Aylmer Lodge Cookley Partnership

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 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 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. The practice had a carers champion who supported those with caring responsibilities. They had effective systems in place to identify carers.For example, during carers week they invited a local charitable organisation in to talk to carers, and this helped to identify more carers. 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. People living with a long-term condition and those with a learning disability were invited for regular review of their health, care and treatment.

The practice planned and delivered people’s care and treatment with them, including what was important and mattered to them. Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. For example, a member of staff delivered a presentation on understanding people with a learning disability and autism. The remote clinical searches we undertook of the practice’s clinical records system showed the monitoring of people with long-term conditions were not always followed in line with National Institute for Health and Care Excellence (NICE) recommendations. We identified 87 patients with asthma who had been prescribed 2 or more courses of rescue steroids in the last 12 months. We found that all 5 patients had not been followed up within 48 hours to check their response to treatment. However, all patients had received their annual asthma review which provided the patient with an asthma care plan. We identified 137 patients with diabetes whose last blood glucose reading was over 75. We reviewed a random sample of 5 records and found all patients had an up to date medicine review and blood glucose test.

The practice 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. Staff demonstrated good working relationships with other services including the integrated care board (ICB). For example, they worked alongside them to deliver a menopause education event to perimenopausal women in lower socioeconomic groups.

The practice 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 focused on identifying risks to patients’ health. They took a proactive approach to identifying those in the last 12 months of their lives, individuals at risk of developing long-term conditions and those with caring responsibilities. Staff supported national priorities and initiatives to improve population health, including tackling obesity. Health promotion material was available in the practice and further information could be found on their website.

The practice 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. Clinical and non-clinical audits were carried out to improve outcomes for patients. Regular searches of patient’s’ medicines were undertaken to ensure safe prescribing. At the time of our assessment, the latest information from the UK Health Security Agency (UKHSA) showed that the practice met the national target for the number of children immunised against various infectious childhood diseases. However, the latest informationshowed the practice’s cervical screening uptake for women aged between 25 to 49 and 50 to 64 was slightly below the 80% target. Leaders told us they were aware of these figures and had systems in place to improve this. For example, they followed up patients who did not attend appointments and invited them opportunistically when they attended for other appointments.

The practice 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. Staff we spoke with understood the importance of ensuring that people fully understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment.Capacity and consent were clearly recorded. Chaperones were available upon request.