West Rainton Surgery

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• 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 79 (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 their health, care, wellbeing and communication needs with them.

Feedback from people using the service was positive. People felt involved in 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 systems to identify people with previously undiagnosed conditions. However, we identified a small number of patients who had not been followed up within an appropriate interval to check if they were diabetic, when initial blood monitoring indicated a concern. We also found some coding issues. Subsequently, the practice told us they had contacted the relevant patients to follow up with them. Staff referred people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

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.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was mostly provided in line with current guidance. We found some examples, where patients had appointments for an acute exacerbation of asthma, that the initial assessment lacked detail. We also found some examples where patients had been prescribed multiple doses of steroids, which would place them in the category of long-term steroidal treatment, they were not offered NHS Steroid Emergency Cards to warn healthcare staff of the potential need for prompt treatment in case of an adrenal emergency. The practice told us they addressed these areas following the assessment.

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. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.

There was positive feedback from other healthcare professionals that worked in partnership with the practice. They told us the approach taken by the practice supported the best standard and fast effective care. They told us staff were very compassionate and committed to proving the best for all concerned.

The service always supported people to manage their health and wellbeing to fully 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, those at risk of health inequalities, 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 worked closely with the PCN funded social prescribing link worker to address patients at risk of health inequalities. For example, the social prescriber developed sustained relationships with the local Gypsy, Roma and Traveller community to facilitate access to healthcare. This led to some joint work with the practice carrying out on site NHS health checks to most of this community to help spot early signs of ill health and to prevent conditions from developing. The numbers of health checks had increased from 25 in 2023/24, to 33 in 2024/25 with 38 undertaken this year so far with 4 months left in the financial year. The practice was unable to evidence an increase of uptake in health promotion initiatives, such as cancer screening and immunisation, due to limitations in the clinical system metrics. However, they were able to provide specific examples of where their encouragement had led to patients to take up these initiatives after intervention from the practice.

The practice had also carried out 14 annual health checks for patients with a learning disability, against a list of 16 patients. They had achieved an increase year on year, due to better recall and monitoring arrangements, with 38.5% in 2023/24 compared with 87.5% (14 out of 16 patients) this year with 4 months left in the financial year. The practice identified that housebound patients had historically received their influenza vaccination towards the end of the Flu season. Last Flu season, they identified this as a risk, as patients were vulnerable to influenza until they had received the vaccine. They arranged for the practice pharmacist and a health care assistant to visit patients at home early in the season, meaning these patients were protected several weeks earlier than they had been in previous years. This supported 94 to receive the vaccination and only 4 declining. The practice also supported flu vaccinations for staff and residents in the first ward round in October at the local linked care home.

The practice was an Armed Forces veteran friendly accredited GP practice. They had held an information session for veterans to help them identify and access appropriate local services.

The practice had achieved park run accreditation, to support patients to participate in health lifestyles and physical activity. They informed us after the inspection that they had also had their first GP practice park run, which had attracted 289 runners from the local community. They also recently supported a local initiative from ‘Man Up Durham’ with a twilight walk to help with men’s physical and mental health. There were 26 men who attended this walk, of which 6 were patients of West Rainton Surgery.

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 some of the national targets for screening and immunisations. Cervical screening coverage as of 30/06/2024 was 74.5% for the 25-49 age group and 75.5% for the 50-64 age group. These were both below the 80% target. The practice provided us with unverified and unpublished data from the Quality and Outcomes Framework (QoF), which showed to date performance of 77.7% for eligible patients aged 25-49 and 78.9% for the 50-64 age group. Although the data provided by the practice was more up to date, these do not directly compare with the UK Health Security Agency data used by CQC, as they are calculated differently. Similarly, one of the childhood immunisations was below the recommended national minimum of 90%. Children aged 5 who had received immunisation for measles, mumps and rubella was at 89.6%. The practice was taking appropriate steps to encourage uptake but planned to explore further the reasons behind the lower uptake.

From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

The practice routinely reviewed each patient death that occurred to check if the practice could have taken any additional action to identify risks prior to death. This helped them consider whether there was any further action they could have taken to prevent future deaths or support people to have the end-of-life experience of their preference and to inform learning and improvement within the practice.

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.