The Grove 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

This means we looked for evidence people had the best possible outcomes because their needs were assessed and care and treatment was provided in line with up-to-date best practice.

At our last inspection we rated this key question good.

At this inspection, the rating has remained at good.

People were mostly involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with some agencies involved in people’s care for the best outcomes and smooth transitions when moving between services. 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 their best interests where they did not have capacity.

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.

Practice staff 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 mostly positive. 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 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 practice had effective systems to identify people with previously undiagnosed conditions. During our search of the practice’s clinical system, we found 45 people had potentially missed diagnosis of chronic kidney disease. We reviewed 5 of these records and found the missed diagnosis appeared to be the result of coding issues only.

Staff could refer people with social needs, such as those experiencing social isolation or housing and financial difficulties, to a social prescriber. (A social prescriber works with people to understand their non‑medical needs and helps connect them to local community services and activities. Their role is to support wellbeing by addressing social factors that affect health, alongside traditional medical care).

Practice staff 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. Clinical records we saw demonstrated care was provided in line with current guidance.

We reviewed the practice’s processes for supporting people with long‑term conditions. During our search of the practice’s clinical system, we looked at people with asthma who had been prescribed 2 or more courses of steroids for exacerbations in the last year. We found that people had been appropriately reviewed and followed up. We also reviewed records of people with hypothyroidism, diabetes and chronic kidney disease and found no concerns. The practice used recall and monitoring systems to identify people and ensure timely review.

Ninety percent of respondents to the latest National GP Patient Survey stated that during their last appointment they had confidence and trust in the healthcare professional they saw or spoke to. This is in line with the average for the local area.

The practice worked well across teams and services to support people. They shared their assessment of needs when people moved between different services. They worked closely with the primary care network (PCN) to support carers. For example, the social prescriber helped organise a carer’s coffee morning with other local practices within the PCN.

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. These included urgent care services, the tissue viability team, addiction services and pain clinics and prison services.

The practice held monthly clinical meetings to share information with staff. Written minutes were also provided for staff who were unable to attend.

The practice 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. People had access to health and wellbeing coaches, dieticians and social prescribers.

Staff focused on identifying risks to people’s health, including those in the last 12 months of their lives, people 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 practice website provided information on wellbeing advice, both local and national, to support people’s health and wellbeing. There was a wide selection of leaflets and easy-to-read information available in the practice for people to access.

The practice did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The practice recognised that they had not always met national targets for screening and immunisations. The most recent data from the UK Health Security Agency (UKHSA) showed uptake was below the national target of 95% for 2 indicators: 83.2% of children aged 5 had received 2 doses of the measles, mumps and rubella (MMR) vaccine, and 88.2% of children aged 1 had completed the recommended course of immunisations for Diphtheria, Tetanus, Polio, Pertussis, Haemophilus influenza type b (Hib) and Hepatitis B. However, uptake for other childhood immunisations was closer to the national target, with 91.5% of children aged 2 having received a Pneumococcal booster, 92.7% having received a Hib and Meningitis C booster, and 92.7% having received their first dose of the MMR vaccine.

Staff told us they had introduced several measures to help improve uptake. These included proactively booking infants at their 6‑week baby check for their 8‑week immunisation appointment at the same time, flagging missed vaccines in patient records and actively contacting parents. Staff also offered vaccines opportunistically when families attended for other reasons to help increase uptake.

The practice was below the national targets for cervical screening. For women aged 25 to 49 years old the observed number was 54.4%, which was significantly lower than the national average of 80%. For women aged 50 to 64 years old, the observed number was 61.8%, which was significantly lower than the national average of 80%. The practice was also below the NHS England averages for breast and bowel cancer screening. Staff had identified some reasons for the low uptake. The practice sent reminders to patients, offered smear tests opportunistically, and there was information in the practice’s waiting area about smear tests. Leaders told us that national screening programme invitations were actively followed up to encourage people to attend.

Patients aged between 40 and 74 are eligible for an NHS health check. The practice told us they had completed a health check with 110 patients out of the 2013 patients registered with the practice who could have one. The practice also offered patients with a learning disability a yearly health check. The uptake of this was 34% in the last year. The practice acknowledged that engagement for preventative health can be challenging across its patient population.

The practice did not always demonstrate that people’s rights around consent were consistently respected when delivering care and treatment.

During our site visit, people we spoke with gave mixed feedback regarding their experiences. Some people reported a positive experience and felt supported. Others reported they felt dismissed and were not listened to.

People were advised that chaperones were available. (A chaperone is an impartial observer present during an examination or consultation when people may feel vulnerable, for example, during an intimate examination. A chaperone acts to protect both people and staff). Staff undertaking the chaperone role had completed training.

Staff we spoke with had a good understanding of consent, and most staff were up-to-date with training in the Mental Capacity Act. However, capacity and consent decisions were not always clearly recorded. During our site visit, we reviewed do attempt cardiopulmonary resuscitation (DNACPR) decisions for a sample of patients. These decisions were not always clearly aligned with legislation and the Mental Capacity Act, and it was not consistently clear which decision was the most up-to-date. In some of the cases it was not clear whether a mental capacity assessment had been undertaken, or how a best interest decision was reached.