not had relevant bloods tests in the past 9 months. This was due to a coding error and was corrected at the time of our site visit.
The service had 733 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 733 patients, 49 patients had potentially not received relevant blood tests in the past 18 months. We sampled 5 patients records and found:
• 1 patients’ record reflected they had not had relevant blood tests for over 6 years.
• 4 patients had not had relevant blood tests within 18 months.

The service planned to assign monitoring to the dispensary team, but this wasn’t confirmed during the assessment.
 

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.
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. Staff we spoke with understood Gillick competency in relation to children’s consent (Gillick competency means a child under 16 can consent to medical treatment if they fully understand it). Clinicians supported people to make decisions about their care and treatment.