The Northenden Group Practice

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.

The service did not always ensure people were fully involved in assessments of their needs. Staff did not consistently review assessments in a way that took full account of people’s communication, personal or health needs. Care was not always planned or delivered in line with the latest evidence or good practice. Staff did not always work effectively with all agencies involved in people’s care to support good outcomes or smooth transitions when people moved between services. However, people were supported to fully understand their care and treatment, and staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people took decisions in people’s best interests where they did not have capacity.

This service scored 54 (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 they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People felt involved in any assessment of their needs and felt confident that 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. Staff checked people’s health, care, and wellbeing needs during health reviews. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The provider had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

However, during our clinical searches, we found that the service did not effectively follow up or review patients who were being treated for long term conditions.
 

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Systems were not always in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw did not always demonstrate that care was provided in line with current guidance.
 

The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Staff did not always have 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.

Clinical searches found that patients moving to the practice from other services were incorrectly coded for allergies. This can potentially lead to patients being prescribed medication that they should not be taking.
 

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.

Staff focussed on identifying risks to patients’ health, including those in the last 12 months of their lives, patients 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 routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The practice did not meet national targets for screening and immunisations. From the clinical notes we reviewed, we found that people who used the service did not always receive positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

People taking medicines known to increase blood pressure had not always had their blood pressure checked for extended periods. This meant rising blood pressure could go unnoticed, leading to possible harm.

We reviewed how administrative staff processed prescription requests and noted one instance where a prescription was issued even though the patient’s medication review was overdue. This meant the medicine was supplied without anyone checking whether it was still appropriate or safe, increasing the risk of continuing treatment without the necessary clinical monitoring.
 

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.