Loddon Vale 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.

People were 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 all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. 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 key question has been rated as good.

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 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 any assessment of their needs and felt confident that staff understood their individual and cultural needs.

As part of our assessment a number of set clinical record searches were undertaken by a CQC GP Specialist Advisor. These search criteria are freely available for practices to access at any time. We identified during the clinical searches that there were effective reviews and monitoring of patients with asthma.

Patients were advised when to seek further help and what to do if their condition deteriorated. A care coordinator at the practice worked with people with social needs, such as those experiencing social isolation or housing difficulties.

The practice 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.

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.

We identified during the clinical searches that there were effective reviews and monitoring of patients following receipt of Medicines and Healthcare products Regulatory Agency (MHRA) alerts.

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 were systems and processes in place to enable information to be shared between the provider and services to ensure continuity of 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 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 found people with caring responsibilities were offered regular health checks and there was regular engagement with community services and referral pathways in place. For example, the practice had identified 267 carers on its register and provided tailored support, information and signposting to ensure their health and wellbeing needs were recognised and addressed.

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 national targets for screening and immunisations. 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.

There was evidence of clinical, non-clinical and medicines audits carried out to improve outcomes for patients.For example, the chronic kidney disease (CKD) audit identified patients not on the correct medicine for primary prevention. There were 17 patients initiated for treatment, with lifestyle advice and follow up blood tests arranged. The audit led to improved adherence to NICE guidance and reduced long term cardiovascular risk.

We saw another audit included chronic obstructive pulmonary disease (COPD) exacerbation monitoring to improve post exacerbation follow up. Results indicated correct antibiotic prescribing but gaps in inhaler reviews contributing to reduced exacerbation rates.

The practice met the national targets for childhood immunisations.

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

The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. In relation to do not attempt cardiopulmonary resuscitation (DNACPR) forms, records showed more attention to detail was needed. For example, in some instances, peoples wish on not to receive additional care and treatment was plainly recorded, and some of the forms were not completed correctly and in line with relevant legislation.

The latest GP Patient survey results indicated that 89%of the respondents felt they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment in comparison to the national average of 91%.