St Thomas Road 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.

People were involved in assessments of their needs, and staff reviewed assessments taking account of people’s communication, personal and health needs. We saw that overall, care was based on latest evidence and good practice. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people and took decisions in people’s best interests where they did not have capacity.

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 service made sure patient’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 any assessment of their needs and felt confident that staff understood their individual needs. For example, patient feedback from the 2025 National GP Patient Survey indicated that satisfaction with how the practice worked with them to assess their needs was high, with 95% of respondents reporting that the healthcare professional they saw or spoke to was good at listening to them at their last general practice appointment compared to the local and national averages of 87%.

Overall, we saw that patients with long-term conditions were managed effectively, although there were some areas where improvement was required. We examined the records of 5 asthma patients who had received 2 or more courses of rescue steroids and found that there were inconsistencies in their care. For example, not all patients had been followed up within 48 hours of an acute exacerbation of asthma, and patients had not been issued steroid cards if it was appropriate to do so. In addition, whilst only a small number of patients, we found that 3 out of 233 patients with hypothyroidism had not received the required monitoring within the last 18 months. Following these findings, we were sent a detailed action plan by the provider which highlighted the actions they had taken to improve care in these areas. This included, adding asthma patients to a duty list for contact and follow-up after an exacerbation, and contacting and booking in patients with hypothyroidism for their required monitoring.

The provider had effective systems to identify people with previously undiagnosed conditions such as diabetes.

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 could refer 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, although we did see minor issues in respect of asthma care which did not follow national guidance.

We saw that systems were in place to ensure staff were up to date with evidence-based guidance and legislation, and the provider held regular clinical meetings where care and treatment could be discussed including guidelines, complex cases and learning. Staff confirmed with us that they were able to keep up to date through training and meeting attendance, and told us that the provider was supportive of professional development.

The service worked across teams and services to support people. We saw that staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support.

The provider worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services such as primary care network staff working within the practice. We saw that the provider had in place processes to ensure the monitoring of referrals to other services including 2-week wait cancer referrals.

The provider liaised regularly with multidisciplinary colleagues including community and palliative care nurses, health visitors, safeguarding teams and local learning disability services to discuss the care and treatment of vulnerable patients or those with complex needs.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff from the practice supported people to live healthier lives and where possible, reduce their future needs for care and support.

The provider offered a range of health checks and services to patients to support healthier lives. These included health checks, lifestyle advice from primary care network social prescribers, and assisting patients with issues such as smoking cessation and weight management.

The provider delivered a dizziness/vertigo clinic for its own patients and for others referred into the service from other practices across Wakefield. The clinic sought to diagnose and appropriately treat patients with dizziness and balance issues.

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. We saw that registers were kept of vulnerable or complex patients and the provider used the information in these registers to manage care and recall patients for reviews and other checks. For example, patients on the learning disability register were invited annually for a health check to assess their ongoing needs. Of 69 patients on the learning disability register we saw that all had been offered a health check, and that 58 (84%) had come forward and received one.

The service regularly monitored people’s care and treatment to continuously improve it. They sought to ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

We saw that overall patients with long-term conditions had generally been well managed, although our remote clinical searches showed some areas of care delivery which needed minor improvement.

The provider had a strong culture of clinical audit and service improvement, and used these to monitor and improve patient care. For example, the provider had undertaken work to reduce prescribing and subsequent overuse of short acting beta-2 agonists (SABA) inhalers by asthma patients. A reaudit undertaken in 2025 showed that prescribing had fallen by 66% from their original baseline. Actions to achieve this included instructing patients how to properly use their inhaler, and the use of asthma treatment planswhere patients used one combination inhaler instead of 2 separate preventer and reliever inhalers.

The provider was below the national target for cervical screening with latest published screening performance (30 June 2024) of 75.8% of 25-49 year olds and 73.3% of 50-64 year olds against a target of 80% for both age groups. However, during our assessment the provider sent us unverified data which indicated an increase in cervical screening uptake showing 91.9% of 25-49 years olds, and 85.6% of 50-64 years olds of the target cohort had been screened. The provider told us that they worked closely with their patients to attend for screening.

Child immunisation performance was satisfactory with 4 of 5 target measures exceeding the 90% minimum target, and 1 measure just failing at 89.2% to meet the 90% minimum target. The provider had in place measures to escalate concerns regarding the failure to vaccinate children and attend planned appointments, and worked with other partners to promote uptake.

Bowel screening rates for patients were above the national average at 72.8% compared to the average of 71.8%. Breast screening rates though were 64.1% compared to a national average of 70.4%.

We saw that 73% of respondents to the 2025 National GP Patient Survey reported that they felt they had enough support from local services and organisations to help manage their long-term conditions or illnesses, which was slightly above the local average of 70% and the national average of 69%.In addition, 95% of respondents felt their needs had been met during their last general practice appointment compared to local and national averages of 90%.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment. The practice had developed and adopted a consent policy which had last been reviewed in April 2025, and which outlined the practice’s approach to consent processes.

As part of our assessment, we spoke with clinical and non-clinical staff, and found they all had a detailed understanding of consent. Most consent was either implied or verbal, although the practice required written consent for more complex or invasive treatments such as minor surgery or the fitting of implants. Staff reported receiving training on consent and the application of the Mental Capacity Act.

During our on-site visits we examined 5 patient ReSPECT forms (Recommended Summary Plan for Emergency Care and Treatment – a document which holds personalised recommendations for a person's clinical care in an emergency), these forms should include decisions related to Do not attempt cardiopulmonary resuscitation (DNACPR). In 2 cases these had not been completed fully, and in particular there was no record of a discussion regarding the decision not to attempt resuscitation (it should though be noted that 1 of these forms had been completed by a hospice not by the provider). After our assessment visit, we were informed by the provider that these issues had been rectified.