Wargrave 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 that staff involved people in decisions about their care and treatment and provided them advice and support. 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 practice made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Staff were aware of the needs of the local community. There were systems and processes in place to identify patient’s needs and preferences. For example, patients were coded to highlight if they were a carer or an interpreter was needed. Staff also considered if the patient had a preference in which doctor they saw for their appointment. The practice implemented a duty team to oversee the urgent on the day care patients. A mixture of telephone appointments and face to face appointments were available. The practice met the accessible information standard. For example, a hearing loop was present, interpretation services were available and letters in braille could be requested. Staff could refer patients with social needs, such as those experiencing social isolation or housing difficulties to a social prescriber within the primary care network. Staff checked people’s health, care, and wellbeing needs during health reviews. 81% of patients that completed the National GP Patient Survey data agreed that they felt their needs were met during their last GP appointment which was lower than the local average of 92% and lower than the national average of 90%. 81% of respondents felt the healthcare professional they saw had all the information they needed about them during their last GP appointment which was lower than the local average of 93% and lower than the national average of 92%. To address these scores, the practice have collaborated with the Integrated Care Board (ICB) to develop an action plan aimed at strengthening patient engagement, enhancing patient experience and improving service quality.

The practice planned and delivered people’s care and treatment with them, including what was important and mattered to them. There were systems in place to ensure staff were up to date with relevant legislation, evidence-based practice and required standards. Clinical meetings were held to discuss specific patients that related to the clinical updates. Multi-disciplinary team meetings were held to ensure staff were updated with the latest information, guidance and changes within the practice. A staff bulletin was also distributed and displayed in the reception and staff kitchen tohighlight the relevant updates and key changes within the practice. Urgent messages were displayed through a task on the computer screen. The remote clinical searches of patient clinical records reviewed the monitoring of people with long-term conditions to assess if National Institute for Health and Care Excellence (NICE) recommendations were followed. We found that the care was in line with legislation and current evidence-based good practice. One of our clinical records searches identified a total of 921 patients on the asthma register. 27 of these patients had been prescribed 2 or more courses of rescue steroids in the last 12 months. We reviewed a random sample of 5 patient records and found all 5 patients had been followed up appropriately, had received an adequate annual asthma review that included an asthma care plan for the patient. Another one of our clinical record searches identified a total of 34 patients with stage 4 or 5 chronic kidney disease. We reviewed a random sample of 5 patient records and found that all 5 patients had been appropriately monitored. A further clinical search identified a total of 389 patients who had hypothyroidism (when the thyroid gland does not produce enough thyroid hormone that can lead to tiredness and weight gain). 9 patients were identified as being overdue monitoring. However, the practice had already taken the appropriate steps to address this.

The practice worked well across teams and services to support patients. Systems were in place to share information about patients electronically with other services. Information was shared between teams and services to enable continuity of care and ensure patients only had to tell their story once when moving between different services. The practice regularly held multidisciplinary team meetings. For example, safeguarding meetings were held with the care coordinator, GP partners, paramedics and care home coordinator. School nurses also attended meetings with safeguarding care coordinator. Staff were supportive of each other to ensure they had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other practices within the primary care network (PCN) to share knowledge to improve patient care. Patients had access to services provided by the PCN, including social prescribers. To ensure staff were able to work together effectively, the practice adopted an open-door policy to encourage staff to speak up so that any queries were resolved to ensure a positive working environment. Each staff member knew their role and responsibilities.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. They supported patients to live healthier lives and where possible, reduce their future needs for care and support by sharing advice and guidance. Patients were encouraged to take an active role in reviewing their own health and wellbeing so they would recognise changes to their health and wellbeing. For example, a height and weight machine was readily available for patients to use in the waiting area. A blood pressure machine was also accessible in the waiting area. A sign was visible to encourage patients to check their blood pressure. Blue disposable gloves were available for those patients that wanted to use the blood pressure machine and there was a sticker to show when the machine was last cleaned. Many staff members were able to advise and signpost patients to the appropriate services to improve or maintain their care such as to the social prescriber or care co-ordinators. Health promotion material was observed in the practice and further information could be found on their website that supported national priorities and initiatives to improve population health by supporting people. The practice engaged with the wellbeing team in the primary care network to encourage the ‘swap to swap’ smoking cessation programme. The senior pharmacist had oversight of quality improvement in prescribing areas. They identified patients at high risk of cardiovascular disease and the initiation of beneficial medicine for this group. An educational video about lipids was sent to patients to provide awareness and information to help reduce cholesterol levels.

Findings from the clinical search records indicated that the practice routinely monitored people’s care and treatment to continuously improve it and ensured that both clinical and patient expectations were met. However, at the time of our assessment, the latest published information from the UK Health Security Agency (UKHSA) showed that the practice met World Health Organisation target of 95% for the number of children immunised against various infectious childhood diseases such as children aged 5 who should have received immunisations for measles, mumps and rubella. The latest published information from NHS Digital showed the practice’s uptake of cervical cancer screening for women aged 25 to 49 years old was below the 80% national target and was observed as 68%. The practice’s uptake of cervical cancer screening for women aged 50 to 64 years old was below the 80% national target and was observed as 70%. Staff told us they had engaged with the wellbeing team to proactively contact patients to encourage them to attend their cervical cancer screening. Since this, the uptake in cervical screening appointments has increased and reasons for those that did not want to attend were recorded. The nursing team also plan to create an educational video about the importance of cervical screening.

The practice told patients about their rights around consent and respected these when delivering care and treatment. We spoke with clinical and non-clinical staff, and they all had a detailed understanding of consent. Staff understood the importance of ensuring that people fully understood what they were consenting to and respected the importance of obtaining consent before they delivered care or treatment. Patient’s capacity and ability to consent was considered and clearly recorded. Patients received information about their care and treatment in a way they could understand. Chaperones were available upon request.