Park Lane 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 requires improvement. At this inspection, we have rated the provider good overall, as the provider had made significant improvements since the previous assessment. Care was generally delivered in line with evidence-based guidance, supported by effective multidisciplinary working, proactive health promotion and routine monitoring of outcomes. Systems had been strengthened to support the management of long-term conditions and clinical coding. However, some patients were overdue monitoring and review and clinical records identified examples where medicines monitoring and treatment were not always managed in line with national guidance. These issues were not widespread and the practice had taken action to address them.

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 were effective because full assessments of need or review were not always completed.

The practice had in place a system for reviewing patients with long term conditions. This included searches on the clinical system to identify those due for a review. The practice aimed to carry out all elements of patient reviews at one appointment, we noted however, through our review of clinical records, that this was not always the case. Both nurses were trained in long term condition management. Long term condition reviews were completed using a structured template. There were regular checks on the system to ensure patients were appropriately coded. In our review of clinical records of patients with long term conditions, we found some gaps in the assessment and review of patients. For example, some patients were overdue monitoring. At the time of our inspection the practice agreed to look into the patients we highlighted as needing further follow up/investigation as to their assessment or review. The practice took steps to improve practice through the development of a medication review protocol and introduction of audits.

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 and we saw examples of this.

The practice had processes to identify and monitor people at risk of developing or living with long-term conditions, including diabetes, hypertension and chronic kidney disease (CKD). Following concerns identified at the previous inspection regarding CKD coding, clinical leaders had strengthened oversight arrangements to ensure patients were appropriately identified, coded and included on disease registers.

Staff carried out regular searches to identify patients with clinical indicators suggestive of a long-term condition who had not been appropriately coded or added to monitoring programmes. Where patients were identified, records were reviewed, coding updated and referrals or follow-up appointments arranged as required.

However, we also found some evidence that a small number of patients were not receiving care and treatment in accordance with current national guidance and recommended monitoring requirements. Our review of clinical records identified examples where recommended monitoring according to national guidelines had not been completed within expected timescales. This included patients prescribed medicines with the potential to affect renal function who were overdue recommended monitoring and asthma management that was not aligned with evidence-based treatment recommendations. As a result, there was an increased risk that patients may not have received safe, effective and appropriately monitored treatment.

There was a standardised system across the PCN for managing and disseminating patient safety alerts. We were told clinical management systems followed up-to-date clinical guidelines and clinical staff received relevant training.

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. Staff we spoke with confirmed they were able to work with a range of other services to support patients. For example, district nurses, and health visitors. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.

The multidisciplinary team included 2 registered nurses and a healthcare assistant. A specialist chronic obstructive pulmonary disease (COPD) nurse provided clinics monthly, while spirometry services were accessed through a local hub. The practice also had access to a range of additional healthcare professionals, including physiotherapists, a mental health nurse, an anxiety health coach and a paramedic practitioner who supported the management of minor illness. In addition, the practice directly employed a community matron who led on the care of patients living with frailty, people with a learning disability and those requiring palliative and end-of-life 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.

The practice offered a range of services to promote healthier lives. This included a stop smoking clinic, as well as health coaches to provide some exercise and weight management support. Social prescribers were available through the PCN and attended the practice when requested. An anxiety coach attended the practice weekly. The practice told us they were planning to do more work to support those with diabetes.

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 met national targets for childhood immunisations with the exception of the percentage of children aged 2 who had received an immunisation for measles, mumps and rubella; the practice was slightly below the minimum of 90% at 89.5%. The practice was above the national average for breast and bowel screening and met the national targets for cervical screening. Staff were all involved in managing and monitoring long term conditions and patients with learning disabilities.They received a Purple Star accreditation for their patients with learning disabilities. This accreditation is awarded to GP practices and primary care settings that provide excellent, accessible care for adults with learning disabilities.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The practice had a Mental Capacity Act policy which directed staff to follow related NICE and other national guidance. We were told decisions about capacity were specific decisions at a given time and we saw evidence of this on inspection; for example, a best interests decision was made following appropriate consultation with relevant parties, taking into account the individual's wishes, feelings, needs and overall welfare to ensure the least restrictive and most beneficial outcome.

If a person lacked capacity there was a record as to who the practice should speak with. Arrangements for end of life care were in place. We reviewed a sample of Do not attempt cardiopulmonary resuscitation (DNACPR) records and found decisions were appropriately documented, with evidence of discussions having taken place with patients and/or those close to them where appropriate.