Abington Park 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 good. At this assessment, the rating remains the same. The provider worked well with other health and social care professionals to ensure coordinated care and smooth transitions between services. Efforts were made to ensure people fully understood their care and treatment, enabling them to give informed consent. Where individuals lacked capacity, staff involved relevant others such as family members or advocates in decision making processes ensuring actions were taken in the person’s best interests. Referrals were made promptly when specialist input was required, and information was shared appropriately to support continuity of care

This service scored 75 (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.

The provider had effective systems for identifying people with previously undiagnosed conditions, enabling early intervention. The provider had developed a system that performs drug monitoring and safety alerts management. The practice had pilot programmes running for long-term conditions such as Type 2 Diabetes androutinely conducted NHS Health Checks to identify patients at risk of developing other health conditions at an early stage. Where social needs were identified, such as isolation or housing concerns, staff could refer people to a social prescriber within the PCN for additional support. People gave positive feedback about the service and said they felt fully involved in the assessment of their needs. They told us staff took time to understand their individual circumstances, including any cultural requirements, and ensured these were reflected in their care. Where additional needs were identified, staff made timely referrals to appropriate professionals or services.

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.

Staff applied evidence-based approaches to improve outcomes and used regular team discussions to review complex cases and share updates on new guidance. Changes to guidance were acted on promptly, with updates shared across the team and built into everyday practice. The service worked closely with other professionals and services to make sure treatment decisions were informed by the most relevant evidence and were tailored to each patient. People using the service said they felt confident in the care provided and trusted staff to make decisions that were safe, effective, and right for their needs.

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 worked well together across different roles and departments to provide coordinated and consistent care. Clear systems were in place for sharing information, including regular team meetings, secure electronic records, and handover processes. This meant that all staff involved in a patient’s care had access to the most up to date information. The service had strong links with other healthcare providers, community services, and voluntary organisations. Referrals were made promptly, and there was effective communication to support smooth transitions between services. Staff told us they valued the open communication within the team and across partner services, as it helped resolve issues quickly and avoided delays in 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.

Staff encouraged and supported people to take an active role in improving and maintaining their health. During appointments, staff discussed lifestyle choices, and the social prescriber offered practical advice on areas such as diet, exercise, smoking cessation, and alcohol use. Patients with long-term conditions were given personalised care plans, which included clear goals and regular reviews to track progress. The service promoted health and wellbeing through targeted initiatives, such as health screening programmes, ensuring eligible patients were identified and invited to attend. Staff used opportunistic contacts to offer brief interventions and signpost patients to local support services, including weight management groups, stop smoking clinics, and mental health resources.Regular medication audits were embedded within the Quality Improvement Programme to monitor prescribing trends and drive improvements in patient safety. Clinical pharmacists had undertaken high-dose opioid reviews for several years, achieving positive outcomes in reducing dosages and improving safety.

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

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 had a system in place for medication monitoring and safety alert improvements which had been added to system one toolbar, making it easily accessible. The provider ran regular NHS Health Checks, which were highly effective and received positive patient feedback. As part of its commitment to women’s health, dedicated menopause clinics and group consultation sessions were introduced, improving clinical outcomes and wellbeing by creating a supportive environment. Additionally, a pilot migraine clinic achieved strong patient engagement and uptake.

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

Consent was recorded clearly in patient records, and staff ensured people were given enough information to make informed choices. This included explaining treatment options, possible risks, and likely outcomes in a way that was easy to understand.Records showed that staff had completed all relevant trainings within the Mental Capacity Act and adapted their communication to meet individual needs, for example by using interpreters, easy-read materials, or visual aids. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.DNACPR audits were completed annually by the provider, achieving full compliance and lessons from the audits were shared across the team. This is to ensure family involvement in decision-making is maintained as a core aspect of ethical care planning, and supported through partnership with care homes. Records showed that staff had completed all relevant trainings within the Mental Capacity Act.